Loading...
0111-192 (SFD)LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed, under provisions of Cnapter 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 674 .'`* ,r 3 M, 13 DateL L:. 7 'r 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). ( ) 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 maintaina 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. vTA'4 E k'Y? t iL- fjS1�i'13R (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 Californiardnd agree that Jf 1, should become subject'to the,�rwor ers' compensation/provisions of Section..3700 of the Labor Code, ,shalhforth to comply with,those provisions. Date.' r !;% Applicant sem' Warning Failure to secure Workers" Compensation coverage is Unlawful and 0,0 Shall subject an employer to criminal.penalties and civil fines up to $1000; in. addition to the cost of.compensation, damages'as provided for in Section'3708 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject ,to 'the conditions and restrictions set forth on his application. #t A .; 1; Each person upon whose behalf this application is made & each person at Whose request and for whose benefit work -is performed under or.pursu"t to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees 2. Any permit issued as a result of this application becomes null and void _if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation, I"cert ify that I have read this application and state that the above information is. correct. I'agree to comply with all City, and State laws relating to the. building construction, and hereby authorize representatives of this City to enter Lipo the above-mentioned property for inspection purposed ,i+�f .• )' Si nature (Owner/Agent) , + Date BUILDING PERMIT PERM T# DATE VALUATION e LOT �+f� TRACT 93121024M 21 2:9457.3 JOB SITE APN ADDRESS 4.9-,` 5 WSTAAWAa OX, %h OWNER CONTRACTOR/DESIGNER/EN (NEER 11) 1% MW DFNWQPYM*MT SPARKS P0BOX" 17.16 79+295RAIR- E1'0IA.,QWiaTADR. I:.,A QUWA CA 92253 LA QURTrA CA 92253 (765,)771-10,41 C.TI:S 2996 USE OF PERMIT SID „ 1,07 23 T,1<:A.N MIM30 PBiYt.Mf!T OO&S NOT MC'LUVE C ' 'f.r000.)OT�A WL➢it reii�3V rL.r4.{:�1v��i�'AY �iF�'i.t�iJ 'Ai.l' P0ki:C;iI110ATiQ,1 s$t►:ati sir ]LW1A.7.YAd2Y.GSD c'6 ." oir 4✓odVkimVaE.d,.oAa :�i.s&r4xm.nw 1I.' . ' ' . LIMMAKV CONSTRUCTION FeLIF, 10) -NO -4 I 8_1XV $1,384.©0 PLA14CHMI MIX 10-000-1439-318-318 �1�i45.9:5 .c� ECHA 'TC1Ai, E .101-000-421,>•anq SUM% ?"&* �ijf�':'7'btd�".H."� lr•,E�iti ! Lyg-E.R€ff1-�& i? C?-Cft30 �adcM. �3 PLUN114MG ME, s`i,Id,0110 'L: atION PEI: n awEWD 4101-000.241-000 �liislt� F�� IaF DOW -0004-23-000 �2ti,m0 MPACT Ma 't i"':a1`'iAND PL��yjAp�_T(��j:9Ee��"yk('��, $5,39(1.aq. , �yp+�yq 100 f t,:D EC 0 b 2001 . , CITYOFLAQ UIRA RECEIPT DATE r i; BY / x1f. DATE FINA D INSPEqrp INSPECTION RECORD OPERATION DATE INSPECTOR • OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Forms & Footings Slab Grade Steel Roof Deck _ _// / �G�� Z _ �� Z1j7 --l��� Underground Ducts Ducts Return Air Combustion Air Exhaust Fans _ O.K. to Wrap 3 —Air dL 144:1� F.A.U. Framing Insulation 3 —�� S — Z Z —O�, Compressor_ Vents Fireplace P.L. 1 Grills Fireplace T.O. Party Wall Insulation i Fans & Controls Condensate Lines Party Wall Firewall s'_ Exterior Lath Drywall - Int. Lath i I Final Final / Z=3' POOLS - SPAS BLOCKWALL APPROVALS steel Set Backs Electric Bond Footings. I Main Drain Bond Beam j Approval to Cover 1 Equipment Location 4 Underground Electric 1 Underground Pibg. Test Final t Gas Piping PLUMBING APPROVALS Waste LinesQ� Water Piping Gas Test Electric Final, Heater Final Plumbing Final Plumbing Top Out , Equipment Enclosure O.K. for Finish Plaster Shower Pans _ _ Sewer Lateral> Sewer Connection Gas Piping y�_ / Z / 'U� Pool Cover Encapsulation Gas Test Appliances 1 Final I COMMENTS: r Final• Utility Notice (Gas)=Z_ ELECTRICAL APPROVALS Temp. Power Pole I Underground Conduit y Rough Wiring - , / " Low Voltage Wiring i Fixtures 1 Main Service Sub Panels Exterior Receptacles _ G.F.I. Smoke Detectors j Temp. Use of Power I I � i Final 6 Utility Notice (Perm)