0304-0170 (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
70,0319 ti[l._ 1i311f r
Date %n .._._
_� "" � Signature of Contractor � iy=••>•• •
OWNER -BUILDER DECLARATION
1
I hereby affirm under penalty of perjury that I am exempt from the Cractor's
License Law for the following reason: v�
( ) 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&RC. 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:
Carrier s3TA.TP FUND Policy No. 3f%"}.I648S3X0
(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_go as to become subject to the
workers' compensation laws of California, and agree that if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
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 attorneys fees. r
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 authorizi? rel resentatives of this City to enter upon
the above-mentioned property for inspection purposes.
,Signature (Owner/Agent) �p " ""� Date
PERMIT #
BUILDING PERMIT
DATE VALUATION
Aa���w �� LOT TRACTJOB
fLJ
ADDRESS 4'9•'820.U1.l`-' $b .Cr�iAJ.►ti.�`
APN
OWNER
CONTRACTOR/DESIGNER/EN &NEER
LA (,; [TM.€4 L. L iL-
Bq °
9 13 A IDER.'r 2D RI ET,111 102
9908 3 "� IAT 11T 317. 10'2.
.
8.114,N1is 00 C `13. 921 1
VKx4 4 :!Y014 ' CA
92'9 :31
G.3&1 C)U3 01VA
4.97'x:
USE OF PERMIT
MOLE F'. '�rY 1. WlaLN.G
NVU • LUT /.0 _ N. ilZl" 1" 7 ,«.: Li'1 IN ..L 1.4$5 C4 .K.Ii K V,41 -34t.,,
POO'k-� OR DWt�,�MY . PPRO4 CH. 7M, RE,DUCTi'OV TO MAN CHSCK FEE
D1111:'f O1V1ULT.Iftg 3,MANCE OF G.ftDNE PLAN TYPE,
TRA4""
POR�:Cpx-lf!3a�v T;
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X411 CI}yV X7
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WAIMAMID VOW OF CONSUMMUX4
Mvml n PER `eA'd. INd
PL AV Cfli..)WI.11,22, 101 -CM -479-318'
is C'z'rAa�IPC�if,r'3' i01-060-4210€0 1,31)
1 ZIC !'.UJCA3, VF L n 0 a -i1C)&-420-000,
PLUtwl,Ot1 0FR . 1014100-419-000
STRONG A+IL3'l`iON MY, -.R= 1) 10 s -1,')00-2A1 -000
lYu�4 r9'Arttc/3�timFU 101.000.-423.000
!�� pf'V;ildlll
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$0,00
27
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RECEIPT
DATE
BY
DATE FINALEDINSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
TINSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Sof Backs
Underground Ducts
Fbp&& Footings
Ducts
Slab Grade
Return Air —05
Steel
Combustion Air
Roof Deck
J
Exhaust Fans
OX to Wrap
..0%._ 3
F.A.U.
Framing
Compressor
Insulation
— / . 3
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 OAFF
BLOCK LL AP OVALS
POOL - S AS
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
— 3
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL XPPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring 3
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
'. � '.,.qy, �.. :.5 �.. ��'{"`s+"F� �.`.�',:�= .-y -` _-d•"..e ..,, :e:: "F' .: ��r4.. ;�?�s�'+ �-'?F'�- .. 4�•n`.t � �ae•..S _ `•.�.:•�-+�.Y-+�.�. �.�A�*�'.�� r n t s a - � � '�+as4 �.
...•:;..,r. • �-.-,-..-tea. � ...�F�,r_ .. �.�.: at �+*rsry�rt►Ji— _ •- ... ._ .. �1.-r 'Ott�"fi'4!!�M'rt9/IF �. - .... .-----`s'r4+.'�ra��
is `�•c
Certificate of Occupancy04
� Gj44�
C
OFTLBuilding & Safety. Department
This Certificate is issued pursuant to the requirements of Section 109 of the California Building
Code, certifying that, at the time of issuance, this structure was in compliance with the
provisions- of the Building Code and the various ordinances of the City regulating building
construction and/or use.
BUILDING ADDRESS: 49-820 ALTHEA CT.
Use classification: SINGLE FAMILY DWELLING Building Permit No.: 0304-170
Occupancy Group: R-3 Type of Construction: V -N Land Use Zone: R -L
Owner of Building: LA QUINTA-TALANTE L.L.C. Address: 9968 HIBERT ST.STE.102
'
City, ST, ZIP: SAN DIEGO CA. 92131
By: GARY SHOWALTER
Date: 12/02/03
Building Offici
POST IN A CONSPICUOUS PLACE
III III III I I I VIII IIII 31
IE
P.O. Box 1504
LA QUINTA, CALIFORNIA 92247-1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
December 30, 2004
Mr. Matt Jimenez
49-820 Althea Court
La Quinta, CA
RE: Building Permit Extension Request
Dear Mr. Jimenez:
BUILDING & SAFETY DEPARTMENT
(760) 777-7012
FAX (760) 777-7011
I have received your letter postmarked 12/24/04, requesting an extension for the
swimming pool being constructed at the above address under Building Permit
#0402-118.
Inspection status:
Pre-plaster/encapsulation: 5/24/04
180 -day expiration date: 11/22/04
180 -day extension date: 5/23/05
Under the provisions of California Building Code Section 106.4.4, your request
is hereby granted.
Because the Building Code specifies that "no permit shall be extended more than
once," please be advised that unless the project passes its next required
inspection on or before Monday, May 23, 2005, your building permit will expire
automatically.
Yours truly,
AS a
Greg Butler
Building & Safety Manager
To: Cneg Butler
From: Matt Jimenez
Ref: Extension on building permit / 0402-118
I write you this letter requesting an extension on the building permit for my pool. You
may have had similar request from La Quinta residents concerning Pelham Pools. Mr.
Brent Pelham has failed to complete my pool and it failed its final inspection on
08/26/04. This inspection was performed by " Steve". Until recently, I was unaware of
any time constraints concerning job completion.
I am currently the subject of a mechanic's lien lawsuit concerning Pelham Pools. I have
filed claims with his bond company and anticipate a form of settlement in the near future.
I have also filed a complaint with the Contractors State License Board which is being
investigated under file # SF2004-5250.
When received, I will use the money obtained from Mr. Pelham's bond to complete the
pool for final inspection.
Your consideration concerning my extension request is greatly appreciated.
Sincerely,
Matt Jimenez CITY OF LA QUINTA
49820 Althea Ct. BUILDING & SAFETY DEPT.
La Quinta, Ca. 92253 APPROVED
760-777-1783 / Home
760-578-1316 / Cell n
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