0204-190 (PLBG)LICENSED CONTRACTOR DECLARATION
U) I hareb);/arm under penalty of perjury that I am licensed under provisions.of,
f— C*ier S (commencing with Section 7000) of Division 3 of the Business and
04 W Professionals Code, and my License is in full force and effect.
O M License # Lic. Class /6x. Datea 490341 ti 1 4#?i13 ill
Z Date 141"��Signature of Contracto""+-
CDOl iF
l 1.—
to
0 OWNER -BUILDER DECLARATION
HLU I hereby affirm under penalty of perjury that I am exempt from the Contractor's
Cn 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).
( ) I am exempt under Section B&P.C. for this reason
LO
N Date Signature of Owner
ON
0)
Z WORKER'S COMPENSATION DECLARATION
Nt o (r I hereby affirm under penalty of perjury one of the following declarations:
=r H O () 1 have and will maintain a certificate of consent to self -insure for workers'
X W ILL compensation, as provided for by Section 3700 of the Labor Code, for the
.J Q performance of the work for which this permit is issued.
4.:, . • U C) ( ) I have and will maintain workers' compensation insurance, as required by
O Q Section 3700 of the Labor Code, for the performance of the work for which this
11 rn H permit is issued. My workers' compensation insurance carrier & policy no. are:.
Z Carriera�TATF 1YUNO Policy No. 1"314"A
00 Z—)
C)
J (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 manne iso as to pecome subject to the
workers' compensation laws of C tifornia, and' a iee at if I should become
subject to the workers' compens tion�tprovlslons f S tion 3700 of the Labor
Code, I hal` o with comply wi those plrovisio s.
'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 allpity, add Stpte laws relating to the building
construction, and hereby a191,01 , repr2�senYatives of this City to enter upon
the above-mentioned propertyyfr. inspetio /purposes. ^�
—Signature (Owner/Agent) f 'r " "~� Date dY
a -
BUILDING PERMIT PERMIT#
'-
DATE,—' VALUATION LOT TRACT
JOB SITE • .i
APN
ADDRES£r'_53t ..i AV R DA 131�t�t;1�'ILIV S
OWNER
CONTRACTOR/DESIGNER/EN (NEER
ROT3:11 1' ZiRI11X3
AB(.PWAIMG OF WAMIll'iTALLEY
51.503 A:EN MA E.11MO :I}1 Ah
67-625 k3"1+uHWA;YII k
LAQUIWI-A 9.2253,
CATHEMAM. CITY CA. 922144
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USE OF PERMIT
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RECEIPT
DATEBY
DATE INALED
INSPECTOR
6Z�
0
INSPECTION RECORD
k OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
Set Backs
MECHANICALAPPROVALS
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
0. K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wail Insulation
Condensate Lines
Party Wail 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
FinalGas
Piping
.19
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 �j�
Gas Piping
Encapsulation
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL A PROVALS
'emp. Power Pole
sUnderground 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)
COMMENTS:
T4hf 4 4(4.4 QgbtM
78-105 CALLE ESTADO - LA QUINTA, CALIFORNIA 92253 - (619) 564-2246
January 16, 1992
Mr. and Mrs. John Mitchner
P. O. Box 438
La Quinta, CA 92253
RE: APN #773-145-014
Dear Mr. and Mrs. Mitchner:
A review of our records indicate that building permits #04581 and
#003614 issued to you respectively February 5, 1988 and September
14, 1988 for phase 1 and phase 2 of 3 phases for kitchen remodel
and garage conversion have not received a final inspection, which
is mandatory pursuant to the State of California Uniform Building
Code Requirements.
In addition, it has been noted that building plans for phase three
(3) which was to have been a.two (2) car garage constructed on the
property to replace the approved garage conversion have not been
submitted for review and permits for same have not been applied
for.
Per prior discussion and agreement, the garage was to have been
built pursuant to City requirements immediately following
completion of phase two (2), but as of this date, no action on
your part to complete the approved third phase has taken place.
It is mandatory that a final inspection of phase one (1) and phase
two (2) be completed and phase three (3) (additional garage) be
initiated.
In order for you to keep any legal remedy from occuring to obtain
mandatory compliance you must contact the Building and Safety
Department within ten (10) calendar days of receipt of this notice
with your intentions as to completion of the entire project.
MAILING ADDRESS - P.O. BOX 1504 - LA QUINTA, CALIFORNIA 92253
Mr. & Mrs. John Mitchner
January 16, 1992
Page Two
Failure to comply with the requirements of this notice will cause
immediate legal remedy to be initiated.
I thank you in advance for your cooperation in this matter.
If you have any questions, please do not hesitate to contact me
between 8:00 a.m. and 5:00 p.m.
Respectfully,
BUILDIN AND'SAFETY DEPARTMENT
Don L. Whelchel
Code Enforcement/Building Specialist
Tom Hartung
Director of Building and Safety
TH/lc
LTRDW33/TXTLYNN
Desert Sands Unified School District
N THIS
CERTIFICAATION OF PAYMENT
NOTICE' THIS D0CUMENTsQ NA LITY FEES �LA
ISE DUPLICATE e
TO: City of La Quinta DATE: p�. Lye .
Department of Community Development
78-105 Calle Estado
La Quinta, CA 92253
This is to rtify that 1/ ,
developer of ich is
located at (' QQAJ)w n
this District, has paid school facility fees imposed p rsuant to the
authority generated by ov rnment Code Secti St 3080 in t e amount of
covering a total of sq(fa# feet of ( ) residential or
( ) industrial/commercial development and that building permits for
this footage in this development may no be issued by your jurisdiction.
or ESERT SANDS UNIFIED SCHOOL DISTRICT
White - Building Department • Yellow - Facilities Planning • Pink - Accounting • Gold - Developer
(10)-37