0102-012 (COMM)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
9�3 � yi,i } n O'i9�li2C
Oate-�/ Signature of
OWN ER-BUILDEWDECLARATION
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 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.
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.
WiA?E1IND 21.79-W0043716
(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 California, and agree,that if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I sh ll forthwith comply with those provisions
Date: —� Applicant j�,i�`, r^ l i���°s •�r�f I i��'° r -y a
L�Warning: Failure to sedure. Wo rs' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to,$100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees,
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuar5 t
any permit issued as a result of this applicaton agrees to, & shall, indert h f�;
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representative of this City to enter upon
the above-mentioned property -for inspection purposes. /
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Signature (Owner/Agent) ` i+PA�ir�a Date+ S�
. BUILDING PERMIT PERMIT#
DATE VALUATION LOT TRACT f
JOB SITE
ADDRESS
APN
OWNER
CONTRACTOR/DESIGNER/ENGINEER
ly./5��1-.�3:•�pry�y[EN
:i2.11�tCHO C,',TIMRAi��}:�11�„tr'�..0;1�MD
Q,Y
� giC
471-100 AVENUE E 5?
79 687 Ce3UMRY MOB DR. -0201
Ldp. (�TtM:i1 d 1-A CA 92253
BIVI AUD A .DiN&S CA 9Z.201,
CIO. )345.7755 01BLO 1969
USE OF PERMIT
COMMEMCW.,
-_i VMP S -f A,'t'lC.3x`$ rINC1:0SY1RS 1:1,,:A.laE 'UMP 1YQiJ1PAt71?NT PAD SQ FT"
VALUATION 840,00 N
r
�.- 77-D COST OF %.;OI�iS'A'.�dUC'RTON
- .. 19,.64:MID
y,Q �4�jgPu"
�y yy.�'�' p.q p ��q�-yy. 9M
,fC ��arilrtYkh1r7.�.L' RF 4�. W.E�/A9SA.iP.�R Y.
PLAN (,Hk�"-t* FEE 101-000-4,39-316 00.439.316 S.129.�"+s
s 1::+1JMUCTIOU bIT 101 -WO -418-000 $199.(w
MECHANICAL PY19 101.Oc_10-42.1.000 560150
RLEC' RIC -AL r 1;}?; IDI -000-420-000 $', 79.30
P1.,UKUl'•iO 1'x;15' 1.01.000.419-000 x%7;04
0P..4Si1t D ME 101-000-423-000 "$15.00
1 1N PUBLIC. l l i 701-000-2,55,000 $97.90
S3'1'ti01�'�} 1ti§d�'�f03� PN. Y'� COMM 15 0-000-2A.1-0 $9.0�
�.
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p Ldp U�1ty7Tid
'•[ }?� t2001 MAND
$654.82 ..
•!H �' T.A1a: PRF -PAW 1%TZ
$0.09
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IIIIIIIIII�IIIIIIIIIIIIII 15 ;
IE
RECEIPT
DATE J
�S
BY
DATE FINALED , -'
INSPECTOR
! �
r�,
i
INSPECTION -RECORD
OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR
BUILDING APPROVALS MECHANICAL APPROVALS
Set Backs Underground Ducts
Forms & Footings �O/� (p� Ducts I
Slab Grade/ Comb Air ;
Steel Combustion Air i
Roof Deck �� j� Exhaust Fans
O.K. to Wrap F.A.U.
Franimg Compressor .t
Insulation Vents
Fireplace P.L. Grills
Fireplace T.O. Fans & Controls 'I
Party Wall Insulation Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final POOLS - SPAS
BLOCKWALL APPROVALS steel
Set Backs Electric Bond ;
Footings Main Drain ,
Bond Beam Approval to Cover `
Equipment Location
3 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
COMMENT
Final ,3Q Q `//.oim �.✓�� ��i!;b�� /S
Utility Notice (Gas) L3B����� ��i✓�✓��
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service C
Sub Panels
Exterior Receptacles
G.F.I. . ".1Z
Smoke Detectors
Temp. Use of Power
.Final /2_p� 07/
Utility Notice (Perm)
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J
A
P.O. Box 1504
78-495 CALLE TAMPICO (760) 777-7000
LA QUINTA, CALIFORNIA 92253 FAX'(760) 177-7101
Mr. Ruben Urrutia, Project Manager
Vertical Construction
81-100 Avenue 53
La Quinta, CA 92253
9/18/02
Dear Mr. Urrutia,
In 2001, the City of La Quinta issued a number of building permits for the Country
Club of the Desert. The three of concern in this communication are: #0012-059
(March 2 — Maintenance Building at 80-955 Avenue 52); #0107-079 (July 23 —
Maintenance Building Site & Exterior Electrical at 80-955 Avenue 52); #0102-012
(March 13 — Pump Station Enclosure for Lake Pump Equipment at 80-905
Avenue 52).
Under the administrative provisions of the 1998 California Building Code, "Every
permit issued by the building official under the provision of this code shall expire
by limitation and become null and void if the... work authorized by such permit is
suspended or abandoned at any time after the work is commenced for a period
of 180 days." (CBC §106.4.4)
That section also allows the building official to grant an extension of said permit
for a period not exceeding 180 days.
Based upon conversations and a written request from the applicant, the
extension was granted on 5/20/02, creating a new expiration date of 8/1/02. "No
permit shall be extended more than once." (CBC §106.4.4) Consequently, these
building permits are expired, with no provision for further extension.
Please contact me directly at (760) 777-7015 as soon as possible to coordinate a
plan of action and timeline to complete the work authorized by these permits.
Building & Safety -Manager