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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
1042 C36BRIC L(r7/3112:
Date 7'1'7 Signature of Contractor t N-,' k�
I t qty -'•�
OWNER -BUILDER DECLARATION '
I hereby affirm under penalty of perjury thatl am exempt from the Contractor's
License Law for the following reason:
( ) 1, 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
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 FAIMIFT Policy No.
A
(This section need not be completed if the permit valuation is for $100.00 or less).
( ) !certify that in the performance of the work for whichithis 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 Se tjo�n1.3700 of the Labor
Code, I shall forthwith comply with those proviso'"
Date• I" Applicant Applicant ,-Y'- Xe 1
\oi•e" .7 1
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.
IMPORTANT Application is hereby made to the Director of Building and Safety 0
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 Sta!teilaws relating to the building
construction, and hereby authorize representatirs,of this City to enter upon
the above-mentioned property for inspection purposes.
.,---Signature (Owner/Agent) .)-'' ---- Date t u 7
BUILDING -PERMIT PERMIT#
DATE VALUATION LOT • 0302480
02i24J2,0C MOM
TRACT
JOB SITE
ADDRESS 54_296 Ave,.. -.t 01 ALVARADO
APN
774-241-M4
OWNER
.MJRE LIO & BEFIT LOPEZ
,.54-296 AVEIIDA ALV l2A'(O )
LA. QTX FA CA ' ',. 92253
CONTRACTOR / DESIGNER / ENGINEER
CORTEZ 8r, ASSOCIATES
7847 SY.L BOX
VICToRVII.EE • CA 92392
(730)244-6341 CBI.gf 36321
USE OF PERMIT
P 1 iNG
WATERHPATL O CRANOt;' C)UT
L
V.AF.UATIOW
;P'neveT FEE
PLUMBING PER
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:
$00,00I
ES'filWATKD COST OF CONSTRUCTION
SUMIVIARY
; 10) 'O00419'.00O
•
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522.50
F'.
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IIIIIII
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f$00400
$22.50
$0.00
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1111 79
S
FEB 24 1003
CITY OF LA QUINTA
FINANCE DEPT.
UB -TOTAL CoNSTRTiC ION AND I I:.AN PHICK,
' 14SM PM -PAID
TOTAL Pki,,OVI T FEES D1J1 NOW
i'''''.4IIIIII1111
RECEIPT
DATE� /1i
,+ l v :...
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
Retum 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 8 Controls
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
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
t, Gas Test
Appliances
Final
COMMENTS:
A'� / 1---0-
•
• ��
,
•
.
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)
'Gilt GePCdrw
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78-495 CALLE TAMPICO — LA QUINTA, CALIFORNIA 92253 - (760) 777-7000
FAX (760) 777-7101
TDD (760) 777-1227
December 10, 1997
Aurellio & Betty Lopez
54-296 Avenida Alvarado
La Quinta, CA., 92253
RE: Addition Permit 9603-018 @ 54-296 Avenida Alvarado
Dear Mr. & Mrs. Lopez
The purpose of this letter is to inform you that your Addition Permit #9603-018, for the project
at 54-296 Avenida Alvarado, has expired. In accordance with 1994 UBC section 106.4.4, no
further work may be performed until a new has been issued.
Please contact Daniel P. Crawford Jr., Building Inspector I, at (760) 777-7012 to obtain any
information you need regarding anew permit and/or any required inspections. Should you
choose not to complete the project, we would then have to pursue any or all of the following
actions:
•`-1) Abatement of the project through the City Attorney's Office and Code Compliance Division.
2) Notice of non -conforming structure placed upon property profile.
3) Action filed with Contractor State License Board. Optional if Owner/Builder.
Please contact us at your earliest convenience prior to 10 working days to resolve this issue, and
for any questions you may have.
Sincerely,
Mark Harold
Building: Safety Mana:-,r
Daniel P. Crawfo d Jr.
Building Inspector I -
cc
•
MAILING ADDRESS - P.O. BOX 1504 - LA QUINTA, CALIFORNIA 92253