9907-526 (SFD)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
,ProfessionalrCode; and my License is in full force and effect.
License #' - Lic. Class Exp. Date
726552 CIO C20B 08/31/201
Date'?Signature of Contractor /,7n,&
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.
ect
( ) I have and will maintain workers' compensation insurance, as required by
Sion 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 Policy No.
it's d 3 F�t14iJ
(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. ,-% �:,� APPlicantM_;1`�
�j
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).. 2. � 711f ' - � Date f r
-O" BUILDING PERMIT PERMIT# A
9 -f 9!3i17-a:ffi6
,DATE VALUATION S2004.2,7180 LOT. Of ,t7.75 TRACT
ADDRESSOB SITE S CALLE ii: 'i� lA _TPN
76"63-010
OWNER
CONTRACTOR / DESIGNER / ENGINEER
-te :lr.'"C3,:iiILIK�]1L,;M
:51275 CALLS QUITO
83900 .F11r E.NIJE 4 3, SUM C
LA. QUINTA. CA 92253
Iii DIO CA
('760)_A42-i36R C1'UA 617
USE OF PERMIT
tiiN(: LE FAAitL DVE'LLING
wOFD - PERMIT DOES NOT N''Ci:ijDE, .BLOCK tirA1,LS ui2POOL. PI.iC:
(;Hh(,K t- IlAi R 4OLIC.W 7Y° 4 VOR NIUL'I'IPLE ISSUANCE. OY SAME PLAN
1'YPE.
Mit T CONS'1 RI MIQly 3,441.00 SF
POkMPA:riO 519.00 SI:
(.iARAiWJ( Akfy(7ib'f &l3.W) Sf
;i'°E.RM�.i FEE S'UMMFlaKV ..
C(: N81.'Dtt1CT..YJ.N rEh.
M . AN f'F .KX PFF. $? 16 A4 .
F EE DE VISIT ) I) i ' 000-.439.31$ $dS�i.00
kij!',CH tQCAL FEE i 0I -o0i)-421 o0u S i yt).5t1
Vi k:C;T'R.JCAL FEE 101-000-42(1-000 3231.20
P1.1 Nt'�
S'.IRONC: N1011101'4 FIEF. - RIISID RM -000-241-000 $20,53
GkADING FIDE 10i-000-42_1-000 $20.00
(AVELOPfiR IMPACT Hai 51.907.00
ART IN Pt)TPAI pl, X07.8 - RfFS)..0 J(1, -f>w-2,5-100 cue.IS
+1.113- IyY A 1, l": f')AI 5'1'(7 i t(.1'1C)N ANN D PIA, .N (7"F ~ K'
$A:f:Ki9
LESS PRE-I'Aft) FEES
4250.00
'ct)"i)'AL PERMIT 1'+54.F. DUE: NOW
fi
RECEIPT
DATE
By/ /
jJ
DATE FINALED
INSPECTOR
K
_•. ),
..
Lin
INSPECTION RECORD
OPERATION I DATE I INSPECTOR
BUILDING APPROVALS
Set Backs
Forms & Fc
Slab Grade
Steel
Roof Deck
OX to Wr,
Fireplace P.L.
Fireplace T.O.
Party Wall Insulation
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
OPERATION DATE INSPECTOR
MECHANICAL APPROVALS
wnd Ducts
Ducts
Return Air
Combustion A
Exhaust Fans
F.A.U.
Compressor
Vents
Grills
POOLS - SPAS
BLOC KWALL-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 -?p - 7'7
Encapsulation
Gas Piping
Gas Test
Final
COMMENT4•
AlI' 4&W S b � o.Jf� G •Ztio- oc7 �✓Z
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final ,-L/ / O/ ( J (/
Utility Notice (Perm) '�(�~—t
FROM Feiro Engineering, Inc.
City of La Quinta .
78-495., Calle Tampico
La Quinta, Ca, 92253
FAX NO. 760 346-2548 Mar.', 15.2000 11:00AM P2
ATTN: Building & Safety.
RE: Lot .2,. LLA 91=150
Calle, Paloma `
APN: 769063-010
This letter. will serve to' state that we have. field checked the.'elevations
for theAbove.:project and�tfound them to -hi: as follows:
High: Low. ;Plan:
FF = 41.34 41.33 4J :10
Pad 40.6 40:6:' 40:6: .
OF.SSIpa` Sincerely,
CoQ
:�,..; . I I r+ • . times D :Feiro,
Lu.No G.24176 Vice:Presrdent
. ``RCE .24176
a17 cp.
BOB �'MOFFMAN , Structural Engineer
,4e June 2000
S T R U C T U R A L O B S E R V A T I O N
of
House under Construction - at Lot X62 50-655 Calle Palnma
As of this date I have made a.casual inspection of the construction
of the subject property. Be advised that I find that the design and
details conform to the calculations and drawings.
" �o QRofESS/0
2.
LLI
CrM
' X10 945
,llheecho Mirage 922704758
Tel/Fax (760)568-2967 (Notetchange) robert-hofma
n@webtv.net
CA�`FD`b
U 'N ME. Tr ave l Bob & ' M : E : Fax ' : 760=568-2967 Mar . 03 18:01
v
BOB HOFFMAN Engineer.
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c _!V .:1145
S1x A[faro Drive, Rancho Mirage 92270-4758` . `r�,9�rRUCT 0����
Td,/,Fix (76aj568-2967.( Notithe change) Oh CAL��