0204-230 (PLBG)LICENSED CONTRACTOR DECLARATION
A 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 2�O
` Signature of Contractgr'' //,�-
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 und�Sianat
B&P.C. for this reason
Date f Owner
WORKER'S COMPENSATIO*QECLARATION
I hereby affirm under penalty of perjury one of the wing declarations:
() I have and will maintain a certificate of consent to self -in for workers'
compensation, as provided for by Section 3700 of the Labor Co or 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 Fjour' 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' compensatiori—,provisions of Section 3700 of the Labor
Pode, I shall forthwith comply,w'ith those,provisions. 1 r"
Date: Applicant e` -v° -G•/ , �_1 _ r.2 z;./ """^-
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 pbrposes. ,
Signature (Owner/Agent /.- '- ' _-r • -.. , ,.� ., Date
BUILDING PERMIT r PERMIT" �e.rw^
DATE VALUATION LOT 'M04-2TRACT
JOB SITE
APN
ADDRESS 7U-f"'SAMA,"tO IWA13
OWNER
CONTRACTOR/DESIGNER/EN (NEER ,
JOU M. V1111A
R Y h 00ave TTRUL-1102V DIZAI N 97MR CE
78-"0 MOUAR0 r:OAD
87. 154 T AHQI TTZ -AME
tAQipbiiiTA ,, C: A 92253.
INDIO CA. 92201
(76DY342-9175 CMA 5f�9
USE OF PERMIT
Pa,UrG
XSETEWAM) CM
"ithlyr VIM
P�',1u4 smPE13 $30.00
APR Z 2002
C00FLAQUIRTA
FIIVRAI�CEDEPT.
i
U01,19 PRE-PAX0
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
r
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:
Final
Utility Notice (Gas)
a 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)
i r?
COACHELLA VALLEY;WATER DISTRICT
CASH RECEIPT DETAIL
p
`
f - I i1L
V ( t r�
Date:
Received From:
f'1`A
)
Address:
�- :1
'-/ '
. LJ�S Lots)
Tract
Account No. - -
i
Service Address
G.A. Code ;
❑ Meter(s)
$
_ ❑ Service(s)
❑ Backflow(s)
4
❑ House Lateral(s)
❑ DetectorCheck(s)
❑ Meter Surcharge
r : C, . ? ``-- v •%
�ff,,Sanitatlon Capacity Charge
-
❑ W.S.B.F.C.
❑ Temporary Construction Meter
❑ Turn on Charge
❑ Uncollected Account - Name
'
❑ Inspection Fee - Tract -
ee-
Fee-
❑ Plan Check Fees Water 1 Sewer -
0
{
Tract -
❑ Bond Payment - A.D. - Bond
Assmt.
i
❑ Customer Deposit
l ❑ Other
i �� J
/ •.� �l
TOTAL $
�::.
ARemarks:
i. /Q Copy to:
Cash
Water Service
f i
Check Lam' CI tJ
Money
0
Cashier
CVWD-438(ii 189)
Order
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-
i
E'q
a ESTABLISHED IN 1918 AS A PUBLIC AGENCY
OIS,TRIC'#.
COACHELLA VALLEY WATER DISTRICT
POST OFFICE BOX 1058 • COACHELLA, CALIFORNIA 92236 • TELEPHONE (760) 398-2651
DIRECTORS OFFICERS
JOHN W. McFADDEN, PRESIDENT THOMAS E. LEVY, GENERAL MANAGER -CHIEF ENGINEER
RUSSELL KITAHARA, VICE PRESIDENT BERNARDINE SUTTON, SECRETARY
TELLIS PATRICIA OA.REDWI E
ELARSON KAS July 11, 2002 STEVEN B. ROBBINASSISTANT
AND SHERRILL, ATTORNEYS
PETER NELSON
Greg Butler
City of La Quinta
Building and Safety
Post Office Box 1504
La Quinta, California 92253
Dear Mr. Butler
Fi 1:T'Cq/,T21__A r)s 31INTA
JUL 15 RECD
BUILDING ANL 6mrr-- ly
Subject: 78-660 Saguaro Drive, Parcel No. 646-312-035
In response to your letter dated May 15 regarding the cancellation of the sewer connection
permit issued Apri129, the district has reviewed and refunded in full the customer's paid
sanitation capacity charge.
Please update you files indicating the above parcel has not met the sewer requirements of this
district. Future requests for a sewer connection permit should not be issued without proof of
a paid sewer receipt from this district dated after the date appearing on this letter.
Thank you for your assistance in this matter.
If you have any questions please call Richard Shonerd, water service representative,
extension 236.
RES: j 1\svc\ws\j ul\butler
Yours very truly,
Tom Levy
General Manager -Chief Engineer
TRUE CONSERVATION
USE WATER WISELY
<Crf c vu-) r-) f
... P.O. Box 1504
78-495'CALLE TAMP.ICO (7 60) 777-7000
ShipjpgBrighter Th" E✓ver LA QUIN.TA, . CA LI FOR'N,IA 9225'3 FAX (7 60) 777-7101
May 15, 2002
Coachella Valley.Water District
P.O. 1058
Coachella, CA
Re: Cancellation of permit•;at�7,,.8!KOISag o Road :.
To Whom It May Concern:
The above -referenced permit In s been. caneele.d' and the owner has decided not to
proceed with the sewer connection. Tho'permit has .been attached for your
information.
If you have any questions, you may contact- me at °777-7015.
Si eA-Breg-
ly,
Building & Safety Manager
attachment
FROM.:RYSCOL-5TRUCTION AND DRAIN SERU: 'FAX NO. -:760 342 6640 May. 15.2002 02:27PM P1
Fax,Cover Sheet:
,.From:
R -y -S Construction &Drain Service
"Without Yaur`Plumber, You Have No Place 7`oGo"
Ruben D Padilla -
CA: -St: LIC: #B�=C421-06-6.10554
CA 92201
82-,154 Tahquitz Avenue Iadlo, ... .. .
Tel: (760) 347-9175.w Cell 58--4009 .Fax (760) 342=6640
Tel:
Fax:
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Return check to requestor X Mail check
Name / Title of person requesting check
s
Tom Hartung
Department individual is associated with:
Building & Safety P�
Check payable to:
R -y -S Construction & Drain Service °•Amount:$ '24.00
(Dame) (Vendor No:)
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82-154 TahGuitz Ave. Account Number: 101-000-'419-000
(Address)
5•
Indio, CA 92201 Project Number:
Check description and, invoice number:
Cancellation. of.permit for sewer connect at 7$-660, Saguaro, permit #0204-230
(80% refund)
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