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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
'
Date- '+ ` ' '' Signature of Contractor ^ �' r �+ =
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjurythat 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).
( ) 1, 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:
Canier 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 All 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 37007of the Labor
Code, I shall forthwith comply with those provision r f
Date: y Applicant—
Warning:
pplicant 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 apd 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 I
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 purpose
Signature (Owner/Agent) %`- -r . 1%%'' Date
BUILDING PERMIT' PERMIT#
CGW-M3
DATE VALUATION 97,�t%,. .70 LOT TRACT
t � r
JOB SITE
ADDRESS 5 1718 i75 B sA. X, DII.,f9l�FDRIJ
APN 761-=,4110
OWNER
CONTRACTOR/DESIGNER/EN (NEER
:E:.rAIn7I3.;a.E:ONMI-RUC270N NC
;int? QUW1.A CA gpnm
,r AQuImA CA AM
66)5641.,,0632 tom ILO 3237
USE OF PERMIT
53M•s'}.�?iTLi°
E`r .1J.)T $,5, P .Akd INCLUDE IA -CK ;
WALiA P001.4 3PA. 101i. DRIVE—WAY APPP.,?AGcZ
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/j y J� �/ A p. (5j
C/L� $J 13��OtNe1%6J� is ids V S •'Cdr/\i�W' L CFul�16V o
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gvifr.GM"IC.A.; FRE 101-00U-421-000
9L -EC Tk TCA1, YZZ 20-000. e�67:59
1':wUf��iY�iSi'Rl�� 1U'<:•�Jt?t➢P�bi�•"t~t4t.! �r�,LS
ST ONO M-O".'ION FffF, • RZ51 is 101-00, 000
rj,)E1►'&q.OpE", 11.t+119AGT Pse "., 2 =sjlS. J;1
ART 114iilil.fC PLACES-'%I�,.l:"1f3a4�.nA�ad5-Ossi:A
ff 4,: £'<3"i:U, C°OA1YTON AWD :PLAWC',T1:ECK..
$6,63439 '
Lal; -0 YRIE-PAJI) bMIS
$0100
03
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CITY OF LA QUINTA'
Clluael�lR�le xeien '
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BY
DATE FINALED
INSPECTOR
G 51
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
D
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
• O 3
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
—S pc
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
rv—
F `
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 Pibg. 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
Z
Appliances
Final .
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
Z4:
Feb 07 04 04:29p RAYMOND FRRMGIE
760 836 0856
P.I
RAYMOND FRANGIE STRUCTURAL CONSULTANTS. INC.
-------------------------------------------------
44-100 MCQNTEREY AVE. SUITE 201-C. PALM DESERT. CA. 92260
PHONE (760) 836-1000 FAX (760) 836-0856
E-MAIL R.FRANGIERNERIZON.NE7
FEBRUARY 6, 2004
SOUTHERN HILLS DEVELOPMENT
91-070 CHANTICT,FF,R DRIVE
LA QUINTA, CA. 92253
Attn.: JIM E V ANDET.I .
Re.: THE SUMMIT, LOT # 56, PLAN # 5 OR "B"
87-875 BLACK DIAMOND
LA QUINTA, CA. 92253
FOLLOW-UP TO WALK THROUGII
JOB NO.: 4034
DEAR JIM
THIS LETTER ADVISES THAT WE HAVE OBSERVED THE STRUCTURAL
REQUIREMENTS THAT ARE VISIBLE DURING CONSTRUCTION AT THE TIME OF
OUR SITE VISIT.
WE BELIEVE THAT THE AS -BUILT CONSTRUCTION AT THE TIME OF OUR VISIT IS
IN GENERAL CONFORMANCE WITH OUR STRUCTURAL PLANS AND RELEVANT
CORRESPONDENCE ISSUED BY OUR OFFICE.
WE OBSERVED THE BUILDING IN ITS FRAMED CONDITION PRIOR TO
INSTALLATION OF DRYWALL AND STUCCO. WE OBSERVED THE VISUAL AND
ACCESSIBLE STRUCTURAL REQUIREMENTS. ( EXCLUSIONS ARE ITEMS SUCH AS:
FOOTING SIZE AND REINFORCEMENT, TOP PLATE SPLICES, ROOF SHEATHING,
AND ANY STRAPS ABOVE THE ROOF SHEATHING.).
RESPECTFULLY SUBMITTED
NICHOLAS ABOU F
FEB -7-2004 SAT 03:14PM ID: PAGE:1
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