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�,.. 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
265214 C42 2/2&!19
L,Daie '��� '�" ' Signature of Contractor
OWNER -BUILDER DECLARATION i.
s
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 pffered 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.
STMI VLT1110 t11G� (1f31JS;�tt
(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 provisioRs�
Date: 3/ %- Applicant Jr
Warning: Failure to secure Workers' Compen'safion 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
PERMIT #
BUILDING PERMITIz_„,
DATEVALUATION LOT LOT TRACT
JOB SITEi
ADDRESS 5"�S AVENIDA BERMUDAS APN }
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OWNER CONTRACTOR /DESIGNER /ENGINEER
}l {tti�`t1,1.S;�;taUfi;Cct,`F A-1 CESSPOOL Si RVIC", MC
J 21 EAST' iALN1 CANYON 16819 11'1'1'LE N101tC?NIGO KI).
J A1.M SPRINCIS CA '92264 IJ11,88KI, Hul, SPIt1Nl;' (.A u:1.240
U�t OF PERMIT
f � NGI�•ft�tiV�.Z•
SEPTIC r',13C NDON - SE%T11 HOOK-UP
VALUATION
I,YX),Qtt I.r.
i:Sc'fkttU F1,'D COST Or, t:ONs mIlC•t• m,
eimiroiT FFJ1's SUMMARY
l?1AJMf31N0 F fX -- SF \k1_, t 10t -000-419-0V S30,00
fi1.,f R Tt:) t'A i . CONS'"IN IK -110N AND Pi #.A N C.H I?f >C
LESS PRE-PAIDRES
1'01'.ti1, 113# RiNII'I• FEES DITIr NOW
'ATE I By %I Y DATE FINALED IINSPECTOR
3.Sfiif.(►(t
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$0.W
$30.41
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INSPECTION RECORD
b 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 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
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
COACHELLA VALLEY WATER DISTRICT
Received From:
Addresa: /79/
AccounrNo. � _ �•
Service Address
V Meter(s)
CASH RECEIPT DETAIL
^
1,F714
� Lo S)
t7 Service(s)
O Backllow(s)
Q House Lateral(s)
O DetectorCheck(e)
O Meter Surcharge
Sanitation CapacltyCharge
Cl W.S.9.F.G.
O Temporary Construction Meter
O Turn on Charge
C Uncollected Account - Name
inspection Fee - Tract -
Fee -
O Pian Check Fees Water 1 Sewer -
Tract -
O Bond Payment - A.D. - Bond
Assmt.
0 CuslamerDeposit
O Other.
7160
Tract
G.A. Code
S
TOTAL
Remarks: CY c't il�Lf �� GN
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Acopy to: l+'
Cash
Check /r y
rftAV F�
Watarservtoe
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A-1 CESSPOOL SERVICE, INC. JOB INVOICE
P.O. Box 183 - Desert Hot Springs, CA 92240
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1 t'.-) t- I J ,'n Tp _S� w e ✓'_
QUANT.
'Since 19b9"
CUSTOMER'S ORDER NO.
DATE ORDERED
(760) 329-6875 - Fax (760) 251-3405
State Lic. #265214
ORDER TAKEN BY
DATE PROMISED
www.alcesspool.com
BILL TO
PHONE
ADDRESS
MECHANIC
1
CITY
HELPER
Jt
DESCRIPTION OF WORK
i Y `, ^�
❑ DAY WORK
❑ CONTRACT
+
❑ EXTRA
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n
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1 t'.-) t- I J ,'n Tp _S� w e ✓'_
QUANT.
DESCRIPTION OF WORK
PRICE
AMOUNT
Gallons
Pumping Fee per 1000 gal.
Dumping Fee per 1000 gal.
Out of Area Fee
Locating / Opening Fee (per hour)
Size System:
A SERVICE CHARGE OF $20 WILL BE DUE
ON ALL RETURNED CHECKS.
A FINANCE CHARGE OF 1 1/2% PER MONTH, 18% PER YEAR
WILL BE CHARGED ON PAST DUE ACCOUNTS OVER 30 DAYS.
QUANT.
LABOR AMOUNT
MECHANICS @
TOTAL
MATERIALS
HELPERS @
TOTAL
LABOR
I hereby adcnovHledge the satisfactory
completion o1 the above describgd work:
TOTAL LABOR
TAX
SIGNATURE
DATE COMPLETED
_
TOTAL
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NOTICE TO OWNER
Under the California Mechanics Lien Law any contractor, subcontractor,
gaborer, supplier, or other person who helps to improve your property,
but is not paid for his/her work or hearing, your property could be sold
by a court officer and the proceeds of the sale used to satisfy the
indebtedness. This can happen even if you have paid your contractor
in full if the subcontractors, laborers, or suppliers remain unpaid.
To preserve their right to file a claim or lien against your property,
certain claimants such as subcontractor or material suppliers are
required to provide you with a document entitled "Preliminary Notice".
A Preliminary notice is not a lien against your property. Its purpose is
to notify you of persons who may have a right to file a lien against
your property if they are not paid. Generally, the maximum time allowed
for filing a claim or lien against your property is ninety (90) Days after
the completion of your project.
TO INSURE EXTRA PROTECTION FOR YOURSELF AND YOUR
PROPERTY, YOU MAY WISH TO TAKE ONE OR MORE OF THE
FOLLOWING STEPS:
1) Require that payments be made directly to subcontractors and
material suppliers through a joint control. Any joint control agreement
should include the addendum approved by the Registrar of Contractors.
2) Issue joint checks for payment, made out to both your contractor
and subcontractors or material suppliers involved in the project. This
will insure that all persons due payment are actually made.
3) After UPON making payment on any completed phase of the project,
and before making any further payments, require your contractor to
provide you with unconditional lien releases signed by each material
suppliers, subcontractor and laborer involved in that portion of the
work for which payment was made. On projects involving
improvements to a single family residence or a duplex owned by
individuals, the persons signing these releases lose the right to file a
claim against your property. In other types of construction this
protection may still be important, but may be as complete. TO PROTECT
YOURSELF UNDER THIS OPTION YOU MUST BE CERTAIN THAT ALL
MATERIAL SUPPLIERS, SUBCONTRACTORS OR LABORERS HAVE
SIGNED.
Tity
4(Q "
78-105 CALLE ESTADO - LA QUINTA, CALIFORNIA 92253 - (619) 564-2246
November 27, 1990
To Whom It May Concern:
The structure located at 53-825 Avenida Bermudas is located
in a "B" flood zone per the revised F.I.R.M. (panels 060709
005 A and 0010 A) for La Quinta. The property was
previously designated as zone AO (depth two (2) feet).
If you have any questions, feel free to contact me.
Sincerely,
BUILDING AND SAFETY
Tom Hartung
Director of Building a d Safety
TH/lc
MAILING ADDRESS - P.O. BOX 1504 - LA QUINTA, CALIFORNIA 92253
April 1, 2009
P.O. Box 1504 BUILDING & SAFETY DEPARTMENT
78-495 CALLS TAMPICO (760) 777-7012
LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011 s
Mr. Joey Acuna
53-825 Ave. Bermudas
La Quinta, CA 92253
Code Compliance Case
Dear Mr. Acuna:
Please accept this letter as documentation that the code compliance case
dealing with the garage conversion and detached garage at the above address
has been closed. Both structures are deemed to be in compliance by the City.
Please feel free to contact me if I may be of further assistance.
Sincerely,
Tom Hartung
Director of Building and Safety
C File