9607-052 (RER)U)
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LICENSED CONTRACTOR DECLARATION
I hereby affirm under penaly 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
MOO B � v3I/97
C.
Date Signature of Contractor f nr d l -
i!
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 lissed�My�roqkers;�+ounpensation insurance carrier &policy no: are:
Cartier Policy No...
,his section 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,
,Ashall 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.,
/ i _t
Date: -) y:� •-. !i � Applicant-�-;��, t d
�. J fi{✓ �
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.
s?
Signature (Owner/Ageni)'r, r�l �' Lt. �_� ' ��� Date
BUILDING PERMIT ' PERMIT# °ONTR°`#
9607-0.t 3 718
DATE 7AW96 VALUATION S."r00 00 LOT TRACT
JOB SITE
ADDRESS 4 k-2" AVENIDA.VERNANDO
APN
631-35?r!"
OWNER
CONTRACTOR/DESIGNER/ENGINEER
JOHN A.R .r"ME t-f.Ee TfT
!ACK CLARK CO, J RAL Ct7NCl:AM
49280 A.VENLDA NERN10foo '
54-350 AV.ENIDA H:EKRERA
COACKV,L LA. CA, 922.36
LA QJINT'A CA D27.53
itS1y)St?►4'- Sd 1 C6LH 1.115
USE OF PERMIT
d'.; INN fAL itEIMtJDPI,
RC.Nt.0DF1L
rL;&-ti%�;tvtOD4 _50.0(Ak00 .LOS
I<+:sSTMIAl.ATE DCOST 0ti C-0-NSlRtJ6.M01V
E19.1060.00
VKHMIT.F.K.F. SUMMARY
PLAN C'W.CK'F Ets 101-4100-43u 3l 9 XV59,43
wCsr.'iuzrtm roc -L 5114,50
. .
11�.tE10JANICAj:,'VU< (1l-04ii� %i l•(){) 1. 0
13 ,f fi"i`12C �1.f» Z .ra 10.1-0OQ-rl2f) O!K)
f'i<tlRti3'.t1�:f# 1�kTs '.. lt1.i •(ltRf �il°;s-OUtl $37.00
1011000-2-41-000 $5.00
,SVI3-Tarr_.. CON.- TMUCTION AND PLAN CHECK
$841 S)3:
L SS R"IT1- 1�10 F&CS
$0.00
1 'k' , RrstIT t;'CVS D"VE' NiJiV
"41.93
.
JUL 18.1996
RECEIPT
DATE
BY
DATE FINALED
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
O.K. to Wrap
F.A.U.
Framing zi
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wail Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
9
p
Final
Final iaPOOLS
- SPAS
BLOC KWALL APPROV S
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:
3. /71
Final 17
Utility Notice (Gas) /
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Vottage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
July 16, 1996
City of La Quinta Building Department
78495 Calle Tampico I .
La Quinta, Califomia 92253
Attn: Mark
:Re: The•Devenan,ResidenceCustom- Home.
Changes to the v Construction Documents:
Dear -Mark,
Please attach this:letterwith,the:following changes to the City of.La Quint's -approved set of.
Construction Documents:
1.. Delete .the. number.4 rebar reinforcing. in the garage concrete. slab, shown. on "GARAGE
FLOOR :PLAN KEYNOTES" note numberone, sheet 5.
2 Change the depth of the 12° wide footing-around-the.house from 18" below. grade to
12° below grade, -shown- on detail # 7, sheet S-3.
I. Delete one. of the -number 4 rebars-in the 12° wide -footing -,around. the house, shown on.
detail number 7, sheet S-3:
If there are, any.questions or comments. please -call me at:(714).361.-5618..
Sin rely,
Obert L. Linnaus,
Robert Linnaus &-Associates.
158 West. Avenida. Alessandro,
San Clemente; Califomia 92672
Phone: 714/ 361-5618
FAX: 714/ 498-61781
i
tCertificate of Occupancy
City of La Quinta
TM
Building and Safety Department OF
This Certificate issued pursuant to the requirements of Section 109 of the Uniform Building Code,
certifying that, at the time of issuance, this structure was in compliance with the various ordinances
of the City regulating building construction or use. For the following:
BUILDING ADDRESS:
49-280 AVENIDA FERNANDO
Use Classification: SINGLE FAMILY DWELLING
Occupancy Group: R-3 Type of Construction
Owner of Building: JOHN A. & ANNE HEWITT
Building Official
POST IN A CONSPICUOUS PLACE
Bldg. Permit No.: 9607-052
VN
Land Use Zone: RL
Address:
49-280 AVENIDA FERNANDO
City:
LA QUINTA, CA., 92253
By:
DANIEL P. CRAWFORD JR.
Date:
DECEMBER 17, 1996
POST IN A CONSPICUOUS PLACE