0209-148 (AR)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 3rf the Business and
Professionals Code, and my License is in full force and effect. ,
License # Lic. Class If i,,/ Exp. Date
Date 1 f 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 VTATE MAID Policy No. IMS.*
J (This section need not be completed if the permit valuation is for $100.00 or less).
O I certify that in the performance of the word for which this per it is issued,
I shall not employ any person in any manner rsoa;to become subject to the
workers' compensation laws of California, and agr�ee that if I s ould become
3 subject to the workers' compensation provisions of Section 37 0 of the Labor
Code, I shall forthwith comply with those provisions.{.
` Date: ���+f td Applicant �.- 1� 1
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 arid 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/thel'above information is
correct. I agree to comply with all Ciiy, a4 State Ia7ws elating to the building
construction, and hereby authorize repr6senta`tives ofthis City to enter upon
the above-mentioned property..'J& inspection purp • ses.
. Signature (Owner/Agent) -� � � Date6 I "i ii !
z
BUILDING PERMIT PERMIT #.
DATEVALUATION- LOT 020-9- 48 TRACT
JOB SITE >f
ADDRESS��
APN
,
OWNER
CONTRACTOR/DESIGNER/ENGINEER.
PAr OEM,,
CITEROM-11F, If 0M U1,
'19-055 CAME BIUU A
7 3-3 60 HICIAWAY 111
LA, Q-,.,I`rCA CA. 922 5L,
c�ALM.0,ES 'RT CA 927460
('/60)341-0920 MA 5,54
USE OF PERMIT
RTMENTIP Lf AID. Y rM.'ill
,384 S.F. (JIMST i• 1C?USMADIXTI014
CUSTOM CONSMUCTION 26100 SP
OAi1AEIMA 'POK a2.BCi SF
ES'7C�.,�t!IA.4 ED :OST OP b'S��IY s''�.1� UVIK?ION
M"1. 0
�+p y, y y,, y � C �, /t -p
A`.S2 RUPSd.". I .kL YS tJh�jli,D�l,Tt [ -
.
CONSTRITOTION 1PU 1 o? -000-41 8_1000 S24 100
I LIMIT ("BECK FTX1 1 91-000-X 319--1d1�3, $144719
MZCH A)41CAJ,FV. 101-+J00-421"000 $46,00
H E,4: CTRICA], PES 1 W -00,0 -6.2a. -MID $32.11
Ir)1-(1013 X19 io0U
u YI?.0140 x%IOTIUf-1 FEE. MMD 101 -006-241 ."M
nC 12 1
CITY OF LA QUINTA
r ; IX 3111 FR R •PAS) F?s3?b`1
ZOO
RECEIPT
DATE
BY `'"�
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
- aj
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
Steel
POOLS - SPAS
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
_
Waste Lines �� G�3 .
Water Piping
Gas Test
Electric Final
Heater Final
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 of
Final �
Utility Notice (Perm)
COMMENTS:
•_
erokeeHomes
`
CUSTOM HOMES • REAL ESTATE • DESIGNS
CITY OF LA QUINTA
Tuesday, February 18, 2003 BUILDING & SAFETY DEPT.
APPROVED
City of La Quinta \
Building and -Safety Department
DA'TV SY
RE: 79-055 Calle Brisa�
Dear Sirs,
1dt2%3 l I
On behalf of- our client; Mrs. Patty Gehlz Cherokee Homes ree -0 t
permit exfended for an additional six months: The Building permit is for renovating• and-
enlarging
ndenlarging the, guest casita_located at 79-055. CalleBrisa in the Rancho La Quinta Country
Club. '
'
Mr, Pat Gehl recently passed away after'several months of battling cancer. At this time,
many of Mrs. Gehl's friends and family are staying and consoling her at their desert
residence. The guest casita is being used during this time and it would not be an -
appropriate• time to start the renovating construction to enlarge it.
`
If is the intent of Mrs. Gehl to starf the casita enlargement at the end of April, of the first
week iii May. 'Her,guests will have departed at that time, and she plans•on returning'w
her beach residence. The original permit will expire just before_ this time, and she would
like to not be pressured into building "immediately. '
\1Ve are•enclosing a copy of Mr: Gehl's Death Certificate to verify the unusual
circumstances. We are confident that the City of La Quinta will be most understanding.
Thank You, `
Don How
`President
_ J
73-180 Highway 111 • palm Desert, California 92260 • (760) 341`-0920 • Fax (760) 341-0946 �'