9609-170 (PLBG)U)
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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
73UH testi 4/307
V ate _ 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).
O 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.
()Q 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 isrissfe�Ta� rworj'terJ't"compensation insurance carrier`''&Wicy-no..are
Carrier 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 of Section 3700 of the Labor
Code, I sh '11 forthwith comply with those,provi ions. -
64Date: ,7, // 4 Applicant
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.
J
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.
Xgnature (Owner/Agent) -1114 �• ����- DateE/. d.`I4;4
BUILDING PERMIT
DATE 9/Z4/%►- VALUATION 5401),00 LOT
PERMIT # CONTROL #
%09-170 4150
TRACT
JOB SITE
� 9416 Ci�l�i,'ii'iRAXA.[iii APN
ADDRESS 631.331-01..2
'OWNER -- .. CONTRACTOR / DESIGNER /�ENGINEER
r!'117Wiplr& imi)E V+NIE /7
490.16COA HELLA.OR: 4u780CL.11+1'i'uN
j.,A QANTA. CA 9V53 tNDiO CA 92201
( (619)347-3629 C13i;,1d 101
USE OF PERMIT
.t='1AJIvlof O
i2f'Pl.ACE i`:,K(STINGWFL'r-l-R.HEA`!'1sR-
1�,?� Y;MIA rED UYS'T OF- OliNSTRUC'8':I;Ot'N �iflti.i.111
F'LQ3NID' `NG FP 101-000419-f)0() $22.50
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5f_1I3_it3'l'Als COr3 "i'iiL�('1'CC�N ANS PLAN CHECK
— L SS PRE- }AOD F X.S 503#0
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IMA -1, jj ERM11 FES OVENOW $22."
SEP 2 4 1996 '
RECEIPT DATE BY {�, DATEFINALED INSPECTOR
RECEIPT 7�T
W�✓r-r_`1
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 tines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
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
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:
78-495 CALLE TAMPICO — LA OUINTA, CALIFORNIA 92253 - (760) 777-7000
FAX (760) 777-7101
TDD (760) 777-1227
December 10, 1997
Ellsworth & Verle Vines
49-016 Coachella Dr
La Quinta, CA., 92253
RE: Water Heater Replacement Permit #9609-170 @ 49-016 Coachella Dr
Dear Mr. & Mrs. Vines
The purpose of this letter is to inform you that your Water Heater Permit #9609-170, for the
project at 49-016 Coachella Dr., has expired. In accordance with 1994 UBC section 106.4.4, no
further work may be performed until a new 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
Buildi .g & Safety Mana r
Daniel P. Crawford Jr.
Building Inspector I
cc: file
dpc
MAILING ADDRESS 4 P.O. BOX 1504 - LA QUINTA, CALIFORNIA 92253 ' '
4