0303-135 (BLCK)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 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).
A
( ) 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.
(A)"1' 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 1 TAT)K C°t�PtAi'ENRATI Policy No. • 046-0168•-2003
(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.fo with comply with,t�osfj,provi :)ns q
Date: - Applicant -'
100,
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. Eadperson 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 author zee representatives of this City to enter upon
the above-mentioned property
ff�nspection,�-�,Date
f
Signature (Owner/Agent) �� (-�z
PERMIT #
BUILDING PERMIT
135
DATE VALUATION ��� LOT. TRACT
JOB SITE
ADDRESS 59-795 CAI LLP QWTO
APN
OWNER
CONTRACTOR / DESIGNER / EN (NEER
MR. MINOR MRS ,i8OXT
C,Pif.MOliMIA P007.S (0P U' CC)
50.795 (,'1.qA. A QtTM
Go Aawm, 54. .
LA QU-W t'A C;'.A 91253 . ,
C:<?AC'l�� Js �1. CGA 912,236
USE OF PERMIT
GUMAJ, B+UUX11110
LAII L.K 0 n LLi .' .,Ly L. AA. V aLft.W1J..F:iC
b FT. WALL 128,00 LF
1gyr " u) Con, are CON517'Ol'Cn03'
3�0►:i.4Di3
k'`ERJAI 'i ME- WIWMARY
C ONn`.f'Rtic:TION FRE 101 -00(.1.418-000
MAR 1 2 2003,
CITY OF EPS QUIRTA. ,.
nNANCE DEPT. '
�w
SU, -TOTAL, C099F9.tU 713:011 AIM IST ' C`l'JR7`""
$663.00
; 2 PRE HMO'
$0,00
T_ OTAX, Z''23OXT1 MKS DVEVOW
3100
RECEIPT
DAT�El, j j .:g
BY''r(
DATE FINALED
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 F L4Main
Drain
Bond Beam U —
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final I
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
t3as Piping
Gas Test
Appliances
Final
COMMENTS:
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)
o � LlY1 � � ^�n �'' �
4 Cv u�i'1�Gv
78-105 CALLE ESTADO - LA QUINTA, CALIFORNIA 92253 (619) 564-2246
November 30,. 1990
To Whom-It May Concern:
.The structure located at 50-795 Calle Quinto in La Quinta is
located in a "AO" Flood Zone per revised F.I.R.M. Panels 060709
0005 & 0010 A (see.attached letter). The structure was formerly in
an A3 depth.
If you have any questions, please feel free to contact me.'
BUILDING AND SAFETY DEPARTMENT
Tom Hartung
Director-of Building and Safety
TH:es
LTRTHI6