The URL can be used to link to this page

0204-020 (RPL)LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensedunder prove''?ions :0 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 # s Lic. Class Exp. Date s :?{+ C-53 � � 112( Df 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). h. ( ) 1, 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: Carrier B`f.AA'TM, FIiid?: Policy No. 033 -Dl (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 provisiorts of Section 3700 of the Labor Code I Sh I forthwith comply,with those provisions. c� Applicants�,�Ea 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 tb� the conditions and restrictions set forth on his application. ' 1. Each pelson upon whose behalf this applicatiomis 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 author'a representatives of this City to enter upon the above-mentioned property forlinspectibn purposes. Signature (Owner/Agent) 'y! ; �' Dated • . PERMIT# - BUILDING PERMIT fJ 0214-0120 DATE J / VALUATIONM o LOT TRACT JOB SITE44ADDRESS` "v�j CDD,.I (as ADLi APN OWNER CONTRACTOR / DESIGNER / EN (NEER 1��.tA,il�it�tr1:�12IS'1; A�,.��.��Tt ISCb©1.,5 4a=250'V%C0 1'.01,1ADO 73-5 r'a moliwl ` 11 i r.A Qcl':Ck�l �'A CA s?22:i IPAI A D&IIMRT +i A 92260 USE OF PERMIT 1?OMMDIOR TA }=OOL,AND ti}',ti, ONLY. ALAS S/AA:irkti:MS S.tfAL., .BE IN PlhIXE PRIOR. . TO PFtR.RAS`t'IM Ihi PEC'TIOR 13 LF 4'POOL EQUIPMENT PC►L Akt�,y/Ci SPA 24,2.00. 4MOO r F-1% WALL rid.R0.3J�.,r:/,lx.7dY +:�tYA33'tifdd'•A cosw.,oip co7 1�t^ .Pmxw �~.F.i�:. t�ar�Xv3 Tim,' y PLAN CHECK Rig 103 y a(tt ,9.318 SIVA Ia FCtl 0,r—AE:L, FEE «> POOL 101-000-4.21-000 �x4.A0 lsf.Et:;TRICALir'ER POOL loi-006.426.001 C4eJ9UC"fiti�II� ', 1�I1 �A R Q(�0 Vit; s,Ra i • s� A � ll �I %'I'ji r ) . {/�T A�4Q((a�)�yy*u,��y�y..('�''(' y�•t�. A' ){>T � � ��.9{Mq OXYD-1V1.i.AT. CK.�v�s`+.M.�/41�1�/JfT i6ND CMR.Vt�!(6%(k�.'%�i-±yii�lj >I AiAx PRE , $0,olD 4Y n. • 'MUL M&=1vn� D111 NOW s RECEIPT D9T(E(a . f d ✓ t�Cd. BY ' DA FI ALE INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck Exhaust Fans O.K. to Wrap 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 Drywall - Int. Lath Final Final 6 6,//,5POOLS -SPAS 4 BLOCKWALL APPROVALS steel — Set Backs Electric Bond —/—Z Footings _L�— _ Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final PLUMBING APPROVALS Gas Piping 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 ✓5 Gas Piping Gas Test , Appliances' Final L — ' COMMENTS: ! 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)