9804-002 (RPL)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
L~-- Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
CSI W ^ Professionals Code, and my License is in full force and effect.
O =) M License # Lic. Class Exp. Date
I-- (1 LOZat
r %�'?` fi. C -S C^ ! 49 3Z r— �/ / Y Signature of Contractor/
C� O
JI.—
C) OWNER -BUILDER DECLARATION
W W I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ d License Law for the following reason:
Z( ) 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).
Co (). I am exempt under Section , B&P.C. for this reason
LO
O N Date Signature of Owner
rn
L)< WORKER'S COMPENSATION DECLARATION
p z01 1 hereby affirm under penalty of perjury one of the following declarations:
U') ~ O ( ) I have and will maintain a certificate of consent to self -insure for workers'
X W u- compensation, as provided for by Section 3700 of the Labor Code, for the
O J Q performance of the work for which this permit is issued.
m Q IJ ( ) I have and will maintain workers' compensation insurance, as required by
O U Q Section 3700 of the Labor Code, for the performance of the work for which this
Il a Z permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
ob Z)
d STATFFt.WD aha -97400,031
J(This section need not be completed if the permit valuation is for $100.00 or ess).
( ) 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
3 subject.to the workers' compensation provisions of Section 3700 of the Labor
Code, IS dill forthwith comply with those provisions.
� /, O' Applicant ./*',, �...�-;A'-
Warnind: 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 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.
1 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
'con'struction, and'hereby authorize representatives of this City to enter upon
tJje above-mentioned property for inspection purposes.,
/Signature (Owner/Agent)"�/fl t �� 'Date—/ P31
p v
BUILDING PERMIT
DATE VALUATION LOT
JOB SITE
ADDRESS
OWNER
PERMIT #
CONTROL#
94304-002 TRACT 8751
APN
CONTRACTOR/DESIGNER/ENGINEER
LOWE,LL & ADRIENNE SIGMUND 0.11. POOL CONSTRUM 10N
52'310 AN E141 MONTEZUM.A 68-465 PEREd RD.
LA. QUINT.A CA 92253 CATHEDRAL CITY CA. 92234
(760)328-2681 CBL# 69
USE OF PERMIT
POOL ONLY; ALARMS/DARRIM. S ARE TO 8E OPERA`I'fONAL PRIOR TO
EN-CAP/PRE-PLA,5TER INSPECTION PAI
POOL AMIOR SPA.
9,800.m) I's
CITY O
SUk340TAL CONSTRUCITON _AND PLAN CHECK
LESS PRE -PAID
TOTAL PERMIT FEES DUE NOW
LA QUINTA
RECEIPT I DATE BY; �� DATE FINALED INSPECTOR
Kii`.1 tis
$0.00
5.1439.05
s
"TIMATE, D C09f Ole CON=i.iltC1C'Q IUN
PERMIT FEE SUMMARY
PLAN CHECK .FEE
101-000-439-31.8
$76,05
CONSTRUCTIONFM
101-000-41&000.
$117.00
MECHANICAL F R -- POOL
101-000-421-004
=.00
E ECTKICAL.FEE — FOOL
101-000.420-DOO
&15.00
PLLTM8IN0 FEE -- POOL
101-000419-000
, $-.7.00
SUk340TAL CONSTRUCITON _AND PLAN CHECK
LESS PRE -PAID
TOTAL PERMIT FEES DUE NOW
LA QUINTA
RECEIPT I DATE BY; �� DATE FINALED INSPECTOR
Kii`.1 tis
$0.00
5.1439.05
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR'
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms 8 Footings
Ducts
Slab Grade
Return 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 & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric ZIP 112 1
Underground Plbg. Test
Final
If 2
PLUMBING APPROVALS
Ga�Tt
c final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
Final
-
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)
COMMENTS:
4
CITY OF LA QUIN T -A
BUILDING. & SAFETY DEPARTMENT
CONDITIONALLY
ACCEPTED FOR CONST' . f : ON
SUBJECT TO INSTALLATION AS; OER
AND LL PPLICABLE COD
BY
V
91
PREPARED 7/23/07, 9:21:48 CASE HISTORY REPORT
PAGE 1
tROGRAM A--E200L CASE NUMBER 07-00003148
CITY OF LA QUINTA
-- — ------- —----------------------------------- — —--------------- "------------------
CASE TYPE DATE ESTBL
-----________-----
STATUS
-- -- -- --------------------
STATUS DATE
APN
ADDRESS INSPECTOR
TENANT NAME
TENANT NBR
-------------------"`-------------------------------•-------------------
Property Maintenance 6/26/07
------------
Active
_ -
6/26/07
773-241-001-1 -000000-
52210 AVENIDA MONTEZUMA Kevin Meredith
Lowell Sigmud/Adrienne Erlick
LA QUINTA CA 92253
CASE DATA: Parcel Number 773-241-001
Inspector Phone Number 777-7017
Admin Citation Number
Hazardous Condition LQMC
LQMC TEXT
Hearing Date
Violation Number
Violation Number 2
Violation Number 3
Violation Name
Violation Name 2
Violation Name 3
Fine
Fine 2
Fine 3
Total
Location of Violation
NOPN date
NARRATIVE: June 26, 2007 10:03:21 AM mrodarte
6/26/07
Project area inspection found trash container in the
6/26/07
street. Also found fireplace built on wall
6/26/07
July 9, 2007 4:20:41 PM jmisurac
7/09/07
Officer Meredith posted a 10 day notice for the unpermitted
7/09/07_
fireplace and trash container at the property.
7/09/07
July 23, 2007 8:52:37 AM amoreno
7/23/07
Mr. Lowell Sigmund 564-8315 came in with a Warning Notice
7/23/07
earlier in the week issued by Officer Meredith on a
7/23/07
fireplace/chimney constructed on the Calle Sonora side of
7/23/07
the property in the exterior side yard setback. It appears
7/23/07
the outdoor fireplace was referenced on the swimming pool
7/23/07
plans approved on 4/2/1998. The case was reviewed with Deby
7/23/07
Conrad. She agreed to have Mr. Hartung review the case for
7/23/07
direction. I took the case to Mr. Hartung and he gav&
7/23/07
n to a the a
d�ma
7/23/07
fire lace. The owner and officer were advised we
7/23/07
ot be pursuing the removal of the chimney. A copy
7/23/07
of this case history report entry was saved to the address
7/23/07
file and a complete case history report with this entry was
7/23/07
highlighted and placed in the Paper building file.
7/23/07
NOTICE NAMES: LOWELL SIGMUND OWNER
ADRIENNE SIGMUND ERLICK Co -Owner
HISTORY: SCHEDULED ACTION STATUS RESULTED INSPECTOR
TIME
6/26/07 First Inspection COMPLETED 6/26/07 Kevin Meredith .25
PREPARED 7/23/07, 9:21:48
CASE HISTORY
REPORT
CODE STATUS
PAGE 2
RROGRAM-.E200L
6.04.065 (A)
CASE NUMBER 07-00003148
CONTAINER STORAGE
Active/Founded
CITY OF LA QUINTA
6/26/07
8.01.060 General
CASE TYPE
PERMIT REQUIRED
DATE ESTBL
STATUS
STATUS DATE
APN
6/28/07
9.60.045 (B)
1
BBQ/FIREPLACE&STRUCTURES
ADDRESS
INSPECTOR
TENANT
NAME TENANT
NBR
------'__ `--_-----^-----`_
Property Maintenance
--------------------------------------------------------------------------------------------------------
6/26/07
Active
6/26/07
773-241-001-1 -000000-
52210 AVENIDA MONTEZUMA
Kevin
Meredith
Lowell
Sigmud/Adrienne Erlick
LA QUINTA CA
92253
HISTORY: SCHEDULED
ACTION
STATUS
RESULTED
INSPECTOR
TIME
7/09/07
Reinspection
COMPLETED
7/09/07
Kevin Meredith
.50
RSLT TEXT: July 9, 2007
4:22:01 PM jmisurac
7/09/07
7/23/07
Reinspection
SCHEDULED
Kevin Meredith
Notice of Violation
PENDING
Reinspection
PENDING
Notice of Public Nuisance
PENDING
Reinspection
PENDING
Final Notice
PENDING
Reinspection
PENDING
Administrative Citation
PENDING
Phone/Counter Contact
PENDING
Dangerous Building Notice
PENDING
Court Appearance
PENDING
Close case
PENDING
TOTAL TIME:
VIOLATIONS: DATE
DESCRIPTION
QTY
CODE STATUS
,
6/26/07
6.04.065 (A)
1
CONTAINER STORAGE
Active/Founded
LOCATION: ON STREET
6/26/07
8.01.060 General
1
PERMIT REQUIRED
Active/Founded
LOCATION: AGAINST WALL
_
6/28/07
9.60.045 (B)
1
BBQ/FIREPLACE&STRUCTURES
Active/Founded
LOCATION: AGAINST THE WAL
75
RESOLVED
i6z:
06/26/ZU@A-