0008-399 (BLCK)LICENSED CONTRACTOR DECLARATION
U) I hereby affirm under penalty of perjury that I am licensed under provisions of
I—_ CpChapter 9 (commencing with Section 7000) of Division 3 of the Business and
04 W ` Professionals Code, and my License is in full force and effect.
License# Lic. Class, Exp. Date '
Q� 04981
7 �? I' f
rI W 6.34981 B 01; :i 1 2
I,- Date • Signature of Contractor " = '•�-
c(0 O "
J U C OWNER -BUILDER DECLARATION
W w r- I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ Il License Law for the following reason:
Z ; ( ) 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
Or N ` Date Signature of Owner
rn
d< WORKER'S COMPENSATION DECLARATION
C) Ir I hereby affirm under penalty of perjury one of the following declarations:
U-) FZ O () 1 have and will maintain a certificate of consent to self -insure for workers'
X W �= compensation, as provided for by Section 3700 of the Labor Code, for the
O J Q performance of the work for which this permit is issued.
m Q C) ( ) I have and will maintain workers' compensation insurance, as required by
O 0 Q Section 3700 of the Labor Code, for the performance of the work for which this
li a) Z permit is issued. My workers' compensation insurance carrier & policy no. are:
oo 5 Carrier STATE FUND Policy No. 154293740
r- 0
Q (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°thoseprovisions.
Date: 21 ,%2(2 Applicant _ -V %a~ i ,.o-4- --.:
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,6f this City to enter upon
1the above-mentioned property for inspection purposes.
\ Signature (Owner/Agent) }1'� -4� f Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT OON-399 TRACT
JOB SITE
ADDRESS 151-2Q AVS ND As CiARRV.ARZ A
APN �. .,"..
-
OWNER
CONTRACTOR / DESIGNER / ENGINEER
BOB KInLOG
CaRol EL COIF ErrRUC ION
LA QUfNTA CA 92253
(760)5644604 10BIR 7261
USE OF PERMIT
0TWERA.L BUILDWO
160 L.F 541 C1.AFLDEN WALL OkC O STANT)ARD ONLY
5 Fid', WALL 160.00 LF
V T OdATIfD COM7 0I0 C{sNS'dl u om
3,464.010
,PERbff M gUr"ARY
6" MSTRUCTJON FEE 101.0(* -416.000 �63.0R
o,
v`J
e�t
WB-11MAL CONSTRUCTION AWL" PLAX CH1.0C
$63.00
MaD FR&PPW IMS
$0,00
it
RECEIPT
DATE
B ` DATE FINALED
INSPECTOR
L
y�.
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
Final ��g B� S�
Underground Plbg. Test
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:
CARLOS ELIAS
REGISTERED CIVIL ENGINEER
38825 Charlesworth Drive
Cathedral City, California 92234
Telephone (760) 328-7271
January 10, 2000
City, of La Quinta
Department of Building & Safety
78495 Calle Tampico
La Qu i nta , . Ca 1 i'f . 92253
Gentlemen:
This letter concerns th.e residences to be constructed at
51240 Avenida Carranza and 52510 Avenida Juarez, La Quinta,
California.
I have reviewed the layout and�bear g poi
y g points of the
roof trusses designed by t Truss Company and
find that their design is in conformance with my.design intent.
e,jkrjos s�oNl �.
C E: j e
°C No. 16839
`P;`�� Cr+; ILP
- Or C Ad_IC�'..
Very truly yours,
Carlos Elias
ASAP
PLIMP111169 Inr7m
Lic #C42 855 851
760 328-7887 - 1-800-334-7255
CUSTOMER'S ORDER NO.
DTE ORD
ED 07
FAX 760 328-6607
Gallons
-DATE
ORDER TAKEN BY
PROMISED ❑ A.M.
P.O. Box 2318 - Cathedral City, CA 92235
❑ P.M.
BILL TO
PHONE
ADDRESS
MECH NIC
Out of Area Fee
CITY
HELPER
JOB NAME AND LOCATION cs '
❑ DAY WORK
Locating / Opening Fee (per hour) $.75/HR
❑ CONTRACT
DESCRIPTION OF WORK
❑ EXTRA
Size System:
OUANT
DESCRIPTION OF MATERIAL USED PRICE
AMOUNT
Gallons
Pumping Fee per 1000 gal. bo
Camera/Power Snake
Out of Area Fee
Locating / Opening Fee (per hour) $.75/HR
Size System:
---------------------------
Fuel Charge
$25
0 0
A SERVICE CHARGE OF $20 WILL BE DUE ON ALL RETURNED CHECKS. TOTAL
18% PER YEAR WILL BE CHARGED ON PAST DUE MATERIALS
ACCOUNTS OVER 30 DAYS. TOTAL
WAIVER: Not responsible for secondary damage such as water LABOR
damage, chipped concrete, mark on street or driveways or trees. TAX
SIGNATURE MPLETED
Z t 0 / O TOTAL
C�