0301-204 (MISC)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
407599 C2- C- - 13 411 Q114
Date '. "ignature of Contractor t
i
OWNER -BUILDER DECLARATION f
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.
( ) 1°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 `1,8' r FL.TN 7 Policy No. IS42844-01
(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/aree that if I should become
subject to the workers' compensation prQsionfSection 3700 of the Labor
Code, I shall forthwith comply with th se p� 4iis' f�
Date: /r 4r�1Aplicant .7 Fe !/ il�_
Warning: Failure to secure Workers' Compensation coves a 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 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 above-mentioned property .for,nnspe•tioH purpposes y ,/
Signature (Owner//Agent, �:� 'a y �' 'Date-/ ?
PERMIT # fto
BUILDING PERMIT
030.204
DATE VALUATION aygDa LOT TRACT
JOB SITE n
ADDRESS . W-2 l5;AWKWA MV4M
APN
l
OWNER_
CONTRACTOR DESIGNER /EN 1NEER
Crr 0) uk (-Uw,
yL.C?LDpY03W
18-4-9.5 C ALLE d°AMPTCO
X54 -MA.0 C'C)U'.E r P L' m Dron'a
LAQUINT..A. 0A 92253
LA Q'Ml 'A (16A 922.13
17�i+�?13��•�30"J. r'1<'��1� 24.4''
USE OF PERMIT
WYMMAXION
R/R AIC C,OND,; ADD 3 MT. .U't3i8`P�, � � F. 2.9 CA:1�OM WALL;
1 :1 n>µl 1J 4:1� COLUMN Ch� d l e EiFMA19 WOOD F ENG"E
VA1,UATION 6, 51 . {3 is
TKOFMIATED COST OF CONSYRUMQK
I'm
?p21al, PRE iSC0��M.�URY
ti
wOiam b Fa 101-000421-000
t!Y.i'+.., TR1C.i',t,1rU 101-000-420-000 i4 5
SUB-`! M L CG;.NMIJ'C"1:'ION,AIR) PUN c~IMCK
$50.29
LESS Ppx pda:.D
$0.00
e
� •1'4
q
. J✓ 2 9:dl,l.P'.h2.t .5���r3�. C.��',v.".e A9OPBW
1.�'w�cfd�`I
U10-715
JAN 15 1003
CITY OF LA QUINTA
FINANCE
DEPT. j
i
RECEIPT
DATE
BY
DATt FINALED
INSPECT
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE TINSPECTOR
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
BLOCKWALL APPROVALS
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Bond Beam �' ci3
Main Drain
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)
COMMENTS:
La Quinta Housing Authority
78-495 CALLE TAMPICO
LA QUIINTA, CALIFORNIA 92253
June 12, 2013
Building Department
City of La Quinta
78-495 Calle Tampico
La Quinta, CA 92253
Re: Property Owner Authorization
TEL (760) 777-7120
FAX (760) 777-7011
The La Quinta Housing Authority is the owner of record for property located at 53-
275 Avenida Navarro, La Quinta, CA 92253. On behalf of the La Quinta Housing
Authority, authorization is given to property owner George Clohessy and Henry's
Masonry for construction of a common property line block wall. The construction
of the common property line wall shall be constructed between the adjoining
properties referenced below.
Adioining Property 1
La Quinta Housing Authority
53-275 Avenida Navarro
La Quinta, CA 92253
Adjoining Property 2
Mr -George Clohessy
53-313 Avenida Navarro
La Quinta, CA 92253
Should you have any questions, please do not hesitate to contact me directly at
(760) 777-7120.
Sincerely,
�4
Carla Triplett
Housing Coordinator