Loading...
9801-030 (SFD)LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. License # Lic. Class Exp. Date • —� 674074 D 7/31199 Date 'y �s r`1 ''" Signature of Contractor OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the following reason: ( ) I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business & Professionals Code). ( ) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business & Professionals Code). ( ) I am exempt under Section B&P.C. for this reason Date Signature of Owner WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ( ) I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ( ) I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier & policy no. are: Cartier Policy No. STKM ITUTNTA " 137I(P,597 (This section need not be completed if the permit valuation is for $100.00 or less). () I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the.Labor` Eode, I shall forthwith comply with those provisions e--- \ .Date: t` Applicant— Warning: pplicant Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his application. 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representativesof this City to enter upon 11 the above-mentioned propertyfor-i for -inspection purposes. Signature (Owner/Agent) -^^ % 10ate Ti� ~ — (4BUILDING PERMIT PERM'TCONTROL# DATE VALUATION ` 'Z6%S9(4Jt) LOT 30 TRACT -96-8 8 8 vv Q JOB SITIf ADDRESS ' 74.9.25 VIA. CARNIEL APN OWNER CONTRACTOR DESIGNER/ENGINEER ry.0, JROSE\Ft1,0.PMe,',py . IS[A-RKS wrytiS eUC11iYN p.o. BOX 1.714; 9295 RA.%JCHO .LA t�UIN'I:A is R. LA A QIJUN-M CA 92253 LA. Q1)1'gt7'A CA 42 53 t7ht917 }.i d1 C:}3C,f# 29S USE OF PERMIT ISM s LOT 30 ,PALA.00 PLAN 3 - ART IN PUBLIC PLA`ES C.RMT IT 10F ;40:1.49 PfiR A(JREt-2V1f.1srt' %V/ OjJxw. l;1 iV. lJi"sP11'. P9../1N C11-MC;i:.FEE, It:l3tfrf3 TSysac2i1tiT1 IIt�I,Iai:int)ANCiifJ�'AM:!`si�LAtd'!'k'PF:. CUSTOM C014.9111wr]031 3.© r.no s;, JAN 15 1998 10IZCMIAT.IO 550.60 ;tr fiiAl2.r'1fhlslC,llitf'tJIZ'I.' t�yi.CHl `��� CITY ®F L k 0UiNTYN }: ESTIMATED COST OF CONSTRUMON' "'mo,;59b.:a!! 11CRA11TYCE SUMMARY CONS`PRUC !ION FEE 101-000-418-004 V%AR C,TT,('K Ff.' 19 f-f?f?f}-4V-118 S�" INI C.II'AN;CALIF , E%1:ECTR1CA1, FrE $198.66 PLLtMSWC1I,X 101-0(X)419 000 rl S,`{'ROWI "(MON FF-rA W7. -Alta 1011000-NI-f"I GZri0/`NG 14D 101,0011-423-000 SIX. 00 NTP FE,G 2,25-ON–i43-3426 3h,h98,t1� ART IN PUBLIC P► e1.C'ES - URSIC 701-000-255-000 "►�143.�t9 ART)IN P11Ei ICS PLAMS - RE;SW, 701-I?t}(1-25,000 4401,451 SIt13-'i'C3ML, C0NS*FRU TIC)N AND PICIAc�pt f�+".�iECKT!_[ x,8,0711 56 L� ' iI SS PRE-� ✓tJBI .6� 1; ES 4401,41% FEKS DUE NOW RECEIPT DATE BY DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs — _ Underground Ducts Forms 8 Footings Ducts Slab Grade _ Return Air Steel�/- Combustion Air Roof Deck j ��` Exhaust Fans O.K. to Wrap - G(/t' F.A.U. Framing Compressor Insulation _� Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath — G� Drywall - Int. Lath Final �2 Final ar POOLS - SPAS BLOCKWALL APPROVALS steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral _ Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test Appliances Final COMMENTS: .Final Utility Notice (Gas) _ 2 ,� Q�I Az% ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring - Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm)