9511-028 (RPL)P LICENSED CONTRACTOR DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with
r W Section 7000) of Division 3 of the Business and Professionals Code, and my
o Q � License is in full force and effect. 334103 A C 1.0 3�i3ia �
n W^ License # Lic. Class Exp. Date
K
Z r Date Signature of Contractor
((0 Fr`
o) OWNER -BUILDER DECLARATION
J IU I hereby affirm that I am exempt from the Contractor's License Law for the
following reason:
(n ( ) 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).
It ) 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
Cl) Date Signature of Owner
N
O rn WORKER'S COMPENSATION DECLARATION
dQ I hereby affirm under penalty of perjury one of the following declarations:
Cg Z ( ) I have and will maintain a certificate of consent to self -insure for workers'
��cc O 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.
Q 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 U permit is issued. My workers' compensation insurance carrier & policy no. are:
d LO Carrier i o, Policy No. MIA
v Z (This sVIon need not be completed if the permit valuation is for $100.00 or less).
n C ( t'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
%D e, I shalorthwithPPplyi those provisions.
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 application agrees to, & shall, indemnify
& 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.
1 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,inspectionpurposes.
Signatire"(Owner/Date '� f
ALC
x.BUILDING
PERMIT
PERMITi�q (m%i
DATE e�•`�'�`'
VALUATION `-' ,'°b ays LOT
TRACT
JOB SITE ADDRESS ➢ � �
APN 774-1754N
OWNER
CONTRACTOR
71 IF111FAt f (""t ltdSI RI1VTfON.
SOFT CC. &I I)I`:RORM-f 40NZx1I,FZ
E 1' .IBX; CmANY(-')N )FC..
3360 AVENIDA NAVAI RO
PALM SPIUNOS CA 412V4
LAQUiN`IACA. 422S3
(614079-3414 (11A;# 50
(GI4)`<) -62:17
DESIGNE R(ENG [NEER
USE OF PERLa ,#OL ! o F 4
�' .'.}�'t'13AC,'Aa. ttKt�trt`�1�I�t Al'l'idG�►Vt.iy Pr`.tt �!4A, `��'�y `�
DESCRIPTION(,�'���ulp,
FEES
d/ ����1y����11,,FEE�
/,. �
.t�L RA , l N0110Y( >7t"Al d•VV\f.�V LS
`fr%%J ',°S'Ifi�s"�
9,410.P"1
Pf.ANrtfF<'KFIT, i/4�1-/t;�tlrt)4q +>:~�CyY:' S70 Y)
f�<?'Y��•�'�iT ����i��:'�i'�a l° iV�`�:ki1`.•{1i7.-:�`ti� �i �fi"�R ilJy9
�&:CII »F_;AI. FEL P001, 101-000-421-000
kf<F;t,'rAICALYFf-, -KKA. IUI_41U0-4?0-000 �1a.tDf►
PTA f"+SF3tNt1FRE --POOL 101-M-1419-000
140V
0 3 1995
E_ _`113-T(YI' AL CONS f'ItCIC" i ON AND PLAN: `HEC
USS
TtD`A'cAL MUdir IT 147='9ES DUE NOW
`s2UX)
TOT'M. PROJECT Pr.RM ' FEES
274.20
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION DATE INSPECTOR
BUILDING APPROVALS
Set Backs
Forms & Fo. tings
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
Drvwall - Int. Lath
OPERATION DATE INSPECTOR
MECHANICAL APPROVALS *,
Underground Ducts
Ducts
Return Air
Combustion Air
Exhaust Fans
F.A.U.
Compressor
Vents
Grills
Fans & Controls
Condensate Lines
Final
COMMENTS:
Final
Utility Notice (Gas) -
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Low Voltage Wirii
Fixtures
Main Service
Sub Panels
Exterior Receptac
G.F.I.
Smoke Detectors
Temp. Use of Pa
Final
Utility Notice (Per
Final
Final
Y BLOCKWALL APPROVALS
steel
POOLS - SPAS
4/Z /
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
i
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
OX for Finish Plaster
Sewer Lateral
Pool Cover
Final
COMMENTS:
Final
Utility Notice (Gas) -
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Low Voltage Wirii
Fixtures
Main Service
Sub Panels
Exterior Receptac
G.F.I.
Smoke Detectors
Temp. Use of Pa
Final
Utility Notice (Per
L
A
5 FT. lkli
GA7Y
''
L ts TO
SELF-CLOSING
SEMLATCf--ING.
SETY C)EPAFITMENT
WTI
NIT
1010 Ag PER.
Y
4
MEMORANDUM
CASE:�Location(s) : l7t/eDl0,/4-
Request(s),:
r
C-)
Your setback adjustment application is hereby approved, subject to
the following conditions:-
Conditions:
onditions: Conditions:
1. Obtain a building permit from, the Building and Safety
Department..
2. The other Zoning Code provisions shall be met.
.3. If ground excavation is required; please contact Underground
Service Alert (USA) at 1-800-422-4133. The service is free of
charge provided USA is given', at least two working days'
notice.
4. Additional Conditions:
After review it was determined that:
1. This adjustment is consistent with the intent and purpose'of
the Zoning ordinance.
2. There are special circumstances applicable to the property,
including such 'factor's as size, shape, topography, location or
surroundings that justify approval of the adjustment. These
circumstances are:
Tha you fo our cooperation.
Sin¢ rely, '
=achments
evelopment Department
c: Building and Safety_Department
' CITY OF LA QUINTA
PLANNING & DEVELOPMENT DEPARTMENT
APPLICATION FOR SETBACK ADJUSTMENT
CASE NO:
FEE: $100.00
APPLICANT: Submit this form .with two' copies of. a scaled site plan,
drawn to adequately depict the nature of the request. A nonrefundable
fee of $100 is required when the?Application is submitted. Check must be
make payable to the "City of La Quinta".
If the Applicant is not the owner'of the property, a 'letter must be
submitted by the owner authorizing the Applicant to execute this document
in his behalf.
PLEASE PRINT OR TYPE
APPLICANT/CONTRACTOR:
CONTACT PERSON ( IF DIFFERENT ) r,/��%�����/��?,icJ�c��; 7�
MAILING ADDRESS :
(Address) .. '(City)
OWNER'S NAME:
MAILING ADDRESS: �j�'� c 7 /��►'�
(Address)
STREET ADDRESS OF PROPERTY:
C•
14
DATE
PHONE 7y j g
State) (zip
PHONE
(State)- ('Zip)
LEGAL DESCRIPTION'OF PROPERTY: LOT # TRACT
i
ASSESSOR'S PARCEL NUMBER:
r
ADJUSTMENT.REQUESTED:
REASON FOR REQUEST:,�u
JUSTIFICATION:. .No request for a Setback Adjustment shall be granted
unless it is etermined that it is consistent with the intend andr purpose
of this Ordinance;.that there are special.circumstances applicable to.the
property, including such factors as size, shape, topography, location or
surroundings that justify the approval of the adjustment of the setback
requirement, and that the adjustment will not be detrimental to the.
health, safety, and general welfare of the community or be detrimental to
property in the area of the parcel for which the adjustment is requested.
FORM.013/CS
0
L.
CITY OF LA QUINT`^
,tractor ia='CJ ( ��•41;�•t� Address C /'•9���yy;t/ �?
Owner Job Address
This form shall be posted on the job with the Building Inspection Card at all times i
conspicuous place. it is the responsibility of the General Contractor or the Owner/Buil
to monitor the sub -contractors that are on this list are the a4me persons performing
work. Any changes of this list' auat be approved by the City of La Quinta Department
.Building and Safety EEjq to work being performed by a changed ■ub-Contractor. Failure
Comply will result in a stoppage of.work and/or Un voidance of building permit.
TRAbE
SUB -CONTRACTOR NAME
CONTRACTOR'S
WOF3DW COMP.
CITY BUSINESS
LICZNSE NO.
NO_ ON i'IL
LICENSE NO.
GRADE/
�"-//,PAO
EXCAVATE'
/� •� �(,a s�.s
7� ,4
PIPELINES
CEMENT/
y i -
FOUNDATIONS
�� ^��
417A 14P7
CEHENT/WALKS
i DRIVES
ASPHALT
FRAMING
STEEL/
STRUCTURAL
MASONRY
PLUMBING
Air O —
00y� Jia
4
LATHING
DRYWALL
PLASTERIN
1%
4/077' ,o
r ®
i -e Q
RVAC
ELECTRICAL
�a ✓�o .- ���s
y "C7
�.t
� /� �/+
ROOFING
SHEET METAL
FLOORS.
GLASS/
GLAZING
INSULATION
.SEWAGE DISp
PAINTING/
DECORATING
TILE •K c C�7�
% Q
CABINETS/
INSTALLATION
ORNAMENTAL
METAL
FENCES/
BLOCK BALLS
LANDSCAPING
OTHERS
5
LO
TA'yl 4.
78-495 CALLE TAMPICO — LA QUINTA, CALIFORNIA 92253 - (619) 777-7000
OF FAX' (619) 777-7101
December 22,y 1997
Jose R & Deborah Gonzalez '
53460 Avenida Navarro -
La Quinta, CA., 92253 7
RE: Pool & Spa Permit #9511-028 _
Dear Mr. & Mrs. Gonzales
The purpose of this letter is to inform you that your Pool & Spa Permit#9511-028, for the t ,
project at 53-860 Avenida Navarro, 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 tc obtain any
information you need regarding a new permit and/or any required inspections. Should you a
choose not to complete the project, we would then have to pursue any or. all of the following
actions: t
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 1.0 working days to resolve this issue, and F"
for any questions you may have.
Sincerely, .
Mark Harold
Buildin & Safety Manager
-Daniel P. Crawford Jr. '
Building Inspector I
cc: file
dpc
MAILING ADDRESS - P.O. BOX 1504 LA OUINTA, CALIFORNIA 92253 � l
i® • rn