9811-032 (RER)LICENSED CONTRACTOR DECLARATION
U) I 1 Rreby affirm under penalty of perjury that I am licensed under provisions of
F— Cf.'.%p�e79(commencing with Section 7000) of Division 3 of the Business and
04 W� rofessionals Code, and my License is in full force and effect.
O =)chi 'License# Lic. Class Exp. Date
W r—
oZ r- Date Signature of Contractor
co O rl�
J U coo OWNER -BUILDER DECLARATION
W WIC_ I hereby affirm under penalty of perjury that I am exempt from the Contractor's
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).
Cf) ( �/1 am exempt under Section B&P.C. for this reason
O N Date / Signature of Owner
rn
0< WORKER'S COMPENSATION DECLARATION
C) Z I hereby affirm under penalty of perjury one of the following declarations:
Lo 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 U ( ) I have and will maintain workers' compensation insurance, as required by
Q U Q Section 3700 of the Labor Code, for the performance of .the work for which this
Il 0 Z permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
ob n
�Q
J
(This section need not be completed if the permit valuation is for $100.00 or less).
(y) 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
3 subject,to the workers' compensation provisions of Section 3700 of the Labor
Co)e I shall forthwith comply with those provisions.
,,Date: Applicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
• correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
signature (Owner/Agent) Date Il
BUILDING PERMIT PERMIT "1111-41M
DATE 11117!4,; VALUATION SZ,.SOO. 0 LOT TRACT 1
AIOB SITE DDRESS %4-273►`�I�iE1 xulri>,
APN 774-2ye-035
OWNER
CONTRACTOR / DESIGNER / ENGINEER i
1
AftT& KARI31.1d LAMBROSE
OWN ERI BUILDER
54305 AVS NIDA RUBIO
t'
LA Q�J1N'I'A CA, 96253
�
{) - (`131.4
USE OF PERMIT
RESIDENUAL REMODEL
MISC. EKIIWOR. WALT. & RE) AMS, ROOF RDAIRS. RILLOCA71 WA'I1, 3it
I$Wl" AOD NEW FAU,
t
VALUATION :,5i)3.00I's l
PE;RMT >1<EES33MMARA'
PIAN CHH(,X F ni l O t-00 -439- i I8 4 35.3 tl
Ct7fJ'�'fti l{'i'T171J FF"'� f f1 t-IN.x1-d i A-t)i)(i x±a t)t►
;41t:r�I;�1NIC'At, f � Its 101 �Q{li)-X4'21-aQU ,"n +2.?fi
0.11A21R(CAI. FEEL If3I-ttJT� �I�it-0t7t) .. S�a.25
N.L%II NG HIZ, 323.4)
"TR(lVI %10'1'fr)N Vr-f? - RF.%In 101 -Alii) -2414)f1(1 $'St1
1
t
SU 71)T ll, (ION-WRU(""I ON ANT) MAN Cf -W -C:)
Elul .14 4%
LESS PRE -PAID H S
Soo)
' tli'tA!_, PERMIT t E'lle-8 11)(1KNOW OW
$01.85
RECEIPT
DATE
BY ! /
DATE FINALED
INSPECTOR
.. ,, �1 #
}�
�- �''� r
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
—y
Compressor
Insulation
3 —/ 0`y r
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 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
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
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
kTemp. Use of Power
Final
Utility Notice (Perm) p 105, b4`
COMMENTS:
12/8/98
On 12/8/98 approx 9am I arrived on site at 54-273 Avenida Rubio to inspect an electrical
service and remodel that was scheduled. The following is a summary of the inspection/site visit.
I found that the trench for the underground required for a new service to be backfilled and an
overhead service and weather head was provide for inspection. The abandoned 100 amp service
was removed from the wall and placed in an attic space not accessible and not secured. There
was a 200amp new service panel provided in a rough framing stage. The framing is incomplete
to support. existing electrical. There were many existing electrical outlets not completed and not
blanked off. There was numerous exposed romex wires strung throughout both structures for
temporary construction lighting per the owner Karen. the remodel was fully furnished in its
unfinished state with kitchen full of dishes and appeared to be used for food preparation. There is
an existing structure that is occupied adjacent to the structure under remodel. This structure is
energized and used for construction power for the remodel. In the bedroom closet of the existing
structure a service panel was identified with exposed romex powering several un -permitted
temporary electrical circuits. The existing structure has many existing code violations that are
not being addressed at this time. The partially framed garage wall was not constructed per plan.
During my site inspection the owner Karen was advised that the structure was not ready for
meter and that the condition of the structure needed to be addressed. The overhead service was
not permissible referencing the municipal code. I left the owner and reported to Tom & Mark
immediately after my inspection.
I produced pictures and code violations that needed be addressed to Tom & Mark. We re-
visited the site and discussed the condition with the owner Karen. There seemed to be a
misunderstanding between the owner and IID and the owner took it upon them selves to
constructed the electrical overhead service as they did. Tom advised the owner that he would
contact IID and arrange a meeting in the afternoon to address the service location for
underground construction. The owner was advised of the remodel structure was not habitable and
posted for no occupancy.
At 1pm a meeting between the owner, (agent) Jeff, IDD representatives, Steve, and Juan Salas,
Mark, Tom and I met on site.
Prior to the end of the meeting the existing structure and remodel electrical code violations
were addressed for correction. Agent Jeff was fully advised of our intent and requirements for
the electrical corrections.
This is m account of 12/8/98 site visit. Pictures are in file.
Daniel P. Cra rd Jr.
- -s
���
womm
Z71
. CITY OF LA QUINTA SUB -CONTRACTOR LIST BUILDER a1z_jPfyC_
PIU PERMIT NUMBERqA I I - 03 7- OWNER _A4T1-&L142U4eS-3 �— authorized to work
OB AAft-
iiis f6im shall be j?osted on the job with the Building Inspection Card a all times in a I 111ace. Only persons appearing on this list or their employees are a
i this iob. Anv changes to this list must be -approved by the Building Division prior to commencement of work. Failure to comply will result in a stoppage of work and/or the voidance
r-- of : ♦ raeprinuzo
I building permit. For each applicable trade, all information
requested below must be completed Dy
Stati Contractor's License
apphcant. U11 r -11c; - "ws. Ulu
Workers Compensation Insurance
usiness, License
Business
Trade Classification
Contractor
Carrier Name
(e.g. State Fund, CalComP)
Policy Number
(Format Varies)
Exp. Date
(xx/xxlxx)
License Number
jxxxx)'
Exp. Date
(xxlxx/xx)
Company Name
Classification
(e.g. A, B, C-8)
License Number
(xxxxxx)
Exp. Date
(xxlxxlxx)
EARTHWORK (C-12)
CONCRETE (C-8)
FRAMING (C-5)
STRUCT. STEEL IC -511
41AI)I-Z-X9 Ikell"e1�6
AIWA,,201 7956 —00
7 L13E
MASONRY (C-29)
PLUMBING (C-36)
flWA6
51/30/00
LATH, PLASTER (C-35)
11
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SME6
�3,2_
rd tlw 7";7 0-r'
0�9
r2
DRYWALL (C-91
HVAC (c 20)
avoz_
ELECTRICAL (C-10)
IVII771AI6.
ROOFING (C-39)
SHEET METAL (C:-:413)
FLOORING (C-15)
t9w1vbA
GLAZING IC -17)
INSULATION (C-2)
SEWAGE D!SP. JC421
PAINTING (C-33)
CERAMIC TILE (C-54)
CABINETS (C-6)
FENCING (C-13)
LANDSCAPING (C-27)
POOL IC -53)
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coy�1-1�1'� Qv13��
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bMLLI 14difffOlti, Tf'*i.Or/VDOPJ PF OLA -TL," f;� C--5 OV-
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Dec -23-98 12:38P Valentine Construction, 760 202+0013
LA QUINTA BUILDING AND SAFETY
To Whom It May Concern:
Subject: NEW AGENT FOR THE LAMBROSE RESIDENCE ON 54273 AVE. RUBIO
ARE NEW AGENT TO REPRESANT US IS TERRY TRYON .
PLEASE MAKE A NOTE OF THIS
TO BUILDING AND SAFETY:
Thank you,
ARTHUR L ROSE
P_01