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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