9909-204 (RPL)LICENSED CONTRACTOR DECLARATION
.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).
( ) 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:
Cartier 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 shall forthwith comply with those provisions.
Date: 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.
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) Date
BUILDING PERMIT PERMIT#
DATE VALUATION �',$4i47. pfr LOT TRACT
I,, '
JOB SITE ai y.9yr5; r•�: I ti �t SFRED,�' x
ADDRESS
APN
OWNER
CONTRACTOR / DESIGNER / ENGINEER
7b A41 "!!1
',.di •dYa i..tv
".,6 ea,'i'l.'dr Y tt.ld cr ) �,
4-750 SA N :sFkErFC'
KIAF iS( A Sr
,..A e 4tiNrr , A 9', ).53
(ND10 f.'A
('760.' 17-10t d 5:.111.# 1 ! 5!
USE OF PERMIT
g .,i,'i , t�i � ti,rl4d 1� �LQi: #'��o �41AU, WE iN A-1
AiL3ie; R WA 40 113
:h'l �'►r(.A'd't"'S3 tr' �`nT' f�l� 'J".!'; UC1 ION'
t"ERMfill FE,IF, 8i►MINI ARI
P1, AN r."t•ika'x VLE i01 W0439-31ki
f`tYNvll?d_k"itts:'9T vlr F. ''j'iN1IN)
fLit::t_'Il, xJiC"riid .FIX I'N_'a: 1L 'to t • 1i(t.424, (00 S'Afi0
3�_Lriti"i1ti�'F+A, f�f:ls �z th,M.IY., Rfii-cxii>!-�#«{!-��l.t+ti Adi:!`iti
W f(41fi3IW1,11 M'Et •- Pz.KA toi-ouo-,ilI
`+UR-1'(YP 1..CONISI'M4d"['i0N AND PLAN('iffzf. K.
14AA6.: IME, NNW
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
3t
sa
-400MOCT-MC-4
o
�ri
m
c
cr
4).
o
=;
(D
a
Z!
>
G)
G)
(6
0)
CD
0
U)
9
n
to
0
7,
o
ar
I
V)
qa
�g
.0
z
—
m
"
I
Cr
—
m
a
co
W
R
Z4
:�
o)
w
Q)
Aft
z
C
0
;,I
-5
5�
T
C:
o
o
CL
05
b
0
OL
c
0
M
-j
m
C
0
0
c
r
X
z
W
CA
rn
M-Uom-pxmooccm>KMT
8
x-0
E
m
fR
M
0
S
-n
=
G)
=
o
0
-n
m
x
:T
o
0
9
x
M
E
o
C
a
a
3
a
-5r-
CL
0
0
9
o
.
w
r-
a
3
0
7S
3
m
q:
10
21
n
C,
21
—
72.
a
;3
3
c:
0
rn
21
RL
:7
vi,
m
:3
E
CL
"D
0-
m
0
aa9L
CO)
>
0
z
CA
L a 2 c z-4&LriL G o.A& L
Commun4t.y AzzocZation
P. 0. Box 162 -
La Quinta Ca 92253
Telephone: 760/564-2177 FAX: 760/564-4882
April 12, 1999
Building and Safety
CITY OF LA QUINTA ,
P. 0. Box 1504
La Quinta CA 92253
RE: New Construction
Lot 430
C. R. Brown/Monument Oil Co.
Gentlemen:
The Architectural Committee of La.Quinta .Golf Estates has reviewed "the. plans
submitted by Christensen Homes Inc..for the above referenced construction and
find the plans meet all specifications setforth in the governing documents of
our Association.
If you have any questions, please contact the office.
Sincerely,
Anne Tuttle
Association Manager
A
++
CUSTOM POOL/SPA BUILDER
serving the desert area since 1977
Allen Elkins owner
Ph 347-5959 Fax 775-7709 +® a
P.D. BOX 1047 - INDIO UC. 8348768
Ar
Ar
5
141W.
FM emmu C=O
I.
7 ---
CITY OF; - -` LA ' QUINTA
BUILDING & SAFETY DEPT
APPROVED:
FOR CONSTRUCTION
1:
DATE BY
A RE -INSPECTION FEE OF $30
WILL BE CHARGED IF THE APPROVED
PLANS AND JOB CARD ARE NOT ON v O
THE SITE FOR A SCHEDULED
INSPECTION.
n cvr%rPT10NR1
y y y y y �Y y �. �...'-.,.�., y � .v
41
W,
48 Iso
sAN D�MAs
LA OuiNTA
CA*
= i�I/A
I.
A -W
FA
i`�
Elio
'#4 r
&via
LA OuiNTA
CA*