9911-126 (RER)+ti LICENSED CONTRACTOR DECLARATION PERMIT#
U) p I hereby affirm under penalty of perjury that I am licensed under provisions of BUILDING PERMIT "tt-124
.'-Chapter'9(commencing with Section 7000) of Division 3 of the Business and DATE fel VALUATION 320.8116.08 LOT TRACT
W Professionals Code,and my License is in full force and effect.
p`= ch License# Lic.Class Exp.Date
Q_L0 S1a1J2 H 0 3112111 JOB SITE 49-578 ANtILA URF' T APN -
I LLI ADDRESS
r- Z � Date 1�/I6 , Signature of Contractor �- ' / OWNER CONTRACTOR/DESIGNER/ENGINEER
I �d !, .___,_j +� t1 A 1rtr A AIT V k-f►Pi 'A{7CT Cf»•f/'`Ill\TCR'Dt r!„f'//1'Ai
.,�n f/R. .1IUll..l\.J♦Nr� ��i.4.ru\J��...Vr\.1.NV•. 11+J�•
r` OWNER-BUIL DER-DECLARATION '+
v 49-578 AVILA DRIVE 7x-,59_ ..6EAVEk TAIL S—IREL i'
H LU I herebVaffirm under penalty of perjury that I am exempt from the Contractor's 1,q Qi1tN J'tti i:`A `►Z'253 1'AJ.M UESliRT ('A '?..>LM'r
C/) License Law for the following reason:
Z_ ( ) I, as owner of the property, or my employees with wages as their sole (760)."1.105� i.T.i4,i1
compensation,will do the work,and the structure is not intended or offered for
sale(Sec.7044,Business&Professionals Code). USE OF PERMIT
( ) I, as owner of the property, am exclusively contracting with licensed KUNWhjv'tW,KEND flAilN
contractors to construct the project (Sec. 7044, Business & Professionals
Code). i`liAN.;k ts01AN6 trf.i%S.S 0lJ4._* T6 a:itikiw H tinJa)Ri 4-fit�:f f{itJ~.h1(9)lk..
cY) () I am exempt under Section , B&P.C.for this reason
LID
N Date Signature of Owner
ON
0)
Q WORKER'S COMPENSATION DECLARATION
CL
C:) 2 Z I hereby affirm under penalty of perjury one of the following declarations:
Lo � O O, 1 have and will maintain a certificate of consent to self-insure for workers' r1I'LA11Viti �' LS
X W !L compensation, as provided for by Section 3700 of the Labor Code, for the
mJ Q erformance of the work for which this permit is issued.
Q C) �($N11 have and will maintain workers'compensation insurance,as required by
p V Q Section 3700 of the Labor Code,.for the performance of the work for which this
rn l– permit is issued. My workers' compensation insurance carrier & policy no. are:
I'* Z Carrier � �,.,, Policy No.
00 ) JU TtCai:A'TFD CC3,"4T OF(TNI STRUCTICJN Z11.00A.AO
J (This section need not be completed if the permit valuation is for$100.00 or less). 111�F 0-10 M: #�t� � y_;lK $134.S3
7� 1 certify that in the performance of the work for which this permit is issued,
1 shall not employ any person in any manner so as to become subject to the 00NWR1 K'i 10N F F 1014110O�4184!S1(1 $207 M1
workers' compensation laws of California, and agree that if I should become N0711ANICAL 11,1:, 101 (fW421-OW $21.50
subject to the workers'compensation provisions of Section 3700 of the Labor i1,l i't'RIt:Ai kFsi: 101-000-4.10-OW 51.4.50
161 Code,I shall forthwith comply with those provisions. PLUMI UWi MFks tt)1-Ot}t)-414-Ofkl $33.101
Date: 4. 14 Applicant
)-- �"• ` / Q C'fitf'tlJC}MfYi"If1N FTI~ RF41C1 1111-�-?d#-t'11>t1 00-100Warnin9� ure to secure Worker Compensation• rvd age is unlawful and !;#{t1[?t:N)hI7? 1111 t1Q!)-•1'. Q00 t�O.iNJ
shall subject an employer to criminal penalties and civil fines up to$100,000,in
4uaddition 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 NI tR-'1'l71•AI-C()A1irMll It-n0N ANT)PIAN 04F('K 1%437-,',
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. LF.S..' PRF-PAD FEES $000
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 It3TAJ,t >k:J NIII•i+'EY.04 DOW,114M W7 YS
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 11111111 VIII IIIIIIII IIII
correct. I agree to comply with all City, and State laws relating to the building 44
construction, and hereby authorize representatives of this City to enter upon /� /. IE
the above-mentioned property for inspection urposes. ✓ J
,/ �/ RECEIPT DATE BY/' � � �• D L I D INSPECTOR
f 13—ate
XSignature (Owner/Agent) / A i �r!f --'r
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 o%/Qj F.A.U.
Framing Z—f7 Compressor
Insulation —_ 49 64 Vents
Fireplace P.L. Grills
Fireplace T.O. Fans&Controls
Party Wall Insulation Condensate Lines
Party Wall Firewall
Exterior Lath $—Z�—
Drywall-Int.Lath -_-a
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 Voftage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp.Use of Power
Final
Utility Notice(Perm)
VILLA LA QUINTA HOMEOWNERS ASSOCIATION
Post Office Box 15
La Quinta CA 92253
November 8, 1999
City of La Quinta
BUILDING DEPARTMENT
P. 0. Box 1504
La Quinta CA 92253
RE: Remodel - Anderson Residence
49-578 Avila Drive
Ladies and Gentlemen:
The Board of Directors/Architectural Committee of Villa La Quinta has reviewed
the plans for subject remodel and find it meets all the criteria of our
governing documents.
If you have any questions, please contact the office at 564-2177.
Thank you.
PATRICK ROSS
President
C:\WS2000\D0CUMENT\V1\ANDERS0N
t
CITY OF LA QUINTA SUB-CONTRACTOR LIST l
JOB ADDRESS y�`S7 e A V, 1, " ���-" PERMIT NUMBER OWNER �� f n-S v r-1BUILDER
This form shall be posted on the Job with the Building Inspection C aryl at All times in a conspicuous glace. Only persons appearing on this list or their employees are authorized to work
on this job. Any changes to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result in a stoppage of work and/or the voidance
it. For each applicable trade, all information requested below must be completed by applicant. "On File" is not an acceptable response.
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B'n # City of La Quinta
:`: Building 8t Safety Division
P.O. Box 1504
Permit# -._ €: 78-495 Calle Tampico
,La Quinta, CA 92253 .
Building Permit Application and Tracking Sheet
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Project Address: -3�7 A V� -Aa )(L i ✓� Owner's Name: 7iq V/-O l\A DEGLSC>'J .
A.P.Number: Address: -_52�. A(/"tA. �!r_.
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Address: /U f �/t/4-)I-2,,CL I- Pe-� �� 1 V 7 A� - Go1JS
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