9712-115 (BLCK)M
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LICENSED CONTRACTOR DECLARATION
" I hereby alifirm 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
74" 117 A
,/Date •i , �. � � / iSignature of Contractor ,,�_
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I amexEimpt from the Contractor's
License Law for the following reason: II
( ) 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).
( ) 1, 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.
(X,, 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.
s;i'X1J,r's F U40
49-Vi'UNIT 00118993
(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'
J 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' compensatio'n'provisions,of,Section 3700 of the Labor
Code, I shall forthwith comply, with those provisions..,
vbate: 7iT .t�! (Applicant •--fir
Warning: Failure to secure Workers' Com&nsation`coverage�s unlawful and
shall subject an employer to criminal penaitiA-and civil fines ul:No $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 allrCify, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for iA`ssspection.purposes.1
/Signature (Owner/Agent)-" x 1•'`-� Date
PERMIT # CONTROL #
PERMIT
`BUILDING
DATE ' f VALUATION LOT TRACT
.6639
��`JL 4 -7
JOB SITE I .
ADDRESS / 49-305 AVJZNH)A P,L N11X)
APN
OWNER
CONTRACTOR/DESIGNER/ENGINEER
GEOR,G) A CLARI 3': {
I.:Smt,:r 1203Si11111N i SERVICE'S
51275 C[\LI F. t �USZ'U .
51275 CtW X, (; U 0
t A QUINrA CA 42253
i.A QAWA C.R. 92253
(11sd1)771-1:�fl4 _ C"F1,� 4�?sa
�g
USE OF PERMITBUILDTINO
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1997
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LESS C RU -i -RIVE', FES
$1.00
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S�•3.t�L
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
r BUILDING APPROVALS
'MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Foo; ngs
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
BLOCKWALL APPROVALS
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings_
Main Drain
Bond Beam 3
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 Our
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
t
Final
l'II* Notice (Perm)
COMMENTS:
LSMG CONSULTING SERVICES
P.O.BOX 937
LA QUINTA, CA. 92253
MR. MARK HARROLD, BUILDING & SAFETY MANAGER
CITY OF LA QUINTA
78-495 CALLE TAMPICO
LA QUINTA CA 92253
SUBJECT: 49-305 AVENIDA EL NIDO PROPERTY LINE WALL
DEAR MARK:
DECEMBER 14, 1998
RECENT DISCUSSION WITH MR KIRKLAND AND CRAWFORD REGARDING THE PAINTING OF THE
OPPOSIT SIDE OF THE NEW WALL, WILL BE POSTPONED UNTIL THE ABSENTEE OWNER
RETURNS
IN MID FEBRUARY. THE LAST DISCUSSIONS I HAD WITH HER SHE INDICATED THAT SHE
WANTED
THE WALL COLOR COATED TO MATCH HER HOUSE. SHE DIDN'T GIVE US APPROVAL TO
PROCEED
AND IF WE JUST PAINT THE WALL APPLYING THE COLOR COAT OR STUCCO OVER THE PAINT
MAY CAUSE ADHESION PROBLEMS.
IN ORDER TO PROCEED WITH THE FINAL AND CERTIFICATE OF OCCUPANCY IT WAS AGREED
THAT LSMG WOULD EITHER PAINT OR ABIDE BY THE WISHES AND CONTRACT BY THE OWNER
NO LATER THAN MARCH 1, 1999, TO ALLOW SUFFICIENT TIME FOR THE OWNER TO ARRIVE IN LA
QUINTA AND
DECIDE WHAT SHE WANTS TO DO.
THANK YOU FOR WORKING WITH US AGAIN.
SINCERLY YOURS,;
MANAG GENAAL PARTNER.