9607-022 (SPIN)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
s •,
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).
( ) 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 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 I should become
subject to the workers' compensation provisions of Section 3700 of - the Labor
Code, 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 $1.00,0001'in
addition to the cost of compensation, damages as provided'for in Section 37.06
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,up-on
/thigabove-mentioned property'for inspectionnpurposesnature (Owner/Agent) J i`..-. 1"`t * Date
BUILDINGPERMIT PERMIT# - CONTROL#
DATE3679
VALUATION LOT TRACT
JOB SITE
ADDRESS $3.471 AVEN•IDA RMURFIZ
APN
774-082-06
OWNER
CONTRACTOR/DESIGNER/ENGINEER
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JUL z °0 1996
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BY
RECEIPT
DATE_`! • '��
Y
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 Wali Insulation
Condensate Lines
Party Wali 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 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
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)
July 10, 1996
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4
78-.495 CALLE TAMPICO LA' QUINTA, CALIFORNIA 92253 - (619) 777-7000
FAX . (619) 777-7101
Mr. and Mrs. Hall
1308 Cypress Point Drive
Banning, Ca. 92220
Subject: Special Inspection.at 53-470 Avenida Ramirez
Dear Mr. and Mrs. Hall:
On this date a special inspection was conducted at the above mentioned location. The
purpose of the inspection was to identify any observable code violations that were
present in the area of the residence, that had been converted from a garage to living
space (master bedroom expansion) without the proper. permits, or usual inspections.
The following conditions were observed;
No structural alterations were made to the existing structure with the exception of the
installation. of two headers in the south bearing wall of the room to allow for windows
to be installed. A picture was provided of the framing and it depicts the nstallation as
being built per code. There were no structural deficiencies observed during the
inspection.
The picture mentioned above also depicts the fact that insulation was installed in the
exterior wall. I verified that insulation had been installed in the ceiling byusing the
y attic access.
Light, ventilation, and emergency egress in the room inspected were per code.
There were no observable electrical violations. The existing service panel ( 200 amp)
is of sufficient size for the 'structure.
The manufactured fireplace that was installed in the room complied with applicable
hearth requirements, and chimney termination and flue clearahce.to combustibles.
A srriolce detector must be installed in the room per the manufactures specifications.
MAILING ADDRESS - P.O. BOX: 1504 LA OUINTA, CALIFORNIA 92253
Mr. and Mrs. Hall
Page 2
July 10, 1996
The alteration is in compliance with applicable zoning requirements due to the fact
that a permitted ,two car garage has been constructed on the premises.'
Pending the installation of the smoke detector the addition will be deemed to be in
compliance with applicable life safety codes and zoning regulations.
If you have any questions regarding this matter please feel free to contact me.
Sincerely,
L
Tom Hartung
Director of Building Sz Safety
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