BLDG (0306-045)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
U1015 /31../2(
Date '1 '' 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
Code).
() I am exempt under Section B&P.C. for this reason
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION
k
I hereby affirm under penalty of perjury one of theAbllowing declarations:
( ) I have and will maintain a certificate of consent Wself-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:
Carver b"1Rwi' IT Policy No. 1-943 W271%2.201
(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.
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
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) w Date i(
' h �
• .'BUILDING PERIAIT6' PERMIT#
DATE VALUATION LOT-�� TRACT
JOB SITE APN
ADDRESS
OWNER
CONTRACTOR / DESIGNER/ EN61NEER
YiMtl
tMiTILE VL4I y t INC
5 2-7 90 AW.241DA rlA"U•AIUFtQ
74• Pic?• AUNAWM DAY Erik
LAQLINTA OA 92253
BEAMt DA,M)NES CA ')12 1
(760)200-0811 (i'W,4 1420
USE OF PERMIT
VALUATION UA TIN U
PERM Er YCE SITWA&P-N.,
r�
1NAND p1mCIE-C&
03 Now
Ctrl'
Fit:. r` T
�r
RECEIPT
DATE, j ,
I_ /-
BY /' -,. :�
D FINA E
INSPE
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 8 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 I I
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:
-
FROM : LA QUINTA REAL ESTATE PHONE NO. : 760 56443213 Apr. 21 2003 12:41PM P1
Sant By: KEL:EY GRAPHICS ; 7604345630; May -21-03 12:11PM; Page 213
FA propaeal submitted to: SHARON BAGL.EY
Mtllham Address; P.O. BOX 232103 ENCiNITTAS, CA
!Jeb Addeess: $2790 AVE, NAVARRO LA QUiNTA,
Phone: KEN AT LA QMNTA REALTY 760.5"42 1 a
T)ascription of Work to Be Pen%rnte d:
OBTA[N ALL REQUIRED CITY PFRMTTS,
RIMOVE EXi'STWO ROW AND 0100M.
P.O. BOX 11257 PALM IDLSMT. CA 92255
MOM 7W -2M41811 FAX 71(0-2W-080
9223
CA 92253
NAIL. ONE LAYER 15# SHINGLE L NIR TQ CLEAN SURFACE.
MSTAL.L NEW SHF.ETMETAL AT AM ROOF TO WALL TRANrS1T ONS. I
INSTALL 30 YL%R SHMOLES TO MANUFACTURES SPECMCATIONS. i
C IAN 108 SITE TO OWNER STANDARDS. !I
1F NOT ACCEPTED IN -30 DAYS rM PROPOSAL IS NULL. AIND VO>D
N01es; in raping VA& 1ltttluauy oAndwft. 1, Tbjs aww tev does Oct cover m ownage t0 the jaw," atlr oxtcrfar
an whkh rho *+varus appii:d or dump to my eea=ta gunin ride guannicc do= not oover dmnage to roof due
to any cine beyond oar control, inellidiv& but not likened to: f9ro, lid windstoem, hwistOniL +mt =M* or
W=aqui1aMM14 %t traffic on root, skudmi fM*or Addatsea% awkins cralbafathue dthe rod deck, wails
or fattodation vP thea building on which Ilfe radii apptiod, 2. MMW it boommo 1>aaoowq for 11ic svnofing
cxu x1=00 to nr'oww tan Vw rcm t U a W amte>aon, coating or buUM appliat" or odisw eguipmeat whdher or
to an add Acud charge is made for susb walk tlto c=Usnvr mx1mmumis tbat ncda Roof Tile Speciatty nor tine
1n"Jor ataa5umm err!' napow1bik for the pedxma= of said equilmm;, 3, Roof 7* SpecWty does nnf. assume
any rasiwo for for eorre ftm of camarng co& violations or fbr the apair of any cxistittg defects unless
specified in oi&w o sad p posal-
Tofnl Cost: 54,460.00 Tena pied on vom on u-1 m ctberWu a ndfied iu the vonbvd. If not
axopwcc in they days thio ptvposttl is myelic. X133 S33_oo per &itto ofrplywood if need.
Aacoptan=-. You are hereby autimrixM to Mmish all coat= w itenIn tfteft cottttaat t0 aoMOM walk Movoncd
is ft pmpow eoakea fw vA&h thio agree to pay the m anti t muwoaod, its sfdd pmpoud, cad a000ttliag to
textus glts'oof. . (Initial). If leakage, ca-miod by dofoeh in ww uansh!A oscura witbdn FIVE years
fd+0slt 4711* of sip IGMien, we will repair it fuse 0(dMr-
inuflatloa. it is 7 d that by the aucc&= dd is pmpusal rou aullmi- Raof Tile SPOdS ty to maim the
iwAxtion; to lsmre vAA order wish alwifigltiwo ul own lwtvia and to pity aur charge for sucb irtstaltnlfoa. You
a5= m 17sy the amount & gmmfitd Dec= which wW cavae ft prlcc of sold t McMalfl Bad labor cl ffp. This
cahmift is based an a. compute; job and Arty sMius nu%W remains p>7vpetty of hoof THo Specialty. Veftl
ur4cnwn& R and zFmumnts with reprse"ivos shalt not be binding unless set fbeh harem. 7fteto shall be rte
liabifid a tier &clays in, at (Wme to dompW deliver or installation Of till or sny of the hi meadooad
mcrctltq &w, ddw to Sae, "am *w, govo" M ttrulkitMm or aq naso beyond our owtirt7ol. Arty chamm
,Dad:, by you ir1 epdat�tions h7mein, ne=ftsilpg adffltiotsaf wateri„* er labor dug tdet be fndudeti or covcmd
by this p mpmal, bun &hall be pwided for encu now*@ and aftdionai cedar from You, —,,,• ( Initial).
ArdhrXioa of OiepatoM: AzW eoabraversy' or claim out of of rabft to (ilia ann"ek or the hmm t. tbdmr,
sball be sate d by a bbralor in nocordwKe with the applicable CottttstlndM bubb-11y Atbit+tt=Rut= of the
Anwdccm A*bit*tttien Amociatiea Which are ie dl7bd at ik time ft dearer, for albitl Um is liked A jukigt:•mant
upnn the award ranched by the xt uratw(s) may be enumd m court haiV" jw 10coon diaeat'. Any mbftratioa
,sward rlDnfl be subjoat 7o covtcUon =00pr Vasaiiorr rw 1674 MEOW Mucd is the nGdc Of civil. pluardun- The
ffibitart0�i�n &tap1189vard reasor8ble atbxr►eys Iona cad bA lass prevailing pointy. Mier bcitrb gvcn duc
nutic e, sbd =W pay flail to appear tit or participate is ibo arbite W p oc=dil A the athittamf dull nu*,u an
award based upon tbo evidence prweajed by the paty(im) who do (dem) appear sed psr;ioyntt. Notadthstalutmg
c wn=ces risf t to ala=&. aartuncw does am vAM aay of fes 10 ri lft In ft wcw Of aeftwt by cifcm m
Qeysmftift e£dse dtuaC� ellmSt aglow to M eeatsor:abla assmtte9a' t ee'e tlatdacst itssvwaai} to
corut=jon with cones d= of said amounU whether or= 1#llt is AliA, i .5%pit' !n0Qlh amdlod Au 80auai
peruezukgc of 183!10,4 will be cl>atged on sill past due amurft. Coesra w's art r+equhvd by lase ao be Ifioeased and
mplatod by ft Coe arrow $alta Bored AW 4=600 oonoarreafl a cotthaebr may be rCi'effM m the fexiul�r Or