Loading...
0007-208 (AR)LICENSED CONTRACTOR DECLARATION _ I hereby affirm -under penalty of perjury that,l 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/2- License;# Lic. Class // 'Exp. Date ' 45 03 B ✓f` ' 011,N. 11 Date !%` �� Signature of Contractor"K'�'""' OWNER -BUILDER DECLARATION f I hereby affirm under penalty of perjury that I am' exempt from,11he✓' ontractor'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). fit, ( ) I, as owner of the property, am exclusively contracting with licensed 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: () 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: CarrierNiA Policy No. (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' compensationprovislonsAof S C ion 3 % of'the Labor Code, I shall forthwith comply with those provlsrons. ,+ / Date: Applicant r. Warning: Failure to secure Workers -Compensation coverage isl nlawfDl-ai., 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 inlSection 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 building construction, and hereby authorize representatives of this City to enter u on e X,'-' , the above-mentioned propertyf inspection�purposes. Signature .(Owner/Agent) •r' �.l. r, Date r BUILDING PERMIT PERMIT# DATE VALUATION LOT'jry—fp TRACT. 07/7.1/7 JOB SITE a APN ADDRESS 79—43-4� CAi.I; YL5 TFe 9,I D—F — OWNER CONT�R7AC�T�jOR/�DESIGNER ENGINEER CONTRACTOR n�,<�• q�p'm�'�]/ IT /</JTr 01( 74 43 3 CALi1T' VIEFTAMDE 51.538 AV1'+.�%iDAMAI� TI1+i.1 L.e'l t"fiTl,tJ'TA ICA 922.5: LA (ZUDTrA CA 92253 ('7601771.3836 C,t37.,4 1463 USE OF PERMIT rtE=xI 17:1'AL ADDID1034 225 S.F. THIRD HAY O3i THE QARAC11r CU14V IMTE13 MTO PLAYROOM PER APPROVED PLA14S ONLY /1DIDI.TION 225,00 S1• `,I'MA,` "COSiTn1! CiDNSTR13'arION 12,217.54) PX;f Wr M SLTBiIXiII'ARX PLAN CHECK FEET 101-000-439-318 Rig1.20 .; C 014S'1 RUC'T101d 117,E 3 01-OOe�-�V' l H-©00 104.04 f ELECTRICAL EE 101-000.420-000 518.00 VT,RO'tdG MOT1O`N FEE -, RZ511) 101-000'241-000 Fi • 1 Mc.,g � # r(3L'-'St'1lLT C:ON3`L12LT1f��3,419'X ASN C:I11�C? $350-12 T 1� T.�.21,s-T'AC1J I+S3,� `FU, ri1f1 m1' P50,42- 50,42RECEIPT RECEIPT DATE , DATE FINALED INSPECTOR I INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR S 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 fl Drywall - Int. Lath Final _ Final POOLS - SPAS _ BLOCKWALL APPROVALS 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 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)