SFD (0002-037)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
777-5519 B
Date ° °^ Signature of Contractory6// %4
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).
O I am exempt under.Section B&P.C. for this reason
Date Signatureof 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:
CarrierIe1i�L'Y11"s' M'UIVAI,Y Policy No. WA? D004 .3012TT
(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 sgall f rthwith comply with thosep visions.
date: _ 2 � - .1 ApplicantR 0�.; _�.. ._..
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;
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts s s
Slab Grade
'j
Return Air
Steel
Combustion Air
Roof Deck
,p
Exhaust Fans
O.K. to Wrap
Framingr7
F.A.U. _
Compressor
Vents
Insulation _
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final _ _L_ _
BLOCKWALL APPROVALS
Final
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
Water Piping
i_/ •D _
_
Heater Final
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
_
— I •� 3 _
Final
COMMENTS:
Filial
Utility Notice (Gas) `—
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring 4 10—
Low Voltage Wiring
Fixtures /
Main Service J
Sub Panels c`
Exterior Receptacles Z7_
G.F.I.
Smoke Detectors o
Temp. Use of Power
Final
Utility Notice (Perm) _���
CUSTOM HOMES RICK JOHNSON CONSTRUCTION, INC. TELEPHONE
OFFICES AREA CODE 619
COMMERCIAL BUILDINGS GENERAL CONTRACTOR 564-2228
APARTMENTS P.O. BOX .2288
LIMITED PARTNERSHIPS INDIO, CALIFORNIA 92202
JOINT VENTURES
August 24, 1987
City of La Quinta
Planning Department
ATTN: Wally Nesbitt
Dear Mr. Nesbitt;
..In regards 'to the fencing issue at.77-165 Monterey we here by enclose
a check for $350.00 to cover fencing costs should Gene Schefner fail to install
his fence per verbal agreement and permit application with the two.parties.
This bond agreement good for 60 days should the other party fail to meet his
agreement.
Thank you,
Brian R. Monroe
Planning Administrator
BM/kc 005182 10 6479 08-24-87 12
enclosure i0 CASH i TOTAL 1 350.00