9511-130 (RPL)U) LICENSED CONTRACTOR DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with
W Section 7000) of Division 3 of the Business and Professionals Code, and my
d C)' License is in full force and effect. 533670 B 6/30/96
r` W^ License # Lic. Class Exp. Date
Z Date //~7-;Msignatureofcontractor
_� - F -
Pr
0) OWNER -BUILDER DECLARATION
W ' I hereby affirm that I am exempt from the Contractor's License Law for the
following reason:
U) ( ) I, as owner of the property, or my employees with wages as their sole
Z 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
N
O 04
rn WORKER'S COMPENSATION DECLARATION
dQ I hereby affirm under penalty of perjury one of the following declarations:
g Z ( ) I have and will maintaina certificate of consent to self -insure for workers'
Lo H WO compensation, as provided for by Section 3700 of the Labor Code, for the
X W . LL. performance of the work for which this permit is issued.
p J J ( ) I have and will maintain workers' compensation insurance, as required by
m Q U Section 3700 of the Labor Code, for the performance of the work for which this
O 0 permit is issued. My workers' compensation insurance carrier &olicy no. are:
d rn H Carrier COPE€J EXCLE Policy No. gu'L?7?�7 00
`t Z (This section need not be completed if the permit valuation is for $100.00 or less).
00
O () 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�� AI shall forthwith. comply with those pro -visions.
//
bate: "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, intarest 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 application agrees to, & shall, indemnity
& hold harmless the City of Indian Wells, 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
• " r above-mentioned property for inspection purposes.
S- nature (Owner/Agent) Date—
ALC 8
ate
ALCM ..a w „�
AINU.ILDING
PERMIT
DATE 777:2 --VALUATION
" ! `"""
LOT TRACT
JOB SITE ADDRESS 4,4?905 t� ;N1IDk� gL-N1(D
APN
OWNER
CONTRACTOR
SI.)H32.OSE CORPORi'f10N
51 WROSE CO1a:F ORA'1`IOIv
72-850 SOMERA RD. -
72-850 SO.MERA RD.
PALM DESIEWr CA 92260
P.ATAIN4 DESERT CA. 92260
(619)346�2840 a CBL# 1137
019,1346'28540
DESIGNERIENGINEER1 /a
USE OF PERMITt;i5t 2 L'15J 4 JAS. n7# M
FEE DESCRIPTION
FEES
CONTRACTAMOUNT OUNT 16,000.00 1,.S
>a,S" "r,,MXfEO COST OF' CONI STRUCfX-# T
16,04H).00
MR:MIT F.151% SUMMARY
PLAN C'1 WK.
CONSTRUCTION M- 1,01.000-418-000 $.171.00
NILICHAN C,AL FEE --.POO 101-000-121-000 $24.00
ELECTRICAL FEE: - P001.. 101-000-420000 `i<45,00
.f?i'..L:TfvMJNG Fkm -- .PoOL 10.1-000419.000
Ip
i
NOV 2
7 1995
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SUB -TOTAL AL CO1'3S't RUCTION iXNle PIJ4,I`r CHECK
LESS 1}.ft:fr-PA:U:):#'EES
$0.00
T0TA*L PERMIT Fi'At S .B ITE 1'�O
TMAL PROJECT 3'��2SY.%•.1,,' FF,,FS
378.15
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
41/
A
INSPECTION RECORD
OPERATION
DATE
INSPECTOR '
OPERATION
DATE
INSPECTO��i
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
Compressor
Insulation
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
POOLS - SPAS
BLOCKWALL APPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Z
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
/Z
Gas Test
Appliances
Final
COMMENTS:
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)
CITY LA QUINTA
E-JILDING & SAFETY DEPARTMENT
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78495 CALLE TAMPICO — LA QUINTA, CALIFORNIA 92253 - (619) 777-7000
FAX (619) 777-7101
December 22, 1997
Sunrose Corporation
48-905 Avenida El Nido
La Quinta, CA., 92253
RE: Pool & Spa #9511-130
Dear Sunrose Corporation
The purpose of this letter is to inform you that your Pool & Spa Permit #9511-130, for the
project at 48-905 Avenida EI Nido, has expired. In accordance with 1994 UBC section 106.4.4,
no further work may be performed until a new permit has been issued.
Please contact Daniel P. Crawford Jr., Building Inspector I, at (760) 777-7012 to obtain. any
information you need regarding a new permit and/or any required inspections. Should you
choose not to complete the project, we would then have to pursue any or all of the following
actions:
1) Abatement of the project through the City Attorney's Office and Code Compliance Division.
2) Notice of non -conforming structure placed upon property profile.
3) Action filed with Contractor State License Board. Optional if Owner/Builder..
Please contact us at your earliest convenience prior to 10 working days to resolve this issue, and
for any questions you may have.
Sincerely,
Mark Harold
Building & Safety Manager
40� D
Building Inspector I
cc: file
dpc
MAILING ADDRESS - P.O. BOX 1504 - LA QUINTA, CALIFORNIA 92253
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