9611-077 (BLDG)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
r#h s9 �L)ic.. Class Exp. Date [}
1-115-7
/97
ate fF 24— 6 Signature of Contractor
OWNER -BUILDER D&LARATION
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.
V I have and will maintain workers' compensation insurance, as required by
Sebtion 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.
(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 shall forthwith comply with those provisions
\/ate: to 2 Applicant �' ` '° •�"�
Warning: Failure to secure Worker=§''"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 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 authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
/ignature (Owner/Agent)„ -6 M Datet
BUILDING PERMIT PERMIT# CONTROL#
G PERMIT
4372
LOT TRACT
DATE 11 /2'V'36 VALUATION S7,7.64.90
JOB SITE
ADDRESS 52090 AtLfIDA MONyMINIA
APN
773-201-0”
OWNER
CONTRACTOR/DESIGNER/ENGINEER
RICH.ARD.J..FWileiii
ls2 if lti b. CO".tMUc:!•'lONN A
32090 AV NiDA mgt\PrEwMA
08-385 VERANO T40AD
LA Oi1Ct I'A C.A. F),2 SI
Ct!'INIFr[AAL CAN CA 927,34
(61_M28-9399
USE OF PERMIT
i,.aiTNtiRM, Kli
143 SIT. I'ti�f41 6il��)tfCIC>.�t
.ills ITTOtd 143.00 W
7,704.90
11, AN 04FCK, l- 1' %4.35
r~1:11.f1'r°(7[tC'flfiiNt:Rt !►t.,(14}t141•()(}Q $sj�i.tu3
�u:�;l�ti",btc./i�, r'�s_ .1�1t-QiiU-•i°�1"quo �1�.��
"►.1 C"i'ieit,t�lRalts sfit-i U -/i24 -CC! it $11.86
S'1'0NO W)TION FFF - RRS]U it)t-tlUf?-241-000
' tiiitittr"t"lC;tN AN:#) P! Ji`N CfJ3:;C''X
$l9 90
D
NOV 2 5 1996
$1rK►3+i
RECEIPT
DATE
BY/
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs A
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck / G
Exhaust Fans
O.K to Wrap
F.A.U.
Framing 9All,
Compressor
Insulation
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
POOLS - SPAS
LOCKWALL 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 Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
78-495 CALLE TAMPICO — LA QUINTA, CALIFORNIA 92253 - (760) 777-7000
OF ��o FAX (760) 777-7101
TDD (760) 777-1227
December 19,4997 -
Richard J Frank
52-090 Avenida Montezuma
La Quinta, CA., 92253.
RE: Building Permit #9611-077
,�-:-.Dear T✓1a-::Frank- - __ _
The purpose of this letter is to inform you that your Building Permit #96117077, for the project
at 52-090 Avenida Montezuma, has expired. In accordance with 1994 UBC section 106.4.4, no
further work may be performed until a new permit 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 M
Buildi g & Safety Mana r
Daniel P. Crawfor Jr.
- Building Inspector I
M file ,.
dpc .
4
MAILING ADDRESS - P.O. BOX'1504 - LA QUINTA, CALIFORNIA 92253 ��
r i
Building 0
90
Address
Owner
N
Address I b 19 b yC % 6
City Zip Tel.
Contractor ^�
-J� M
Address f f
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
firC' y Zip Tel.
) Ci 1y 9/g
oy a13 9s6 31S.
State Lic.q City
& Classif. Lic. #a s3
Arch., Engr., �7
Designer -);:A A IV
Address Tel.
// 41/ `I 54 Lki C-a,a s f I 340 i 1 14
CitZi State
PGS 7, ZZsv Lic. III
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's -License Law for the following
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to file a signed statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis
for. the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
17 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, Buisness and
Professions Code:The Contractor's License Law does not apply to an owner of property who
builds or improves thereon and who does such work himself or through his own employees,
provided that such improvements are not intended or offered for sale. If, however, the building
or improvement is sold within one year of completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose of sale.)
I l I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner of property who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
17 1 am exempt under Sec. R P.C. for fh s eason
Date Owner
r�
WORKERS' COMPENSATION DECLARATION
hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of thg 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.
Date Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
Ihereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives sof this city to enter the above-
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
BUILDING DIVISION
BUILDING: TYPE CONST. V N OCC. GARP.
A.P. Number %7.3 Sol j!J0 O
Legal Description—5 F R .
Project Description _2 lrtU
ZONE:
BY:
Minimum Setback
Distances:
Sq. Ft. p6 No. /
Size �O �7 Stories
No. Dw./
Units
NeWK Add ❑ Alter ❑
Repair ❑ Demolition ❑
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE
INSPECTOR
Issued by:
Date Permit
Validated by:
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
O (,h Ax 4,(,
Mech.
j J
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
ZONE:
BY:
Minimum Setback
Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE
INSPECTOR
Issued by:
Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO, ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. @ $
2ND FL. SQ. FT. @
POR.SQ. FT. Cu
GAR. SQ. FT. @
CAR P. SD. FT. @
WALL SO. FT. @
SO. FT. @
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC..
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
VV
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FOUND. REINF.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
ABSORPTION SYSTEM. B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE, TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT, @ c
BATH TUB
SQ. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID @ 1V. c
SEWAGE DISPOSAL
=$
SO.FT.GAR @ ?Ac
HOUSE SEWER
FINAL INSP.
FRAMING
FINAL INSP.
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST, FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACKGROUND
It
PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
VV
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE [ 1
U
a
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM /` 3e1/{�
WATER SYSTEM
GRADING
cu, yd.
$ plus xb
=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
/
CERT. OCC.
FENCE FINAL
1VM0Q1U-UnC 11'1111HLJ
GARDEN WALL FINAL