0210-140 (PLBG)U)
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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
AB WC 06W12C
'bate .� � � � t. �Slgnature of Contract -
OWN ER-BLIILDER,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). 1 .. W
( ) 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.
(,C) 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 STAIM FUND Policy No. 044-0201M
(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: r,� 7 w ,� ,Applicant _---
� J�
Warning: Failure to securamwnrkers' 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 arid 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 no�t,commenced within 180 days from date of issuance of such
permit,kor 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.
/r
rSignature (Owner/Agent) ea- ✓''�'C _ .iDate A) �!
BUILDING PERMIT PERMy#
r'
DATE VALUATION LOT TRACT
411215W100 17
JOB SITE lCdiL-e.
ADDRESS CAp6ZR7A
APN
T T.Irt0.14M
OWNER
CONTRACTOR/DESIGNER/EN (NEER
MR. A MRS. JACK Y30CHMACtEL
TRI STAR COXS'fRTJ'MION
51.1 ZO AVE, CARP -MMA MA
r4730 DAT,- PAUL DRIVE
IA Q?Yx"•ij+rfA CA 9225
t:KOXMIRAL C-TrY CA 92235
(71661)321.0598 CIA* 762
USE OF PERMIT
d+k"8'.IC AFS.U.C7t7T9, 385YaR HK2{;}:•tl P (1,f7i4401) FRUi, YLt".'f 244�.
VALUATIOX / 2,SGl.aq 1.3
OF E".Cl.'itGTRUMION
2, ,110
1:'-MjVaTFRE flC,3WNIARY
i�LRIl1 tI3+ICl 3? 103.000.419-000 1.30.00
:: r J"R'C►MON AND PIAW' C' EJF
IMIS PRE-PAS3 �,I
$ 10.00
T91010
OCT 2 X001 4L Prffiffr YKE15XIVE T10
CfiYOFLAQUINTA �
FlNANCE DEPT.
RECEIPT
DATE
h.
•BY
___<1
DATE INALED
INSPECT R
��ry k / t� ?_
_ �(j2—
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 Wali 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:
HAMMER PUMPING INC. JOB INVOICE
P.O. Box 2448
CATHEDRAL CITY, CALIFORNIA 92235-2448
17Cn1 '2an _ 7daa
•.•.• . -.v
• v..� —32--1-7,4,4,-8
(760) 321-7448
DESCRIPTION OF MATERIAL USED
PRICE
CUSTOMER'S ORDER NO.
DAT RDERED
j�- +K-O,L
ORDER TAKEN BY
DATE PROMISED 0 A.M.
0 P.M.
BILL TO �, / y
f dQa
Pumping Fee per 1000 gal. r<
PHONE
ADDRESS
�o
i
METpNIC �
\
CITY -
1660
Dumping Fee per 1000 gal.Out
HELPER
JOB AME AND 40CON
C;N
„ `^A^• ^�+v�
6AY WORK
DESCRIPTION OF WORK
of Area Fee
❑CONTRACT
0 EXTRA
QUANT.
DESCRIPTION OF MATERIAL USED
PRICE
AMOUNT
0400
Gallons
f dQa
Pumping Fee per 1000 gal. r<
c
G •—
?5
�,S`-
�o
i
1660
Dumping Fee per 1000 gal.Out
of Area Fee
Locating / Opening Fee (per hour)
Size System: -1
A SERVICE CHARGE OF $20 WILL BE DUE
ON ALL RETURNED CHECKS.
18% PER YEAR WILL BE CHARGED ON
PAST DUE ACCOUNTS OVER 30 DAYS.
HOURS
LABOR AMOUNT
TOTAL
MATERIALS
MECHANICS Qa
HELPERS Q
TOTAL
LABOR
11¢¢ereby a nowledge thed� q'sf,cto OTA R`%%
cdtnpl tion the above deBcAibed work
TAX
SI ATRE /
`\
DATE COMPLETED
( (Y d �`
TOTALS
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July 18, 1995
_M
.4
78-495 CALLE TAMPICO — LA QUINTA,. CALIFORNIA 92253 (619) 777-7000
FAX (619) 777-7101
To Whom It May Concern:
This letter will confirm that the City of La Quinta Department of Building and Safety records do
_not reflect issuance of a permit/permits for improvements to the garage at 51-120 Avenida'
Carranza. %
The scope of drywall installation and additional electrical circuits would require obtaining permits
and inspection.
Please feel free to contact us should you have additional questions regarding this issue.
Sincerely,
BUILDING AND SAFETY DEPARTMENT
Mark Harold
Building Department Manager
MAILING ADDRESS - P.O. BOX 1504 - LA QUINTA, CALIFORNIA 92253 �..1