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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 Contractto l
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 Signato,e 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 1ft*q:i'p � ,� 11TF �y 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 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 Y�Seetio 700 f the Labor
Code, I s alforth It comply with,.those pr v'siODS:`'•
Date: ' % 19 "" Applicant
^-WaY frig: 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 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.pur, ses
SiDate
gnature (Owner/Agent).> r
BUILDING PERMIT PERMIT#
DATE VALUATION LOT a(_ TRACT
24 23470-2
JOB SITE
APN
ADDRESS
OWNER
CONTRACTOR / DESIGNER / EN (NEER
I N
662 WThM 1A130 MIN
(;60y337-0289 337-0289 tn.`," IX 5 503
USE OF PERMIT
f
�.5'�.[.Y...RA�.F"L7M F?CJi�duiL./J.LV SJ
14.57 6�°;t:It,,��i�Rt'i3pkt� 4 W:AF.,S,r`701.,1" T trtiALL
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�it.�6i:d� rJ 1.A'159 f.�.PLA�X
ffm_ MMID (10ST W C4,3NF1:RA7MON
111062_5.00
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CONSTAUCTION FEE 102 -WO -4118.000 MIR
AUG 1 0 2001 1
OF l.: �ti
._ciFi
I flidAtvCE UkPT
DEPT
TOTAL PEWM :I M DUE NOW
RECEIPT
DATE�
BY
DATE FINALED
INSPECTOR
W. INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
i
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 Well Firewall
Exterior Lath
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 Plbg. Test
d -
Final
Gas Piping
Gas Test
PLUMBING APPROVALS
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
COMMENTS:
Final
UH14 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)
From: Jimmy Hatzopoulos To: Kirk -Inspector Building Dept. Date: 1/23/02 Time: 10:33:10 AM Page 1 of 1
Cal -Tech Development Corp
LUXURY HOMES - DEVELOPMENT - DESIGN
Phone (760) 773-9574 Fax (760) 773-4723
www.caltechdevelopment.com
To: Kirk -Inspector Building Dept. From: Jimmy Hatzopoulos
Fax #: 777.7011 Fax #:
Company: City of La Quinta Tel #:
Subject: Rose Res. Inspection Card
Sent:. 1./23/02 at 10:33:08 AM Pages: 1 (including cover)
MESSAGE:
Attn: Kirk
Please see attached copy of Inspection card for the Rose Res. 52-611 Cahuilla Ct. La
Quinta, CA 92253, per your request.
Thank you,
Jimmy Hatzopoulos
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