Loading...
0404-031 (BLCK)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 forceand effect. License # Lic. Class 1 Exp. Date Date L ! - ;- C t 6Signature of Contractor OWNER -BUILDER I hereby affirm under penalty of perjury that I am exempt f7om 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 performance of the work for which this permit is issued. / . ( ) I have and will maintain workers' compensation insurance, as required by Section3700.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 EXEMPT i 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 Ias to become subject to the workers' compensation laws of California, and agree that if I should become Subject to the workers' compensatioA provisions of -Section 3700 of the Labor C k"' 1 hall foVith comply with ttio_se�provisions. 4 ,Date: "� 9 Applicant A A ,n Warning: Failure to secure Workets' Compefnsation coverage is unlawful and shall subject an employer to crirriinalpenalties ,vand 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 applicationbecomes 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 upon the above-mentioned property for ihspection purposes. [[ Signature (Owner/Agent) �t �`y Date'.' BUILDING PERMIT PERMITN DATE VALUATION LOT. , TRACT z . (MA112aW S43e�:'•C+ 9 13640 JOB SITE�j APN ADDRESS{7"2• 11T(jp�i�e.•1i7 OWNER CONTRACTOR/DESIGNER/ENGINEER I -RRY C.OTA 7 C'a COM' iOCTION & MAI M -MANCE 53345 AMUDACAPMANZA 53345.A't7W1DACAREtANZA :LA Q'TliSdTTA. CA ' 92253 LA OtMgTA CA 92253 (760)564-4864 CBI)f 2093 USE OF PERMIT 20 11? 3'BLOCK WAIA. PER CITY ST,04DAAIIJ). 2001 C:'8C.. • 5 F7. WALL A00 IS LpmmA is con oyr CommupT+mi 433M YERMT 11TESIMMARY ce�1���TfuC•rk©�r .���. �t c� 1 ��c�a�� I sRGG�i . ' �.I �.�io ,rt . `V RPR 02 2004 , CITY OF LA QUINTA DEPT. FINANCE RIB -TOTAL COAD P.i' UCM0114 AND PLAN (,.Tipin' K $15,00 LF3.3 PREPAID T4EF4 'rar—AZ T$1#'��J'VlS ' h;-.k)I* Now RECEIPT DAT7_ B �' DATE FINALED INSPECTOR C7 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 Exhaust Fans O.K. to Wrap F.A.U. Framing Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wali Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath Final Final BLOCKWALL APPROVALS POOLS - SPAS Steel Set Backs Electric Bond Footings _ j _ 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 Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fbdures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Fina] Utility Notice (Perm) COMMENTS: 61051W q.30-07 .g7