Loading...
0311-155 (RPL)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 Date Signature of Contractor-, -J" OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that lam 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: Carrier Policy No. INSCOPIT, 1G7f�04j1'35 00 (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 Code, I shall forthwith comply with those provisions. Date: t Ar A%�, Applicant 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 & eacli:person at whose request and for whose benefit work is performed under or pursuan (t0 any permit issued as a result of this applicaton agrees to, & shall, indem if' & hold harmless the City of La Quinta, its officers, agents and employ es. 2. Any permit issued as a result of this application becomes null and vo d if work is not commenced within 180 days from date of issuance,of s h permit, or cessation of work for 180 days will subject permit to cancella on. I certify that I have read this application and state that the above informati is correct. I agree to comply with all City, and State laws relating to the buil construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for �inspecti n purposes. Signature (Owner/Agent) *r//*'%'�f '-== " Date �- �,• c PERMIT# BUILDING PERMIT DATE / "' VALUATION LOTTRACT JOB SITE _. ADDRESS W-8255 VM SAliOl A APN OWNER CONTRACTOR/DESIGNER EEN1NEEER q.i11gA1Y)MEJ� .No, d.wJ►pPOIDUS, & 1&C S '77-564 CYOVITY&YCSUB DRWE .'BMIT 137 RG. BO 1.791 F '.€ 21,11 DERR`r CA. 9,2211 LA. Q7JINTA. C.A., 9212,53 (71540060-3585 C:RUI- 1945 USE OF PERMIT 1 CIC L ANDl'f.:[t. UPA � r P001 SSPA.A+t.ARMS/8ARP.tXP'X SHALL, BE, IN P.),ACF, At P.RBtPLASTLPPI INISP.''t:;='1'lCM. HQUIPhADIT ENCLU:"F,1RE NOT 44MUDRD ' ric P00,6.A,NDADR SPS; k5,9�,ii�00 3,a✓ • j ESIVEMD C O'471r CYF a aa9NM?!3C'MON � �0 ii1.JdD PWI 011ECK FEE 101-.(1t>U-4399310 $1051 -110 COAIri'RUCT:ON''n, is 1011 -000-418-000 $1.62.00 MECHANICAL FEE -- POOL 101-000-421-000 3?A, 010 Zf.,=,TWC.A.L 1rXL? ,, POOL 101-000-424-000 ,. W:00 PLUMBING FER11 — POOL 10 1 -000-419-000 MAI • yt C:0143TRUC110W AND IJ'1 d C;1 -i -C:1K D IX 0.9 .1-R —P'AM M3 t�,Cici NOV 191003TCYTAL CITY OF LA QUINTA / FINANCE DEPT � VVV , RECEIPT DATE ' t 2 BY f DA INA D O T IN PECT 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 OX 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 BLOCKWALL APPROVALS POOLS - SPA 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 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: