0005-109 (BLCK)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.
License # Lic. Class Exp. Date
??8250 B513� 82t
f.
Date > /.t Signature of Contractor
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 Ma3MPT Policy No.
(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 not employ any person in any manner so as to become subject to the
workers' compensation laws of California, and agree that if 1 -,should become
subject to the workers' compensation provisions of Section 3700 of -the Labor
Code, I hall orthwith comply with those�tprovisions. J ��
Dater V z . 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) •��' �f � � �-�'W.. Date
BUILDING PERMIT PERMIT# _
l
DATE �i VALUATION LOT OWS-109. ' TRACT
JOB SITE
APN'
ADDRESS 51^:5b5A.VEAWA. F.AM.=Z
773-125-01 7
OWNER
CONTRACTOR / DESIGNER / EN INFER
Rt DY & 9HARON laMLS
IMACY HOMES
42.335 WAMM-•CvTON VT SUlM F376
7 R-555 .3AGITARO RGAD
PALdc 1 DES5E1ZT CA 92211
1..A QUINTA Chi 92253
(760)564-7820 CKA
USE OF PERMIT
Gl!..:t3M.i L BiiRDII.10
50 WjJ 6'(ga) & 501-F Y(H) C1.A.1.D9N W. A1.,L CITY STANDARD
6 FT, S; ALL rD.R0 LF
3 1ri'. 'WAL1. 50.00 LF
E AMW COST OF COI\] 'LTMOR
C0NMUCTION F'1 E 101-000.416-000 $54,00
r• ,ga
gb.
SUB -TOTAL C 0kSTRUMON AND PLAN CIO C rK
$S4.00
PRE -PAM .0
$0.00
jp■ymp�* y�
�d
tl i d.+l.'IMS
sJR, r�~..2"it'1e.g. ?; Se.Ls� E -wow VT
.Wl
MAY 112000
TY 0 LA QUIW4
`RECEIPT
DATE •ABV
IDS 11 f 0
�.,
DATEFINALED
INSPECTOR
P
INSPECTION RECORD
OPERATION I
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs 1
Underground Ducts
Forms & Footings
Ducts
Slab Grade I
Return Air
Steel I
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing i
Compressor
Insulation I
Vents
Fireplace P.L. f
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall }
Exterior Lath }
Drywall - Int. Lath I
I
1
Final
Final I
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
Set Backs i
Electric Bond
Footings !
Main Drain
Bond Beam 1 j ad
Approval to Cover
Equipment Location
Underground Electric
1
Underground Plbg. Test
Final } (
Gas Piping
PLUMBING P ROVALS
Gas Test
Electric Final
Waste Lines 1
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
i
COMMENTS:
1
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole }
Underground Conduit 1
Rough Wiring
Low Voltage Wiring i
Fixtures i
Main Service ;
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
Final i
Utility Notice (Perm)
0
A05109100 TUE 11:10 FAX 619 231 6995 GAFCON SAN DIEGO 0001
Legacy Dames Lie. 778280
Memorandum
Date : May 9, 2000
To : Jesse
City of LaQuinta
From: Randy C. Bills
Legacy Homes
RE; UTHORIZEDLL - GE� NTS
Via Fax: (760) 777-7611
Pages : I
Please consider this your written authorization to allow Sharon S. Bills to sign on my
behalf, in my absence, any documents required by-theCity-lconcerning the_ construction
of the homes built by Legacy Homes. This includes but is notzmited to Permits, etc.
Should you have any questions please do not hesitate to call my cell (619) 954-4035.
Thank You.
78-555 Saguaro Rd., LaQuinta CA 92253 Ph. (760) 564-7820 Fax (760) 564-8601