The URL can be used to link to this page

PLBG (0011-032)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 4.221.55 13 W ,Date Z -A, ^ 1-) Signature of ContractorTi X_�f� 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. AMERICKH ZURICH (This section need not be completed if the permit valuation is for $100.00 or less). ( ) I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor .Code, I shall forthwith comply with those provisions. Date: / Applicant a' J�e�$..,a �� •. .��s4 /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 construction, and hereby autho.ize representatives of this City to enter upon the above-mentioned property for inspection purposes. Signature (Owner/Agent) i't'g. L! _,g d Date r BUILDING PERMIT PERMTk DATE VALUATION LOTxs-tr TRACT U106WX JOB SITE APN ADDRESS gypDA y rysy OWNER CONTRACTOR / DESIGNER / ENGINEER RW."FAIRWIMAMONS R(YM RQCi r PAT 24DESERT CA 92260 3ENFIF CA 92543 ;i 5! •RS�II t;i;;7 3.060 USE OF PERMIT PLUMBING ;SEPTIC TANK ABANOGINAMN'T SlIt'W&P HOO -1UP "VALUATION U9 PFIRMCFER SMOINRY PLUMPILTNO M It- SEWER 101 -000-419,0010 $30,00 C.iD-')`:�C01lir `E�UC°I,ION AND ;PLAN CB $30.00 IM PR PAID.P793 $0,00 RECEIPT DATE ` �)) r 1 fir, �r•�n BYDATE :fin � s:, FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS . MECHANICAL APPROVALS Set Backs Underground Ducts Forms & 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 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 '—Q n Gas Piping Encapsulation Gas Test Appliances Final Final Utility Notice (Gas) .Z9' Q 5� 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: I 0 'Tz):-malQ�q7 �j'Tn: Mo�i� COACKE" VAUD MATER OWNCr CUM RI MPI DRAIL 112 '62-110 0A er N A r R 9 6 V% Us v T- ro- 2 ro-7 3 W W,',v �- Armupt 5arMlaaAddltbof_"o.IsJCL�dre�� 4A Goo Mau" Uftw(*) % ~Mod Accalm-Mangy - FN- Z: tion Cho" Fat vftlol I often - Tifts- P"R%M - ka. - sans TOTAL 0 q;a 5% I A - or 1 \-, c- � � a- a � s s- CfTY OF LA QUINF--'. BUILDING & SAFETY DEF'; APPROVED FOR CONSTRUCTION DATE 4 -11 -66 -MO— By 4 P.O. BOX 1504 No. 15100 Buildin'g78-495 CALLE TAMPICO Address 51-966 Ave • Mendoza LA QUINTA, CALIFORNIA 92253 Mailing Address BARIC City Zip Tel. .1,6 .Quznta i, CA 92253 Contractor ress . . . . . . City lZio State Lic. I City & Classif. Lic. # -Arch., Engr., Designer Address Tel. City Zip State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) tot Division 3 of the Business and Professions Code, and my license is in full.force and effec: 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, after, Improve, demolish, or repair any structure, prior to its issuance also. requires the applicant for such permit to rile 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 rive hundred dollars ($500). ❑ 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. ff, however, the building or improvement is sold within one year or completion, the owner -builder will have the burden of proving that he did not build or improve for the purpose of sale.) W.1, 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 or property who builds or improves thereon, and who contracts for such projects with a contractor(s) (kensed pursuant to the Contractor's License Law.) - ❑ 1 am exempt under Sec. ` B. & P.C. for this reason fhl.e I_Z fV) Owner II,' .A,- E�k 17 WORKERS' COMPENSATION DECLARATION I 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. 3900, Labor Code.) Policy No. Company O Copy is filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed ff 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 parson in any manner so as to become subject to the Workers' Compensation Laws of California. Date Owner NOTICE TO APPLICANT: ff, after making this Certificate of Exemption you should become subject to the Workers' Compensation provisions or the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS. ($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. '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 agreeto comply with all city and county ordinances and state laws relating to building construction, and hereby authorize. representatives -of, this city to enter the above-. mentioned property for Inspection purposes. Signature of applicant Date Mailing Address City, State, Zip BUILDING: TYPE CONST. OCC. GRP. A.P. Number Legal Description Project Description sever Connect Sq. Ft. No. No. Dw. Size Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ -Demolition ❑ Estimated Valuation 411000.00 PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing 3Q.00 S.M.I. Grading Driveway Enc. Infrastructure TOTAL 3Q • 00 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: APR 2 8 1" CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBINU FEES 1ST FL. SO. FT. @ $ UNITS �. 2ND FL. SO. FT. BONDING YARD SPKLR SYSTEM POR. SO. FT. @ MOBILEHOME SVC. BAR SINK „ GAR. SO. FT. ® POWER OUTLET ROOF DRAINS CARP. SO. FT. GAS (ROUGH) DRAINAGE PIPING WALL SO. FT. @ OTHER APPJECUIP. DRINKING FOUNTAIN s SO. FT. @ TEMP. POLE URINAL ESTIMATED CONSTRUCTION VALUATION $ GROUT WATER PIPING NOTE: Not to be used as property tax valuation FINAL INSP. FLOOR DRAIN MECHANICAL FEES WATER. SYSTEM WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER FINAL INSP. GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRY TRAY AIR HANDLING UNIT CFM KITCHEN SINK ABSORPTION SYSTEM B.T.U. TEMP USE PERMIT SVC WATER CLOSET' COMPRESSOR HP POLE, TEM/PERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SO. FT. @ c BATH TUB SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID t@ 11A C SEWAGE DISPOSAL GAR. FIREWALL SO.FT.GAR ® 3/ic HOUSE SEWER LATHING 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 SETBACK GROUND PLUMBING UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE 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 APPJECUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER. SYSTEM GRADING cu. yd. $ plus x$ _$ LUMBER GR. FINAL INSP. FRAMING FINAL INSP. ROOFING REMARKS: VENTILATION FIRE ZONE ROOFING ' FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS GARDEN WALL FINAL i• a(8+�y j t .j APR-28-'95 FRI 16:42 ID: TEL NO: # DIXIE,,;, ESCROW COMPANY INC. I, Catherine Hammons, the undersigned hereby give my authorization for Richard Hammons to sign the permite. Thank you very much! Cath ne H ons h s. a <fi t'1 e d \ (6 19) 508 521 FAX (''19) 568.628'3 - 43.645 N4(DNTEREI' AVE, SUITE A, P.O. DRAWER 387k PALM DESE a Yi COACHELLA VALLEY WATER DISTRICT i CASH RECEIPT DETAIL Receered From:14 Address: -JZ 3S CCM i i DaleL4- 9�" , .f Account Nd.(��l.J , Lot(s) Tract Service Address. � [— �(_nl1�iy�/�•�� ❑ Meter(s) G.A. Code r r] Service(s) $ I 1 ❑ Backflow(s) (I ❑ House Lateral(s) I ❑ Detector Check(s) }t ❑ Mater Surcharge B Sen". lion Capacity Charge - l9J� ❑ ws.B.F.c. �_ C, . ❑ Temporary Construction Meter ❑ Tum on Charge �— ❑ Uncollected Account - Name �— ❑ Inspection Fee- Tract—�— Fee - , ❑ Plan Check Fees Water I Sewer�— Tract - ❑ Bond Payment - A.D. - Bond Assmt. ' ❑ customer Deposit —�— ❑ Otper Remarks: �� 1, t n� r� l t 1'�i r 1�. YlQ L _ .TOTAL U q ❑Copy to: - Cash cneck / 3 wale service �,, Money ./ i 1 to L Cashle Order _ 78-495 CALLE TAMPICO — LA QUINTA, CALIFORNIA 92253 – (760) 777-7000 FAX (760) 777-7101 TDD (760) 777-1227 December 19, 1997 Cathrine Hammons 51-960 Avenida Mendoza La Quinta, CA., 92253 RE: Sewer Permit #15100 Dear Mrs; Hammons _ The purpose of this letter is to inform you that your Sewer Permit #15100, for the project at 51-960 Avenida Mendoza, 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 a new 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 aniel P. Crawfor Jr Building Inspector I cc: file dpc MAILING ADDRESS - P.O. BOX 1504 - LA OUINTA, CALIFORNIA 92253 ��