9605-081 (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
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
Lice a Law for the following reason:
(, 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).
O I am exempt, under Section B&P.C.ffor thisireason
Date 5//& to 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 Policy No.
(This ection need not be completed if the permit valuation is for $100.00 or less):
(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: '¢,010 Lice Applicant
F. -•- .�.
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.
0
Signature (Owner/Agent) / jIjL, Date-�k� 1
ey
PERMIT# CONTROL#
BUILDING PER96 �)�;.:a�l�
3335
{MIT
DATE �?IiBI�DG VALUATION •�SG��SrR�I•;�.R' LOT TRACT
JOB SITE 5.1-245 CALLIL, PALOI+ A
AP.N 764D 1 32A?.15
ADDRESS
OWNER
CONTRACTOR / DESIGNER / ENGINEER
13DWAR D 4'A'f11 ii3ciJftihIF1
0NVNEIt/BUI GDC;t
41285l�L.l i?til.Ut�fFt
LA r;?L,f[ivTA CA 9'a' d 53
USE OF PERMIT
Ise!(„-.t,k I-"AMiL V 0`01.I..l..NO
TO F1.37.1,CNOT f/ 1-4327., W!iICII EXPIRED `J-30-94. ,SPLt-2695 SC,?t) AdCL FFR
C3f1i<A.0+i3l�'kltit'Utt`! ,�17..f)f) ;sly'
I•ORCI`UPA't10 648.00 SF
M%TIAIATED i:Mr Chi+' Ci.316;Sx RilCs"1.0N.
aC,a,580.10
Coo s'I`ILIJSw"7 rot,4° �t. 1101,.000-419- 000
Tt!fECIIAHICAI. PEE 101-000-42i"000
F3i: FC'ri?1CA1., I:UE 1.01-000-42041[) $9.71.61
#'i UMSING FEE 1014.)00-419-000 $2?fR:nO
;179 7�a7 kD F1.4 -N CHECK
�
1,�.1 F�t?
0 LESS .ME-iWO FEES
$0.00
I I
D A f?'t+;R MIT VE'ES OlJ1t,NOW
$x.36.3,3:7.,
MAY 16 1996
RECEIPT
DATE
BY
DATE FINAL ED
INSPECTOR
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
OX to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wail Insulation
Condensate Lines
Party Wail 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
O.K. 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 Power
Final
Utility Notice (Perm)
COMMENTS:
N
78-495 .CALLE TAMPICO - LA QUINTA, ,. CALIFORNIA ` 92253 - (619) 777-7000
FAX (6.19) 777=7101
January 2, 1997
Mr. and Mrs. Ed.Brummel
51-395 Avenid,aMendoza
La Quinta, Ca. 92253
Re: 51=285 Calle Paloma
Dear Mr. and Mrs. Brummel:
The purpose of this letter is towinform you thafyour building permit, #9605-,081, for a single
family dwelling located at 51-285 Calle Paloma has expired:
7
A permit (#10091) for this.project was issued`:ongmally October 2,, 1991:. Lound plumbing and -
foundation inspections were perfo-med:under tivs permit prior -to its expiration in January of
1993. Permit number .13327 was issuedao continue workF6n'March 31,.1,994, with a roof nailing
inspection performedrprior to expirationlin January of 1996.'May,16, 1996,.1permit # 9605-081
was issued to continue, and complete the pro�e'ct with the understan'drng that no extensions would
be granted 'due to the adoption of the secon , -,code cycle change since the original . plan review in
1991.
At this time I have turned th6,file over. to. Don Whelchel,.Code Compliance" Officer II, of the City
Code Compliance Division to abate the structure,per°the provisions of the La Quinta Municipal
Code and the Uniform Code for the Abatement of Dangerous Buildings.
Please feel free to confact me with. any questions you,may have regarding this matter.
Sincerely,
Mark Harold
Building and Safe(ty Manager
c:Don Whelchel, Code Compliance.Oricer II.
Tom Hartung; Director of Building and Safety
MAILING ADDRESS - P.O. BOX 150,4„ - LA OUINTA, CALIFORNIA 92253 `40