0109-096 (BLCK)7.
CO
. F—
N CO
W
ir�O 0 tM
� W �
o Z
CID O O
J
UJ UJ
Z
co
L0
N
ON
0
0_ Z
`rHCr
0
w
X w —
mUU
O
rnH
'IT Z_
ob —)
C3
Q
J
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
767086 P. Date 4J"• r Signature of Contractor f�' �•
r.sem" t, (Ii, -pi (/-
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 Policy No.
X92IMP '
(This section need not be completed if the permit valuation is for $100.00 or less).
r.(0� 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 forthwith Comply with those provisions.
Date:, 1 • r I Applicant ✓:r'
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 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 purposes.
Signature (Owner/Agent), � /�'.r' Date'✓
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 01ca-(W9 TRACT
JOB SITE APN
ADDRESS
77-740 CAME C:OLiMA. -
OWNER CONTRACTOR/DESIGNER/EN (NEER
JACK Me -MM DEff Mr CCNU DEV. ;f -U-, L:ONSTMUO DF.,� W grn'.EAri;`3.111C
PO B9X 628 P, 0. BOX 628
,LA Q: GA 922`x51 LAQU.'WrA. CA 59225?
(i6q)771-x.359.4 CB141 5830
USE OF PERMIT
23 LF 4' H1011 P*ROP.A.i3Z K IC°LOSI,IIxZ • ("I TY s'I'AhbA:F,tJ
FOD
�EP 12 2001 Ll
ITY OF LA QUINTA
FINANCE DEPT.
Tff.lif'.4 ;T°f¢:D COST 010 CO�d�`"�T..7C#•L7MION
C:CaN3`3'Rt14'rT1014 MSS 103-000.416.000 WIN
UB-TMALC:JNwar a.Ut'.'t'iCBNA M'0 PkAW C.`XFCX $15.00
`TOM PY)" AW YM PUT NOW $15.00
RECEIPT I DATE I BY I DATE FINALED I INSPECTOR
INSPECTION RECORD
OPERATION
DATE,.
I INSPECTOR
OPERATION
DATE
I 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
Set Backs/ice/ 6l 57
Footings /!/ [[`
POOLS -SPAS
steel
Electric Bond
Main Drain
Bond Beam
/ —/ _ C
Approval to Cover
Equipment Location
` ll
Underground Electric
Final
_
aj ZpCp 2
Underground Plbg. Test
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
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:
MAY.21^2001 8:56AM CDS
.; CARDING 12EQUBS7] dyMY
AICA00 TITTLE CMV
AND WHEN RECORDED MAIL TO
P.O. a0X 157
MEM0NT, CA, D4539
N0.495 P.4/4
L
EserOm Va. 17014152 -89n
0 BI A, LIR143S2-- I VACS A2014 THIS UNE FOP FRE:=FWR& USE
gJ
TFM M413SRZS GNE D C*ra.ArI1ORCS)1 ECLAT EM
DO AP.YTPANVF.RTAXIS $59.40
� .
® tonsputed on rhe cult valve of the letmt at ptnprM waveym, or is
(� C=putad on rhe fuU wdoz less the value of Boas or enrumbno= mmalnirtg at 0M of sale, anr'
FOR A VALUA,BU CONSIDERATION, receipt of which is hereby aftowledged,
GLORIA A, Pis, AN DIED WOMAN
hereby GRANT(S) to
JOEX M. MCKMIE, A MAMX= MAN AS HSS SOLS AND SEPAP-kTE PROPERTY
Aaeaaam's Farcel Not
774-086-024-1
--, qa 1. t
the following descHlied real psopeM in the
Cotaaty of RXtsml, , State of California:
LOTS 3.1 A= 12 IN BLOCK 410 OF SANTA CARMLTTA AT VA3�2 LA QV=TA UNIT NO. 20, 1N T I3
COMgTY OF 12IVERS=3, STA'R'E OF CALIPORNIA AS PER MAP RSCORORD IN 2100% 19, SAGE 39 OF
WWS, = TRE,' OFFIC$ OF TO COUNTY RflCOMER OF SXID COUNTY.
Dated F15-bruaXy 27, 2001
STATE OF CALIFORNIA �'� ..� .........A.... .
COUNTY OF V ) M
on -- - betore me.
a Notary Publle In and !or tald Ceun and State, pers"ally appeared
� ra r 6l S
7-1-14y ftl to MI -9
(or pfOVed td Me o*,amnat
rsls of sstiefaeeory
evidence) to I,e tha verson(a) whoco ner>tie(ssubaorlead to the
whhth instrt+me t and acknowledged to me that nothey exaou the
fame In hla .r air Auth0ftsd ospeatt (Ims)I py We�lioe their
"natur'e(@) an the Instrument tho paraen(a), or tits entity upon"de'F+alf of
WhW the paman(e) aid, ®xacytea the instrument.
0010A1L StiN,
IMON T HEttAWEIL
COMM #1283794
~
meiv
CpGgomla �
I gap Mae
�mmtei+on res
AMBER 10►
WITRVI?55 my hsird and offlelal eeell
pnature of Notary cam MY UarnmMACM-5004Fos NOTAW MAL On eTAMit
AIL TAk STATgMPNTS TO PARTY SHOWN ON PeLLaWING UNM IF NO PARTY SO SHOWN, MAIL AS 01820TE0 ABOVE
GM -WM�9)bk� Stroet AaCrtfaa Stave &Zip