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LICENSED CONTRACTOR DECLARATION
1 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
603362 B 1213108
ZDate -1_ZLf'rf ' 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.
STATE, Fu"I.
235,913 UNIT 0(0954
(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 wif d�i ose proyyislons. 1�
Date: 7,•9C1~t{� Applicant—
Warning:
pplicant 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 "late 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 prop rty for inspection p rposes.
✓Signature (Owner/Agent) -- Datel"_ZLt"q9
BUILDING PERMIT
DATE 124/98
VALUATION S fi LOT
PERMIT # CONTROL #
TRACT
.6983
JOB SITE
ADDRESS 48-86 !��r1�NIDAELM APN �3A•32A-U(3
OWNER CONTRACTOR/DESIGNER/ENGINEER
U15T R.L E) TNC AN trii±2 7 ;I.S. 1;t3NS #';;4JMON
48865 AVEN10A EL, N100 PO BOX 1019
LAQUIWA, CA -92 5 RANCHO MtRA.Ci1 CA 92270
185
USE OF PERMIT
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FIREWfAi.1...Si kA?trli'1 Dpi RTvti I` k� C}Ui t T) IrC?it A2L CCiN T.3.{fr<C" i'dij'd.
I •CITY OF
3�
PERMIT FFIR, SUMMARY
ti
DFA40LTION:fr.Ell 101_000423_000 S45 0
C ONS-fR C711ON 14. INO PIAN. CHECK
QUINTA
a
RECEIPT DATE BY DATE FINALED INSPECTOR
9100
$45,00
t) w
$0.00
> F
INSPECTION RECORD
OPERATION DATE I INSPECTOR
BUILDING APPROVALS
Set Backs
Forms & Footings
Slab Grade
Steel
Roof Deck
O.K. to Wrap
Framing
Insulation
Fireplace P.L.
Fireplace T.O.
Party Wall Insulation
Party Wall Firewall
Exterior Lath
Mviiall _ Int I ath
OPERATION DATE I INSPECTOR
MECHANICAL APPROVALS
Underground Ducts
Ducts
Return Air
Combustion Air
Exhaust Fans
F.A.U.
Compressor
Vents
Grills
Fans & Controls
Condensate Lines
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
r -
Final
Final
BLOCKWALL APPROV LS
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Uriderground 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
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
r -
April 2, 1998
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78-495 CALLE TAMPICO — .LA OUINTA, CALIFORNIA 92253 - (760) 777-7000
FAX (760) 777-7101
TDD (760) 777-1227
Gunnell Construction
P.O. Box 1019
Rancho Mirage; Ca. 92270
Attention: Mr. A. J. Spade
Re: Permit 9803-146
Dear Mr. Spade:
Please find enclosed a check for $36.00 for the�em7_fito03-1Hem6 not nerfor'�medTa"t�
4886 Avenida �El Nido in La Quin'ta� Also enclosed is Uniform Building Code Section 107.6
which will justify the discrepancy between the amount of the permit fee and the refund returned to
you.
Please feel free to contact us should you have any questions and we look forward to working with
you again in the future.
Sincerely,
*WWA, #��
Mark Harold
Building and Safety Manager
MAILING ADDRESS - P.O. BOX 1504 - LA OUINTA, CALIFORNIA 92253 ���