BLDG (9908-013)51400 Avenida Martinez
9908-013
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
,41151. C39 10/31P20(
IDate** Signature of Contractor S.
OWNER -BUILDER DECLARATION
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.
( ) 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:
Carrier Policy No.
.TATE I 71INT MI TS4.2SI 9.9
(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,ith comply wit those p ovlsio`ns.
Date: l Applicant,-,,--
Warning:
pplicant - -- `-- - w
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 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
consf'ruction, and hereby authorize representatives of this City to enter upon
tt e above-mentioned property for -inspection purposes.
r Signature (Owner/Agen" ^ ^• ,"`Date
BUILDING PERMIT
DATE mit"VALUATION M5 ,oto LOT
70
PERMIT #
TRACT
JOB SITE
ADDRESS 51-400 AYI,'i EDA MARTINI: APN 771-093-002
OWNER CONTRACTOR/DESIGNER/ENGINEER
Jt' ME' S V 111JU IP -01 J):. PRO:rf?f 111 ItC3Ut'CO.
51 400 AWNIDA NVIJUINEZ &1.597 KIVU SI'.
LA OIANTA CA 11225:; IND10 CA ')2201
Oi4)775 5477 C'13).# 1025
USE OF PERMIT
ORNERA.i., A( Ai.vi U
123_R00- - Cia?vIt*i:.+Si 014 SWNGU5, Wt BUd,T-iiN M FLAT ARE&&
(CLASS `A"'i'kfiLc tlt;tfC?kt'1's
11MAUT UT ih'E rs, S4AMI ARY
RA -Roup Rai 10I-StN-1(i#1 )o 5:0100
iuk-furA-I.t`oNIR,'t`ftlh'-'' ON ANN? a'I,AN CHVC K
1.'F!Z' MV-PliIDPETS"S
T(VI'Al, PKIRR4IT V EE.4t DUE -WAV
RECEIPT I DATE I BY -" I DATE FINALED
INSPECTOR
SX)AXI
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underg-ound Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck _
Exhaus.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 —�,
BLOCKWALL APPROVALS
Final
POOLS - SPAS
steel
Set Hacks
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 Coiner
Sewer Connection
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:
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1 N 0 R P 0 R A 1 f D
September 30, 2002
Building and Safety Dept.
City of La Quinta
78-495 Calle Tampico
La Quinta, CA 92253
Re: Huffman Residence
Dear. Sir or Madam:
I have reviewed.the Huffman residence remodel located at 51-400 Avenida Martinez. I
am satisfied that this structure complies with the structural design as shown on the
approved plans. Please call me if you have any questions.
Sincerely,
(-:)• Vj-
Michael D. Hacker, P.E.
` c No. 55606 -- a
* Exp.'12/31/04
68-487 Highway 111 Suite 43 • Cathedral City, CA 92234 • (760) 202-1800 • Fax (760) 202-8267
engineer@hockerengineedng.com