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rte. LICENSED CONTRACTOR DECLARATION
! I here a rm 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. 681()12 B 1.1/30/95
License # Lic. Class Exp. Date r
Date t I..11 r SignatureofContractor ?�1ra n,ae P (' in ) :( .0
' OWNER -BUILDER DECLARATION +
I hereby affirm that I am exempt from the Contractor's License Law for the
following reason:
( ) 1, 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).
(`)f 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 lA
Date j 1d I i t(( Sig nature ofOwT'r—i— .K.) of l
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.
( ) 1 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 C1OJAi VN RAOLF?. Policy No. NWC".29757100
(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 sh I 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: i j t [i i 'If / Aoolicant 1O.N .1+0 �'A JA06 (.' i..,)__1 j
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 application agrees to, & shall, indemnify
& hold harmless the City of Indian Wells, 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_p)urposes.
S'Ig renatu (Owner/Agent)Mt11�(Tai^�lV[ Gj Date }.� 1
ALC0
BUILDING PERMIT
PERM I `,,., 1x3
DATE 1/X4/161
VALUATION ;i)�T
TRACT
JOB SITE ADDRESS
.54-635 XVL BERMUDAS
APN
OWNER
CONTRACTOR
t3CJT,(1 IX3 D CONS"rKUC'Tf N
DO( MU, D CIGNISI '.UCV11ION
51960 AVC.1`4IDA CTF-P,R VRA
51960 AVEN IDA. R RC FRA
IA QUINTA C'A, 92253
1.A QUUINITA. CA 92253
(611))'/71.1561 CRL0 32:;
(619)771-1561
DESIGNER/ENGINEER
USE OF PERMI7j;IZ.t1i.. f1(111,%?11o;t 1
82%1..1.00 4' [UGH OAl OEN 13 OCC WALL.
FEE DESCRIPTION
FEES
4 V['. WAU 82.00 LF
1~:,_S1'.1MA`1*K0 COST OF C ONS'i`C+;UC;'i't0N
),3 alto
IE'k;k11g1i'a` FE% 3Vh1.MA.kN'
CON1ST[tUG;P 014�[ifi 101-009-418-00 $3100
'._..___._
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SUB-T01'f, CQNSTRUCcION AND PLAN CIJECK
$33.00
USS PKB-PAJO F13
$0.00
"TOTAL T'ERNOT ft EES 1)UC NOW
$13.00
RECEIPT
DATE
BY
DAT77
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 Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
steel
Set Backs G
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROYA S
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping r
Plumbing Final
.Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection 1;
Encapsulation
Gas Piping
Gas Test
Appliances =+
~�
Final
M
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:
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RECYCLE YOUR HOLIDAY GkENERY
DECEMBER 26, 1996 TO JAN;IARY 8,199.7%. •�'.
Collection programs and drop off locations have been planned in most valley ci ies�
To recycle your holiday greenery:
Please remove all ornaments, tree stands, bags and nails.
Flocked trees, trees w0 tinsel, ornaments of tlee,sfa`hos will not be recycled.
Curbside PigK.0 -' " •.- .
Please cut in lengths not exceeding 4 ft., and place at the curb.for pick up on
your regular trash day, between december 26, 1996 to January 8, 1997. Please
do not put trees into Green Automated Trash Containers.
Drop Off Loc-ations... t•- `�'
1.
Hours of Operation (unikss stated differently below)
Monday - Fri4by, 9'am to 3 pm
Saturdayw.9 am to 12 pm , -
Closed Sundays and 14pw'Y4dr's Day t-.
Cathedral City: Fire Station at 32-109 Desert Vista
Fire Station at 36-913 Date Palm
Rancho Mirage: Whitewater Park at San Jacinto Dr. and Indian Trail Rd. - west end of
park December 27, 199¢ and January 3, 1997.00N - 9 am to 3 pm
&-A '` • 6
Palm Desert: Palm Desert Town Center - use G29od�edr Tire entrance rear of lot
Recycle America at 41-800 Corporate Way
Indian Wells: fCity Hall•'kire'Stattoa It 44,95�QJ Qrado Dr.
December 27,1996 and January 3, 1997 ONLY - 9am to 3 pm
La Quinta: Behind City Corporate Yard and Fire Station on Frances Hack Ln.
Wal-Mart at Hwy. 111 and Adams Street
Indio: Fire Station at 46-990 JaGksQn St.
Residents living in apartments and condominiums with commercial bin trash
service are encouraged to recycle their trees at the drop-off sites! If placed
in bins, trees will be landfilled and not recycled, and valuable space for
trash will be lost. r
•X
For more informlItion, call;
Waste Ma 'emenf of -the Desert
9
.19-340-Zl 13 �
4
Reminder: Trash and recycling services will bf one day late during the holiday
weeks. Closed on December 25th and JanLIbry 1st. Please put your trash and
recycling out one day later after the holida , through Saturday of that week.
• Thank you
t'-