Loading...
9907-087 (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 r�iG 4 Gi1X/19! 7 to / Signature of Contractor t� P 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 owrfer of the property, am exclusively contracting with licensed contractors 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 he affirm under penalty -of perjury one of the following declarations: () I.have and will maintain a certificate of consent to self -insure for workers: comp ensation„'as provided{for by -Section.3700 of the Labbr,Code; for the performance of,the work•for which•this permit .is issued. ( I have and will ;maintain workers' compensation insurance, as required by Se pion 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. ; ,i'i'egi�.i'�.�'ii 1;$b•-t3iiC29��� (Tfiis section need notbe completed'if-the permit -valuation is for $100.00 or less). O I certify that in the performance of the work fo.(which this permitis issued', I shall not employ any person in any manner so as'to become'subject.to the workers' compensation laws of California; and. agre,e� a if 1 sho Id: become subject, to the workers'compensation provisi ns of Section 3700 of the Labor Code,'I shall forth .ith comply Withathose p cions: „Y Date:""77ti, V, Applicant 4arning. Failure to secure Workers •Co'mpiahsation coverage Is unlawful and shall subject an employer to criminal -pe a1,0, tie_s_W 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 attorneys fees. IMPORTANT Applicationishereby 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, notcommenced within, 180 days from date of issuance of such4 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 r correct. I agree to comply with all City, and State laws relating to the building '^ construction, and hereby authorize representatives of_this City to enter upon thee above-mentioned pr/opd- for�in pection purposes —� 3i nature (Owner/A ent)� / -----"�Date�"���'> I `r' PERMIT # BUILDING PERMIT 9907-.087 DATE VALUATION 5168 50 �0 LOT � TRACT a,S1.s4r�. JOB SITE[/ ADDRESS % .915 W A.;I w��'kNA VIA APN ' OWNER' CONTRACTOR/DESIGNER/ENGINEER '" E -sr. J''t.�J+'brJa ILO SPAJLK� CONIMAUC'.'TfC, N O BOX 1716 M9 295 RANCHO LA 9UNI A. IFIL Q.A QUIN'iA. C'lk 92253 LA. QLIJI!'tA CK 922.53 f76�►}7?1-19-tY tom,# 7.995 USE OF PERMIT SJ_ OLE .11A.M.T Y MULNG . orb.• -.LOT -36 PLAN'VLE .#? 13tH T D069 NOT INCLUDE Bf.Ut,.i' . WALL 0, _NOJL: r / L r.'.v.STOM Cd�.•v'T4S1l..i4 ; A 10N 2.0,38.00 :i' , d fktl`;2ritJ ucATt1'C`i4t T W0-.06 SF Ei t acit b aii � i' OF CMR CONv']?i2iJC"1IONFEL8 101,000418-000 SiS4,t:f10 141, N C 3C:JS,.x l:> iO i .f (1-43 - t 6 $709.75 k=H/V0 AL f'M $53.50 .r, ituc%. C,,r toji-Olin-4.29-ooJ 1.291 1�LCfiHCi� I+iC11 i,E 1.f31-000-4194,, 9136A -r r `c� Ml�?'it� F TtrES tttt-_01-24l-tOs) �rw�;t1F ' i~►r�i�'�N� t �.� Z�Ji-��23-t}©0 �?+�iit? tNt W- TR706V EE 225-000.443•'342 S17922.60 Aftf (NI PITS+ UC #�$.E1 1 ; .tZ£s'S.iL'IFJ.l-GU4-.` -Qtlil S+1%1.40 < F PAID r LESS PRE -1 US R ra r { TOTA.L Pit;R HT Ff,'ES ME NOW $:3,910.94 dr�� Ali �-•yi9 � '' i 1q.A ' x•11 i^1. ' RECEIPT ” DATE` BY r!` DATEFINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs en Underground Ducts Forms & Footings - _ h Ducts Slab Grade _ = aj 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 60 - Final POOLS - SPAS BLOCKWALL APPROVALS steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover .Equipment Location Underground Electric Underground PI . 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 UQ (1 K Appliances Final COMMENTS: Final Utility Notice (Gas) 0 ELECTRICAL APPROVALS Temp. Power Pole , Underground Conduit . Rough Wiring Low VoRage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) - ®• GQ