Loading...
0301-098 (SFD)LICENSED CONTRACTOR DECLARATION x ? BUILDING PERMIT II he e6y affirm under penalty of'perjury that I am licensed under. provisions of i y Chapter's (commencing with Section 7000) of.DIVISIon 3 of•the Business and DATE VALUATION LOT Professionals Code, and my License is in full force and effect.' � ( � v2,,tt>a�i�l3i2. License # Lic. Class Exp. Date 274JOB SITE ?f �� .B TTCr° e7131 /03 ADDRESS tag-Jni� �A �.0XQU���iA.��YR. ,� J ya r� 1 Dater, `{� Signature of Contractor-- -r') OWNER OWNER -BUILDER DECLARATION TD 1).W% M-71 iJ1r'�IU10—T&ON ' F0 BOX' 17.3 6 I hereby affirm under penalty of perjury that I am exempt from the Contractor's �, +12j., 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 strurtt,re. is not intended or offered for sale (Sec. 7044, Business & Professionals Code). USE OF PERMIT ( ) I, as owner, of the property, am exclusively contracting with licensed 3�TC3k"a%?"3J �3f: contractors to construct the project (Sec. 7044, Business & Professionals Code). ' ' O 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: ( ) -1 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 Sction 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:' PERMIT # 43, APN CONTRACTOR/DESIGNER/EN TRACT, :SAAams t"'.fSAd:TRUCTIow LA QUWTA C:.A. 922 S 3 Q00)e71-1941 C -M 1 29916 aYid a 1.&$1 <4,3�. P'1AftJ144 -136.' 1-MTUVJA1. &Jia a S401114%,LAP U {� I•., 7Sbad4,�ii OR DRIVEWAY APPROAdH. T3% RIU)UCTION TO PLAN Clip= ME T.)U > TO MULTIPLE ISSUAVCZ OP M—ME PLAN ` Y"Pt+ CUSTOM CONSTRUCTION Am r/ou Carrier . S'i`Nf l? .FUND Policy No. €146.7)33.40. COST OF C:tQXIMUM0,JR • xk q yg��9,:yS1E'9W.TSD A �t4��3J��t�w tSVJuhi;K.2r (This,section need not be completed it the permit valuation is for $100.00 or less). COQ€ ? RUC'CTION ;?FE 101 «000-4.184.000 ( ) 1•certify that in the performance of the work for which this permit is issued, WEAN C:HP.0 FER 101-00*4.S9"328, $204.23 1 shall not employ an person in an manner so as to become subject to the - F (i�..kl����i,�f��� 101-000--01,-000 114%.50 workers' compensationaws of Clifornia, and•,agree That if l should become workers' to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with;tho'se,provisions. 3��3MOT140 �(i2 iBO^? 1s_00t) ; r , �•, T�:'2�C)AaCI'>'fC3'i�i731 Date.. Applicant Sii 1532Q(t-?.4 itJOz€i 71 ' ;. t°6"INO FEZ Warning. Failure to secure Workers' Compensation coverage is unlawful and i31Jl.Olaft IC�'I% �t�� q0 shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided fo�Jn Section 3706 ART f' 111 P 161,eIt`: N3'a�.fwR4 �- REM 270-0i10 �14�4ow. S20,217 of, the Labor Code, interest and attorney's -fees. 4 IMPORTANT Application Is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on kis,-' . 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 applicator 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:.. 2.106.00 I � z . o .t c, 3i4 -A x ,` 1ftC1!"l'7C�%Y 141TO PLA9Ct „ $4,764.50 I= PRE-PAJD FEED Ayx� ry�yy��•p�q�rq+,I y� ' 0 1 &1Fa d"•:•T+.Y61KAllA .C'3� 09 Ai U 1L NO YID $4,764--.9D 2003 it 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 loathe building st : �IpNWE eAc1�Y / construction, and hereby authorize \ representatives of this Cdr to enter upon V/ �t the above-mentioned property for inspection purposes e \ r S RECEIPT DATE ;BY DATE FINAL D .,rSignature_(.Owner1Agent)l' M -.; 3 r t ' ca' � ar ew s a� 3 +•:... .r F + .n • INSPECTOR 1J INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR .vw ' BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings — — Ducts Slab Grade g3 — /z -3 Return Air Steel Combustion Air Roof Deck Exhaust Fans O.K.toWrap 3 F.A.U. Framing //— y' — _v Compressor Insulation - Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath Final Final BLOCKWALL APPROVALS POOLS - SPAS 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 Neater Final Water Piping Plumbing Top Out _ _ 3 Plumbing Final Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection "% 3 Encapsulation Gas Piping Gas Test Appliances Final Final Utility Notice (Gas) 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) COMMENTS: �-. by �. - � L- :Certificate:- of .Occ.:u t �- .anc � fes. •� � '7 1ti �� � of 9ti �� , � ` . � 'Build, :& SOW D'epartrrment � ; , � � f �.r .f �,, � 11+. p� �. • .u_ n �, .. � i .. F � ., _r t . • 1... �Y .�, �' .. �y ] �3 .r r...— wry 4 .-, ,� ' _ > 'l_ _ t._C _. �� a.•_�.. .Y c" s.f t This Certificateris. issued pursuant 'tor. the requirements -of Secti6d 109''of the California Building ' f Code, . certifying;�_that,a't',:thetime, of- issuance, #his- 'structi►re`in 4 compliance with the _ 1provisions. of, the Building Code "`and the various, ` ordinances '`of the ``City regulating, building . construction and%r,use:- ._ Lp _ W . , BUILDING ADDRESS:49:.784�VIA CONQUISTADOR ' 4 a 1 •} f *, r . i L_ r � F s ' r- t I: ' 't . ,�-f4 � � _ ��`'� � + _� � �cF• •$� ,�- T�1 _ Use classification.-S:F.D: =� 'Building Permit No 0301-098 Occupancy Group::R-3 ; `. ,: -Type�of Construction .'V -N- ' . .. F - '� Al �•.� .. _F'1 �' �� :} _ + --'r' ,/ �, _' `4_ �.:r' 7 - Owner of Building'TD. DESERT'DEVELOPMENT -, Address PO BOX 1716' - f. City,ST; ZIP -LA QUINTA CA"92253 _ By; G SHOWALTER i ^ .. _Date:- 05/14/04 j Building Offlcia -POST INA CONSPICUOUS PLACE -t.