9512-052 (ELEC)�•_
LICENSED CONTRACTOR DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with
o ? M "'Section 7000) of Division 3 of the Business and Professionals Code, and my
n (:y u) License is In full force and effect. 594851 8
r W/License # . Lic. Class Exp. Date
ZA� Date 12 </ t "f 5 "Signatureof Contractor l • •-,1a
c'o 01_
OWNER -BUILDER DECLARATION
J IU 1 hereby affirm that I am exempt from the Contractor's License Law for the
0_ following reason:
cA ( ) I, as owner of the property, or my employees with wages as their sole
Z 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
co Date Signature of Owner
LO
N
O rn WORKER'S COMPENSATION DECLARATION
dQ I hereby affirm under penalty of perjury one of the following declarations:
Cg Z () I have and will maintain a certificate of consent to self -insure for workers'
Lo H 0 compensation, as provided for by Section 3700 of the Labor Code, for the
X W LL performance of the work for which this permit is issued.
p J J ( ) I have and will maintain workers' compensation insurance, as required by
co Q U Section 3700 of the Labor Code, for the performance of the work for which this
OU permit is issued. My workers' compensation insurance carrier & policy no. are:
LO Carrier Policy No.
, Z (This section need not be completed if the permit valuation is for $100.00 or less).
00 :) () 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. 1
Date: ] I /d S Applicant
Warning: Failureto secure Workers' Compensation coverage is unlawful and shall
subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
ti
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his application.
1. Each person upon whose behalf this application is made & each person at
44
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this application agrees to, & shall, indemnify
& hold harmless the City of Indian Wells, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such -
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter •upon. the
• above-mentioned. property` for inspection purposes.
Signature (Owner/Agent) A . Date
ALC.I
BUILDING PERMIT
PERMIT9�$�0.
DATE JV S/4JS
VALUATION S.14 ,f)(;rrU,f)ij LOT - TRACT
JOB SITE ADDRESS - -
77-975 LAtR(313�i:�' '
APN
63:1-40-"r)
OWNER
CONTRACTOR
NVILLIAM 1.1.1'R1TZ
EMIL 1iARLEY
54-550 AVE. VELASCO
7' 775 :LAGO DMZ
LA. QU1ATVA CA 92233
LA. QLRWA CA 02253
(617)564-6402 CRL4 1123
DESIGNEIVENGINEER
USEOFPERMI11E,CrINIECH/P1:+ 113CC3MBINA IO.
ADD FIREPLACE, PATIO LXX)R Al. ERArION,. ANI-) OPV -N (2) NON-B13MING WALL.
FEE DESCRIPTION
FEES
CONTRACT AMOUNT 1.5,000.00 LS
&ST► INNI'ED CQ3T .0V COINS I"WI C'F10N
15,000.00
.LAN CHE..Ci M- 101:-000.43$-31.$ $i0s.30
CONSTRUCTION FEE 101-000-4183 000 $16100
PdECUANWA1 FEE 101-000-421:•Ot)0 $21.50
STONG MOTION FEE - RESW 100 -000 -241 -OW $1.50
r
SUB- : CONSTRUCTIUN AND PLAN CHECK
$290.30
D LESS . PRE -PAID FEES ES
$0.00
DEC 1 1x..1995 'PERMIT
.T FEES Xt.TE NOW
$290.341
RECEIPT V
DATE
8Y
DATE RNALED
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
ZQ� / G
Compressor
Insulation
3
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wail Insulation
Condensate Lines
Party Wali Firewall
Exterior Lath
li
Drywall - Int. Lath
/ f
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
G
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 ((aas)
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:
s
564-4151 , 346-29740
•
COUNTRY CLUB
WOMEN'S AUXILIARY
LA QUINTA, CALIFORNIA 92253
Iii I �
� .•tikes ¢<.,
.78-495 CALLE TAMPICO — LA _(aUINTA, CALIFORNIA 92253 — (760) 777-7000
FAX (760) 777 -7101 -
TDD (760) 777-1227
December 23, 1997
Emil Harley
77-975 Lago Drive
La Quinta, CA., 92253
RE: Building Permit #9512-052
Dear Mr. Harley
The purpose of this letter is to inform you that your Building Permit #9512-052, for the,project
at 77-975 Lago Drive, has expired. In accordance with 1994 UBC section 106.4.4, no further
work may be performed until a new permit has been issued.
Please contact Daniel P. Crawford Jr., Building Inspector I, at (760) 777-7012 to obtain any
information you need regarding a new permit and/or any required inspections. Should you
choose not to complete the project, we would then have to pursue any or all of the following
actions:
1) Abatement of the project through the City Attorney's Office and Code Compliance Division.
2) Notice of non -conforming structure placed upon property profile.
3) Action filed with Contractor State License Board. Optional if Owner/Builder..
Please contact us at your earliest convenience prior to 10 working days to resolve this issue, and
for any questions you may have.
Sincerely,
Mark Harold
Buildi g & Safety Manager
Daniel P. Crawford Jr.
Building Inspector I
cc: file
dpc
3
MAILING ADDRESS — P.O. BOX 1504 — LA QUINTA, CALIFORNIA 92253