Loading...
0008-125 (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 674(YI.4 B Date �� �� �' 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'tiie•project (Seca 7044, Business & Professionals Code). () I am exempt under Section B&P.C. for this reason Date Sianature 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: Carver STATE FUNDPolicy No. 04g.0007330 (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 mane so as to become subject to the workers' compensation laws of California, and agree that if I sh�uld become subject to the workers' compensation provisions of Section•.3700 of the Labor Code, I shall forthwith comply with{those provisions!: ,f Date: e / ' i9 -0; Applicant • t J �, .�. �. —"`� r ,. 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 & 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 ad 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 upon the above-mentioned property for inspection purposes. Signature (Owner/Agent) ' " Date` /'. ` BUILDING PERMIT PERMIT# 010 DATE rt j VALUATION LOT -126 TRACT c, +�i #f~}p�a2,iA8.tTtf 92 29457.1 JOB SITE; APN ' ADDRESS 49-203 V.% AX&TIVIDI A 649-100-009 OWNER CONTRACTOR/DESIGNER/EN (NEER W D98EWr I)1!V. F ..dPA,3MT s'i"9 cons"L'P.L1C.pnoN PO BOX X;16 79.295 X &N'C:HO.L,A Q1,T1W_rA VR. :LA QL7ft A CA 92253 LA.tg311MA CA 92253 (760)771-1941 CDI. J 2996 USE OF PERMIT SM1312.1;AIVOL ' DWELL11 0, VD .LOT 93 fal.AW:M 1 ,Pf�ifils<lIT 000 NOT ]INCLUDEHLOC)CWA.LIAS OR POOL. 75% PLAN CHECK YJE_ I?,DliCTXON MR MULTI IPLE 1501JANCE OF S.AMZ PLAN TYPE. CUSTOMS C'ONSTRY,OTION 3,34&OP SP POR,C:WPA210 $80.00 SF 0ARAGWARPORT (8r) 131532,30 E5miAmw cosi Ulf' CUPI'SyI't2U'(:'!.T(Dn 282,106.00 &b9RW'i'FX1± RUMAWZY CONSTRUCTION M?C 101.0100-418.000 $I,no,00 PLAN CHECK FEE 1tj1.0Q(3-A39-318 $364.23 MECHANICAL LEI; 101-000.421.000' $149;30 fr: ELI!,C;TKIOAI.YEE 301,-000-420-000 3213.04 PLUA9:i3iA1G FRF 101,000.419-000 $202.25 STRO 10 MOTION ISN - R,191L3 101-000-241-000 ORADINO PER 101-00042.3-000 S24.00 DEVELOPER. IMPACT FEZ ART IN PUrfLIC PL&CES - R►011: 701-000-255-000 SM -` (YrAL C>OAY=U(nION AND PIAN GElll= S4,271.50 LRUS PRE=PAID FM 1$0100 T1(Y+AL. P)�&.0 M' 11 OW $4,2716.0 r RECEIPT DATEt 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 _ Q ReturnAir Steel Combustion Air Roof Deck y p Exhaust Fans O.K. to _ y �/ F.A.U. Framing Compressor Insulation _Z2_ � Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath � Drywall - Int. Lath Gv � Final Finaldy 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 AP ROVALS 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)