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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
Date Signature of Contractor
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
r() I a axe pt. under Section B&P., for this_ r�}Ason
Date 14100 Signature of Owner�
ti
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.
(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
�Cocle, I shall forthwith comply with those provisions.
K. Applicant
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 authorize representatives of this City` to enter upon
i thh Bove -mentioned property for inspection purposes.
+'signature (Owner/Agent)` i`"•�+
Dat.,5i--
%0
J'1-00 'BUILDING PERMIT PERMIT#
DATE VALUATION LOT, 2-5,3TRACT
JOB SITE ^i/
APN
ADDRESS si_= Avjv®A
A
.NAVIAAO
S
OWNER
CONTRACTOR/DESIGNER/EN (NEER
MAhTtii<;f� itgt9i�ii'��3�tIkO 1,
t' �" 2�i3i7t 3EEt
51-A00 A MAH.ASiARR0
51 •�00 AAM41DANAVARRO
LAQUINrA CA X2253
sAQt>I rA ; CA 92233
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CBL#
USE OF PERMIT
Sb7']C ABA?dLKI]dMENT. SMER Cf3P NECT
3 !
xt�
VALUATION S+Ja.aa LS
"
AMWX= LOST OF CONS"Tli UCiTON .
SIMAD
PLUM) Frmi. 101.000-19.000 �3t1.aa
BOB T01 AT, C 01,M. UC ION AND PLA9 C FMCK
$30.00
LESS -PAD FE.
$0.00
TOTAL IYIMKTT MEN DUE NOW
=100
RECEIPT
DATEB
DATE 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
0. 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 - —
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:
1 s i ? ti �'� E i , cc s r'' ar •� ..�.
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•j,44 �
p T E/j EST 4LISHED IN 1918 AS A PUBLIC AGENCY
ADISTRIO
GUCKELLA VALLEY VIM ,. ISTRICT
POST OFFICE BOX 1058 • COACHELLA, CALIFORNIA 92236 • TELEPHONE (760) 398-2651 '
OFFICERS
DIRECTORS Y•.
TELLIS CODEKAS, PRESIDENT l THOMAS E.LEVY,GENERALMANAGER•CHIEF ENGINEER ,e '
r l Z i' BERt.,ARr.>)NE SUTTON, SECRETARY,
RAYMOND R. RUMMONDS, VICE PRESIDENT a Y ' < OWEN McC K. ASSISTANT GENERAL MANAGER r
JOHN W. MCFADDENy 4 a. •� REDV�NEANDSHERRILY,ATTORNEYS r q
DOROTHY M. NiCHOLS A
THEODORE J. FISH r' May 3, 2000 -- )
File-' 077
_
Sylvia Rubio-
31-380' San Ysidro Avenue
Cathedral City California~ 92234
Dear Ms. Rubio: N
Subject: Account No..0606014,811.0.6
51-800 Avenida Navarro. La Quints
On April 27, a field investigation was "completed verifying that the property N
described above is connected to the district's sewer system.*
In researching our records, we founds his property.has'.not met the snwea a
requirements of the district. The
d��' ri.ct has 'no record of receiving
i J
(petition or the p:y(i nt;of sewn fees for.,thiskpl! Erty' t r
signed annexation , ti .c.,.• , {
i , wtei.4 h'•b�o-Uld• autt%of-ine connection to tY� sewer system. 1 R_
f
' You are charged the .prevail ing,sanitation: capacity chargeinaccordance with
district's current, regulations for,-equivalent dwelling units. The sanitation
1 T p a uivalent dwelling unit. We ate
capacity charge is;cur.rently $-,.925 er q _
enclosing Invoice No. 14569 in the amount of $1,925. •A petition for Y,x
annexation is also enclosed which requ res the si
gnatures of.all owners of the
above-described property. '
Receipt of the signed (Do Not Print) p, ition for sewer service and the above
continue seer service. Your attention to this
amount will be required to
matter within 45 days ,Of the- ante Of t .s. letter mill prevent any
inconvenience due to sewer service int�rrurtion. �
If you have any questions please con' act Jude Frazier, water service
representative, at (760) 398-2661, extension 467.
Yours very truly,
� R 1
Tom Levy
}.
d.teneral tanager-Cl: ief Engineer
JLF:jf
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l DA:i i DESCRIPTION AMOUNT
5/01/00 SUE+_ EC I ACCOUNT M - 606014 9 el l .0.6 .•
51--800 AVEMT+s'a 14rtVAm�0, {_A CSU tN A
SAWI:TATION1 CAPACITY C TARGE= ti
1.0 E411.,U. X $1.-9251100 1s925o00 `.
CCs J J r 'r
!!VOICE: IS DUE AND PAYAPL..E Ui='Oi\t !rEcETF•'T
JF Y TG '/� N `
J '' .x " -PAY THIS ��MOtlNT . 4 11 t 925. 00
MAY Q.52000', ' K x r ۥ
LLAT C'JA H E VALLEY
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COACHELLA VALLEY WATER DISTRICT P.O. BOX 1058 • COACHELLA, CALIFORNIA 92236 #
INVOICE-NO. _14569. i
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