9910-005 (RER)F7
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
5, 7776 131 , 091301 G1
Date %cJ s : % S gnature of Contractor -
f 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:
Carrier 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 3.700 of the Labor
Code, I shall forthwith comply with those provisions-,
y15ate: Applicants
f
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminalpenalties 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
thee'mentioned property for;.inspection purposes.
'Ignature (Owner/Agent) Date i
BUILDING PERMIT PERMIT#
DATE. 00/13/�VALUATION � .LOT TRACT
JOB SITE
ADDRESS 76.- 0 £OV&N1DAF1r111t'N N1 DI0
OWNER
CONTRACTOR / DESIGNER / ENGINEER
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76"0 AWAI.[DA'FERNANDO
39725 C.iAKAND #1:
Lei QLJ►'Tv`'rA CA. 9'2253
PALM W1,SCRT C.R. 97241
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('760)345-97.1 ^,43.4. ;Do
USE OF PERMIT
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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 Exhaust Fans
O.K. to Wrap
Framing
Insulation
_ _ _
Zl ��j �7
F.A.U.
Compressor
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 1_ /7/_�_
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) !9 a
COMMENTS:
FA
09/02/1999 13:05 FAX 7605664087 KA.RRAKESS CC 002
Anna 1-7, 19'
Mr. SMe Tray i l - lcspt ac
City of La W i a
DepVMxa of I uildtng and Safety
76.495 Ctk 7 I mpim
La QaWta, Cal penia 92253
STRIltMMAL ENMEMNO COMSULTANT
5"M AVENIDA BERMUDA$ . LA QUWTA CAUFORNLA WMI
760a64.09F4 PHONE 0 7M771 AWS FAX
SECONSLTNTGAOL•COM
1�?-1910 Ave, Ret3' gDo
'To �CV2.M fnDer,
Rgwdi G: eja Rhee, 76-M Aw Fa MMA if;anlls Rosa Cort — Aut dom%W r a idmw
Dear Steve:
I hopcood the i tsidenoe boated at 76-990 AweWda Feu m ia, La Qaonta in the SaM bm Cove for Mr. Bill Hays — agemr m the
awaa. The to i a wu dam apd by Sze that sba W nm the air oottditioa bg mft locatod at the South side or the ndd= (above the
bathroom and: i *cnt to Qte Widen). 'Ibe Ste spreadIlMmghThe sootand tlpreadover the ltathroom,-study armpmtioac of ttte
ktc bre and d, sg area 'lbac was IhWted tieitntge to nonce hftdor prtitioas located in the viciahy of where the fire sleeted
Much of rite a nor finis/► was removed to expose the roof oo as to de6ntmine the egg of dwnW. I behave the damago
r 7ceenss, cot! r athtly, lea fim 40!ti of the fatal gnic ml framing
I rempenda I bas the owner's rive contact Trus Ma MacMtDaa — the mamtf=m of the TA plywood web roof nun —
so as to asoezb i t bow mw of the job r wdcd to be roplsoed •I boliewe that the joist can be femoved and espbamd w1ca ivefy to limit
te exteui of u: t tagmred to return the smxt +e to the cotTdibon pciar to tate fire.
It isray profes 3t 0opinion dM tk dwUp was limitedto a portion of the residence andthat the amount ofs;Uw;V►ml framing that
needs to be rm ! mad a and repi=d. r+ep u=s beat tbm 40% of the emu: t>ttx m. I also believe tial this is an extreuwly co sur -atm
figure that mai x to &red dk3- as appopdase ins cWo by tate Truss Joist or aoartidied i LVo; ion agmxy rn g a testing
I expeol to be i i minced duft the .rebu Mm of the bow. lie refam if you have aW mccific faquacmeW of qum t wvr pleme &mot
thereto me at, - ur exrgeu oomwieaoe.
91
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