Loading...
9704-021 (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 1'97 Date Signature of Contractor OWNER-BUILDER DEC�LAfiATf N I hereby affirm under penalty of perjury th�x'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 pert rmance 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. . ZEN1 11 WS. CO. ZW29 902 (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 shouIdxbecome subject to the workers' compensation provisi'on's of Section3700 of the Labor Code, I hall forthwith comply with t, o�e`provisions. Date: Warning: Failure to secure Workers' Compensation-cdberage 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 buildinD construction, and hereby authorize•" representatives=of this City to enter upon . the above-mentioned property for inspection purposes." Signature (Owner/Age )� - Date ,"7l L '� Frs �: l , BUILDING PERMIT PERM';#j � CONTROL# 4704_021 4949 DATE 4170 7 VALUATION ssv'i sm) LOT ! TRACT � slol-] JOB SITE ADDRESS 79,295�rI�L..Y0111A .,1)I.CiVII APN 60"41-007 OWNER CONTRACTOR /DESIGNER EYN}GINiE�ER , . f�yIVR Y 0 !: '-111.11UC�I1q.1IpVIES, 9l6SL! \. :. ti?3 S 1°.11 19 .1 s 0rilN Su, "ry SAN 14t i2PlFlf 1�Cfs€ I"A 92409 SA l BF[WAR]X140 0'A 02408 USE OF PERMIT _ Sir f9 G. 0r di.1±113. i ikGs N:' .I NC;t X.i Ri 131.009. *413 t`.it7" :#`'C✓ -A— I,)VL !d.%V PLANUA.. C 4i1't,�.K.l>r~13� t'�F 3tJ� kf� ii1` rS°�„ k Ul2 Ml sf.`f'TI'[,£ ISSUE,, OF SAfEiE PLIA34 TYPE, TRACT CON�rITZICfilON SF t'Ui't�''t1l1?A't3',sj :�.Uft �r± GA12A0E/CF R.0'aP'9etr PLAN C 4-1,Ciis:f,-U 10M1(10-439-318 $121.72 aS±f17d HAN1C;AL r l M 101 -ICU 421..400 SV/Ati) 1'1.14�,:.f�ftCC'.flis.)rt5!s_ �ul.�Cli3}-d20-f)ii1 �B©�t.vt► f�'d.,i111!(31NCi ��i3 l®I•UUl�•4i�-0€�I $1lR.Gk1 STO*NO NOT TON MT" - 'RF.3 _) .101-000-241-000 58,79 'RADIN FhP 10 1 -00. 0423-000 $20.00 17mFAAS`tRi.1Sr"1'(.R FFE 225fis€iG 443,.342 $],961.11,, ti SMA PAID�T�i A -If .1,1f�I:.� 0-�JYpy fi!��l+;fttX7l.QJ'Y AND. PLAN y.6]Eloiy., LESS PRE-RU13 RES S0.00., APR 0 1997: o,oT c Pv.Rm rrri- -S, O i VI NOW $2,976402 e OF Lk RECEIPT j DATE BY DATE FINALED 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 7 Exhaust Fans O.K to Wrap G F.A.U. Framing Compressor Insulation p 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 I fz= POOLS - SPAS BLOCKWALL APPROOLS 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 41 Pool Cover Sewer Connection Encapsulation Gas Piping ., Gas Test Appliances Final 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 6 Utility Notice (Perm)