0012-024 (PAT)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. r
License # Lic. Class Exp. Date
595320 13 06/30/2E
Date Signature of Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contract
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 & Professio s
Fate
am exempt under Section B&P.C. for this reaso
,fes �, y, 030 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.
(This section need not be completed if the permit valuation. is for $100.00 or less).
(;J, 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
subjeerto the workers' compensation provisions of Section 3700 of the Labor
gode,-I all forthwith comply with tho a provisions
✓Date:,1;�� Applicant t. ,sem°: ^--�
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 a•s 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. of
1. Each person upon whose behalf this application is made & each person-aty
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 ee,presentatives of this City to enter upon
the4bove-mentioned property for inspection ptyirposes.
"Signature (Owner/Agent)4� f�"ri Date roc /®�! `• d�
BUILDING PERMIT PERMIT#
DATE ✓ VALUATION LOTTRACT Rd'
/
JOB SITE - C'�� ; ({_ f CC).
APN
ADDRESS T�y ���A�^qq �•{g /j
fes• '!�"vt1'La.f. .��'1,Ff'r i
.. ._
OWNER
CONTRACTOR / DESIGNER / ENGINEER
RO13UT WOWNTT
TSE A',�AME,19C.
79.561 IJC1'A
41.6.59 MMDOa'iW MI°11111114"
LA QLl'S3nk CA, 922,5 3
M'OI.J' aRAND PALMAS CA .92276
C160>343.1211 MIR 4600
USE OF PERMIT
PORCIlr'1✓AT1t'9 32,0100 VF
PXMIT A .nA' E NUMMARY
PLAN CHECK 'l� Inez S1 (iJ �#1{3��n;��J« i 1 S $46,80
CONS'6`RUCTf47'ld I73 101-000-418-000 $71,Om
WRONG MOTION FRIK RMID 101-000-2.41-000 MID
r
OM1 9 -TMA. 0009 ITMO.N .pct) PLM CHEM,
i'.=u im.1 rpm mt&s,
- $M00
��
, _ r 3`�:€'� �`I+�1V��1':�'1``1.1�S :3)d�.� .i��)�`
•.. 'C:l,�:�,::ri#
DEC 06-2000".
NiTy Qi— QuitAl v�
1 >A .
RECEIPT
DATE
BY
DATE FINALED
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 Pibg. 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)
15'-10"
14'-4"
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FOUNDATION DETAIL-
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DALE E. BROOKS
79-795 Tangelo
La Huinta, CA 92253
760 771-3305
760771-3365 (Fax)
FA C S I M ILE TRA N S M I TTA L
TO:
Joanne Williams
C C :
Ken Mitchell
FAX:
346-9918
DATE:
12/2/00
FROM:
Dale E. Brooks
<� Fax is 1 pages, including cover.
COMMENTS: Wolcott Residence 79-561 Liaa
Ken Mitchell and I have reviewed the application and plan from Mr. & Mrs. Wolcott,
.received by us on 11/28/00, to install a wooden trellis in their side yard at 79-561
'L.iga. (Note this application and plan was delivered to us directly and we have the
$50 deposit check, which I will get to you. A security deposit is not needed.) '
We approve the application and plan providing the height of the trellis does not
exceed tthe.height of the top of the existing roof joist and that the trellis is stained the
same °color as the joist.
Please get;a letter off to the Wolcotts as soon as you can, as they need it before
they can get their permit from the city.
If you have any questions, please call.
If problems occur during transmission, please call (760) 771-3305
2 \.1,0 14'-4"
SIMPSON CCT
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CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
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CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
DATE ( 211(01,n `
BY ,