9812-065 (PAT)• , LICENSED CONTRACTOR DECLARATION
A I:hereby affirm under penalty of perjury that I am licensed under provisions of
Fes- Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
C14 W' Professionals Code, and my License is in full force and effect.
O
=), ch License # Lic. Class Exp. Date
QL
' W 14248 C-61
oZ e ^ Irl-J Signature of Contractor, -
�O�-
J U C:) OWNER -BUILDER DECLARATION
UJ WW r- I hereby affirm under penalty of perjury that I am exempt from the Contractor's
U License Law for the following reason:
Z ( ) 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).
C'') () I am exempt under Section , B&P.C. for this reason
LO
N Date Signature of Owner
O�
a- Q WORKER'S COMPENSATION DECLARATION
p 2
Ir I hereby affirm under penalty of perjury one of the following declarations:
Lo FZ O () 1 have and will maintain a certificate of consent to self -insure for workers'
X W compensation, as provided for by Section •3700 of the Labor Code, for the
m_ Q perfor h'ce of the work for which this permit is issued.
Q U I have and will maintain workers' compensation insurance, as required by
Q �i ection 3700 of the Labor Code, for the performance of the work for which this
U
li rn H permit is issued. My workers' compensation insurance carrier & policy no. are:
? Z Carrier Policy No.
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(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±fowith comply with those provisions.
Date: Applicant • '1��
Warning: Failure to secure Workers' Coppensation 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�a.eve mentioned property for inspection purposes.
gnature (Owner/Agent) ._40'Z�, _-o-W-0bate
BUILDING PERMIT PERMIT#
DATE VALUATION LOTTRACT
�2/ 8l'37d
1912.103JAM
JOB SITE APN
ADDRESS 79-663 COMO CT -
OWNER CONTRACTOR / DESIGNER / ENGINEER
111013.M V WCt"sNT 'MNY &I. Y. 8ARRrA CON'SM CO,
76-663 COA110 CI' Sur s1`L►itGEON UIt14t.>r
LA Q1JKCA CA 92253 COA fit}:SA CA 92622)
(734})719.5493 CIS fl 4240
USE OF PERMIT j
PATIO �
I
D C 0 8 1998
iili,,
�3•1, 11.111 a i1D C:AS. OF C�s Hie H�FCi, \,`l\r 0.A t.!'�Vi�
I?'E.iiMIT FE11,: SC'f1iMAR%'
PLAN CHECK (--HE f01 -0W-43.9-318 $9 4.60
f"ONIST"l if; 111ON 7PP !011-00 41 "9n 8144 66
`Y".t'I.�:)Nii'(4it f`.t'SOi�! 1 #»I» • S?:f `i e� 1{))-000,24 -0 9)
CI jU TYI:A3, C'C1hi t6:JC1'If`iN ANI) PT AN C_FffbC . $219.91
LESS 11RE-PAjD I -TES $().Of)
Tt'Y!i A.i. C' +;#€A', R' F@`.i� S DUE NOW $218.81.
f/
RECEIPT I DATE
c� o
DATE FINALED J 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
POOLS - SPAS
BLOCKWALL APPROVALS
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
COMMENTS: u
..
r.
-
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)
S
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PLOT PLAN
NAME N(7 9 J// tx 6r*%- PHONI '
SrruS ADDRESS '7$66,3 C611-fO !J Fes`
TRACTIPARCEL MAP IAT �.
ASSESSOR'S PARCEL NO.
REAR PROPERTY LINE
FRONT PROPERTY LINE
_r
STREET _
63 Co^ a C7-,
284-263 REV 4199
CITY OF LA A GT
BUILDING & SAFETY DEPARTMENT
CONDITIONALLY
ACCEPTED FOR CONSTRUCTION
SUBJECT TO INSTALLATION AS PER
AND ALL APPLICABLE CODES
/Z�� BY
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4
78-495 CALLE TAMPICO — LA QUINTA, CALIFORNIA 92253 - (760) 777-7000
FAX (760) 777-7101
TDD (760) 777-1227
May 18,1999
Norm Vincent
78-663 Como Ct
La Quinta, CA., 92253
RE: Patio Permit 9812-065
Dear Mr. Vincent
The purpose of this letter is to inform you that your Patio Permit 9812-065, for the project at
78-663 Como Court, has expired. In accordance with 1994 UBC section 106.4.4, no further
work may be performed until a new permit has been issued.
Please contact Daniel P. Crawford Jr., Building Inspector I, at (760) 777-7012 to obtain any
information you need regarding a new permit and/or any required inspections. Should you
choose not to complete the project, we would then have to pursue any or all of the following
actions:
1) Abatement of the project through the City Attorney's Office and Code Compliance Division.
2) Notice of non -conforming structure placed upon property profile.
3) Action filed with Contractor State License Board. Optional if Owner/Builder.
Please contact us at your earliest convenience prior to 10 working days to resolve this issue, and
for any questions you may have.
Sincerely,
Mark Harold
Buildin & Safety Manager
i
1
Daniel P. Crawfo Jr.
Building Inspector I
cc: file
dpc
MAILING ADDRESS - P.O. BOX 1504 - LA QUINTA, CALIFORNIA 92253 ' f