9906-054 (PLBG)to
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LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Ch"apter 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
482180 C21 C42 _,� 11/30/19:
t,Date G fsn f ��� Signature of Contractor pa/— • ,' ---- �'
�j . , _ ..
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
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.
STATE FLTW)
(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 nomemploy any person in any manner so as to become subject to the
workers"compensation laws of California, and agree that if I should become
subjjp6t to the workers' compensation provisions of Section 3700 of the Labor
Cgde, I shall forthwith comply wit se provisions.
ate: ii .T. , rrr, Applicant + of,!
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. t
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
th6 above-mentioned property„for inspection purposes.
'Signature (Owner/Agent) ���+�� 1 Date. t• - t%'7
BUILDING PERMIT
DATE 0(,/()w1t VALUATION $1,$00.JW LOT
PERMIT #
9906-054
TRACT /
JOB SITE
ADDRESS 51,363AVENID ANIA APN
.�1'�e'�RP774-031-07
OWNER ' CONTRACTOR/DESIGNER/ENGINEER
TAMES R WALKER A NLS UhlDCRGRO(. ND C:ONS'T.
51363 AVENIDA CARRAN7A 33703 ViSVV DIUVE
LA QU ] CA. 92253 CKITTEDRAL CITY CA 92234
(766)324-191.1 031.9 769
USE OF PERMIT
TIURN-3.A7J!'ali
SEPTIC ABANDON, SEWER Ci?"i+iZ`iE; T
VALUATION
1,500.00 LS
T�.ii�E�ii ED C�+�ST 0.1P � :11�P�1 a.I��3C`3 i0N
PERMiT PEP, SUMMARY
1S1.L%1SI1t1G- FEE -- .*FWFR 1014)00-419-000 $3ti.C}0
U
c
SUR-1MAL 0'_YN '-! Un1 ON AND PLAN CHECK
LESS j?t+'.4.t",PA1D "'' ES
11100.0440;
RECEIPT I DATE I By, I DATE FINALED I 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
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
POOLS . SPAS
BLOCKWALL APPROVALS
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
COMMENTS:
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)
I
COACHELLA VALLEY WATER DISTRICT
{P CASH RECEIPT DETAIL r :' 7'"�
03
Received From: ��� s - �,%�%nL i�L �� !
/� _�} t Date:LZ-22 I
Address: ' ; - 'i� ? � � f 11 i C�C�f� � ?� LA l�% 1.1:1 IJ l A rA �-�c•Z.\
Account No. � t(, O/ l t`! -�^% 1 Lot(s) T� Tract
:. Service Address �a i !A, — G.A. Code �
{ ❑ Meter(s) $
❑ Service(s)
.'� ❑ Backflow(s)" )
I
❑ House Lateral(s) 1
❑ DetectorCheck(s)
❑ Meter Surcharge
Sanitation Capacity Charge
❑ W.S.B.F.C.
❑ Temporary Construction Meter '
❑ Turn on Charge
❑ Uncollected Account - Name r
❑ Inspection Fee-Tract -
Fee - !
3 ❑ Plan Check Fees Water I Sewer -
I Tract -
❑ Bond Payment - A.D. - Bond
Assmt.
`` ❑ Customer Deposit
X. .
f ❑ Other
' -- TOTAL $
Remarks:
iCopy to:
Cash ,, Water Service
j Check
Money < Cashier
Order 2„3 i
'.T --c, CVWD-438 (11189) l
P.O. sox 1584
ACOS CALLE ESTAOO
LA OUINTA. CALIFORNIA f22S3
Contractor_41 Owner
Address Job Address
La Quinta City License No.: Expires: Bldg. Permit No.:
26. Landscapingj�r�,e,/
27., Others
28.
DO NOT REMOVE THIS CARD !�
Before Final Building Inspection Will Be Made
This Form Must Be Completed and Filed With Title 24 Calcs and Plans
This form shall be posted on the job with the building Inspection Card and it
shall be the duty of
the General Contractor or if Avner-builder Permit, the owner
to see that all sub -contractors
sign this card, giving his City of
La Quints
Business License Number, Contractors License Number
and a current certificate
of Workman's Compensation Insurance Certificate when he starts the
job. Failure
to comply may cause
building Inspectors to stop work, or complaints
to be filed
against such contractors or owners.
CITY
CONT.
SUB -CONTRACTORS
NAME
LIC. NO.
EXPIRES
LIC. NO.
EXPIRE
1.
Grade i Excavate
4 e A
I
1> >. Ci
3, 1 2 fA r L,
i i
2.
Pipelines—
3.
Cement -Foundations
_
�.�`:F
-602,7t��1
11311'
4.
Cement Walks i Drives
4"Yr,W AS I13
—
5.
Asphalt Paving
SWIM a< tFJ
—
6.
Framing
go,., r2, FF Co,
5,82
-"551575
J 3
7•
Steel Structural
8.
Masonry
,[1y (,,c80
9 3t r
9.
Plumbing
v!0 r
.� ; o
e /1 9L
5� 10
'3
10.
Lathing
.,�I J..Ai4f
ay R
J 3
-
.?S R &7 6,
Ll.
Drywall
Mo.-Ic_ Ayrre{c
172-50
J2 3/
jj512y 1
1
L2.
Plastering
XHrw 0{ .#f /O
HVAC
AK 4 ; c Jain
Ci ;;� o
T (S y y
3
14..
Electrical
a, .
lP X20
12F Iq2
si 9 to (4
2 J
L5.
Roofing
` r , z
't
It S1
3J Z
yr Joy ie,
8/31 `
16.
Sheet Metal
�H:;(. aS
17.
Floors -All Types
�f , /�' r: S
.97-
' 4
? 5 Z .' C, 0
/a4-.
18 .
Glass - Glazing7
/,/E,vi t / S G %ns S
70
Id � I 1
L1 � 0 2 7
161;,( ;
�
19.
Insulation/Weatherstrips i1 m ;
o (c Z
6 ' %i 9i
; d ; 5 17
/ 31 A
20.
Sewage Disposal
eVv
D3 1
(3(
-S L4
MIA
21.
Painting/Decorating -r
�'eaN Zo FF
22.
Tile
23.
Cabinets -Installations
t. a��` /'� i ,
/ ? �l
`cL
`>'��= >
24.
Ornamental Metal
25.
Fences/Blockwalls
26. Landscapingj�r�,e,/
27., Others
28.
DO NOT REMOVE THIS CARD !�
Before Final Building Inspection Will Be Made
This Form Must Be Completed and Filed With Title 24 Calcs and Plans
CALVIN C. KAMINSKAS
Asslslonl Commissloner
(714) 275.3000
OFFICE OF
AGRICULTURAL COMMISSIONER
JAMES O. WALLACE, Commissloner
83-612 Avenue 45 Suite 7
Indio, CA 92201
(619) 342-8291
DAN RILEY
Sealer, Welghls & Measures
(714) 275-3030 .
DATE 0- do ' f a CASE NO.
DEVELOPER'S NAME: eA
ADDRESS : -) 7 - -2 4/ S
TELEPHONE: ((p/a/) 7+6%�" 0(J V6
Lai 3� AeM 773-'0A/' 007-7
Dear Developer:
After reviewing your landscaping plans, all plant material listed is not in
violation of quarantine laws governing the Coachella Valley. If substitutions
do occur and they differ from plant material listed, this office must be notified
immediately.
Thank you for protecting and preserving the Coachella Valley's pest -free environment.
Agricultural Commissi is Office
cc: Indio and Riverside
4080 LEMON STREET, ROOM 19, RIVERSIDE, CALIFORNIA 92501 - FAX (714) 275-3012
Cs