9603-036 (RER)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
34333.5 13 1:::11:1 i.'n 1:, ur k, i
Date 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).
( V%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. fo9,ir his reasen� (/A
Date .9 ' jj a —9 h 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 4is"sNO My`I'wdrkers' compensation insurance C9114ft poli"ey no. are:
Carrier . Policy No.
(This, section need not be completed if the permit valuation is for $100.00 or less).
( y/l 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 with1t 9se provisions:
-,.,Date:. 2 • 9'i 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' purrpoossdS.
Signature (Owner/Agent) Dates `�r7
BPERMITv���`�� CONTROL#
BUILDING PERMIT 2909
DATE '3111196 VALUATION S 1.11 SAN) LOT TRACT
ADDREOB SITE �d-(I •(Y t �'�I g.�ji�
ADDRESS
APN
OWNER
CONTRACTOR / DESIGNER / ENGINEER
1 !1 •>+.1. f./1..f ♦
111 • t - /f'i iJ .• 11\�.',
,.
5 11 �(3 tit lisdii ►rs itl� .li k;r.".
.;1GIO 11.4`r ilii it aiblitR .
LA cjt &'IN`I'A CA 922ti_+
I..l1 QIANTA CA 92753
1 t; I tit: l -SIA 77 C''f3LH 111051
USE OF PERMIT
Af: D WINDOW
c,,!_iltl 1 l.H.fll, ! l�tY.1.41lJIV !. 1., 1 &A.VU Lb
,
EST b NW11 ED C.O s l'.0V CMNti'. RUC"1'IGON
1,1R2.i#(I'
CO)NS__M,VCTIt!6NFAE (9I-0oo-m8_0()() V9? 00
SU13•Tt7M CONS1RILCTION :AND pLf1N CIIEr'K
$2.9.00
1 LESS PRE- PALD HES
LIro fl ,/6,Rf0 IT i4ls'„ES 9g1EN0'Vi/
$0.00
MAR 12
1996
11By
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION DATE INSPECTOR
BUILDING APPROVALS
Set Backs
Forms & Footings
Slab Grade
Steel
Roof Deck
O.K to Wrap
Framing G
Insulation
Fireplace P.L.
Fireplace T.O.
Party Wall Insulation
Party Wail Firewall
Exterior Lath
Drywall - Int. Lath
OPERATION DATE - INSPECTOR
MECHANICAL APPROVALS
Underground Ducts
Ducts
Return Air
Combustion Air
Exhaust Fans
F.A.U.
Compressor
Vents
Grills
Fans & Controls
POOLS - SPAS
BLOCKWALL APPROVALS steel
Set Backs Electric Bond
Footings Main Drain
Bond Beam Approval to Cover
Equipment Location
Underground Electric
Underground Plba. Test
Final I I 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:
I Final
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
Wilily Notice (Perm)
CY
78-495 CALLE TAMPICO — LA QUINTA, CALIFORNIA 92253 – (760) 777-7000
! sr OFT �} FAX (760) 777-7101
TDD (760) 777-1227
December 17,1997
Audre J Slack
52-020 Avenida Ramirez
La Quinta, CA., 92253
RE: General Building Permit #9603-036
Dear Mrs. Slack
The purpose of this letter is to inform you that your Window addition Permit #9603-936, for
the project at 52-020 Avenida Ramirez, 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
Building & Safety Manager
Daniel P. Crawford Jr.
Building Inspector I
cc: file
dpc
L
MAILING ADDRESS — P.O. BOX 1504 — LA QUINTA, CALIFORNIA 92253
d -
US Postal Service C
Receipt for Certified Mail
No Insurance Coverage Provided.
Do not use for international Mair (See reverse
Sens to
Audre J. Slack
SlraC a Nu her
5I-020 Ave. Ramire
Posl Ofrtcc, State & ZZF Code
La Ouinta, CA 9225
Postage $ 3
Certified Fee
l 3.�
Special Delivery Fee
Restricted Delivery Fee
Ln
rn Return Receipt Showing to
Whom d Date Delivered /0
Retum Receipt S wmj to wh m,
D -91e. 6 Addres!�s Address
O
Q TOTAL Postage & Fees —7 7
Postmark or Date
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30X 1504 - LA QUINTA, CALIFORNIA 92253
P 277 543 767
MAIL
Audre J Slack
52-020 Avenida Ramirez
La Quinta, CA., 92253
RE: General Building Permit #9603-036
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