0306-390 (PAT)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am liceAs8d 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
&16125 Ili 2 TIC 0&13012(
Date- Signature of Contractor 4'1! " 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 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 9TA,T:;�. r'LFMI3 Policy No. 044-OWDIMP
(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 forthwith comply with those provisions..,(..
/Date: " - Applicant—
Warning:
pplicant 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.
1
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'Signature (Owner/Agent) ' Date
BUILDING PERMIT
PERMIT#
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DATE VALUATION t2,5WA0 LOT
TRACT
JOB SITE
ADDRESS I1a�C'iL .k�C:��
APN
OWNER
CONTRACTOR/ DESIGNER/ EN INEER.
MUNI
Xurl Z .r`01:J,MUTr`ITC 2wr
49-1 I5 R.c NC:lIO POlO1" F,�
'74A421 PARMMILh
Via' QUNTA C'irry'i 92233
P11M DA -13F r CA 912216;;/
(760):W-6932 i~'! 11- 14547
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USE OF PERMIT
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RAI: CW1, K XIM 101-000=439-,3 ; F> 131.10
t.I. NIS TRUCTIUN, FFA 101 -000-411 S••000 ,.x.00
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IYAS3 PRE-PIND FE ES
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RECEIPT DATE BY 4 ` DATE FINALED INSPECTOR
IA INXI4%_
$190,60
+1'0'00
$t%60
INSPECTION RECORD
OPERA—ION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Steel
Return Air
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing S
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
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
OX 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 Powe,
Final
Utility Notice (Perm)
COMMENTS:
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INTEROFFICE MEMORANDUM
TO: NOLAN SPAARKS — PATRICK O'DOWD
FROM: NANCY
SUBJECT: MOORE RESIDENCE LOT 49 PARCEL 23
DATE: 5/7/03
CC: CINDY'
ATTACHED, PLEASE FIND A REQUEST FROM THE ABOVE HOMEOWNER TO ADD A WOOD
PATIO COVER AT THE ABOVE REFERENCED LOT. This is'a Montana Plan 3 and the Patio cover
would be located off the living room per the attached.
Columns will be used to match the existing, lattice and corbels will be painted .to match the unit. .
Attached, please find the Front Elevations, Side Elevations, Details and Plan View.
If you approve the above, please stamp so that we may schedule this installation.
Escrow has not closed — scheduled for approximately June 12th.
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Tbank you
Nancy
1
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CITY OF LA QUINTA
BUILDING & SAFETY DEP
QPp
FOR CONSTRUCTION
DATE6 23d3BY
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