9608-026 (PAT)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
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). Ld,(
O I am exempt under Section B&'.0 forasons r^
Date t.. Signature of Own 4 a
..�� �• -
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:
Carrier Policy No.
(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 provis ons of Section 3700 of the Labor
Code, I shall forthwith comply wjth those pr visions. .
Date: ./, Applicant
Warning: Failure to secure Workers' Compensationlov rage is unlawful and
shall subject an employer to criminal penalties and civih i es up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby But erize r (Resentatives of this City to enter upon
_r Ir
the above-mentioned;pro�Le,f'nsecti n' oses.
Signature (Owner/Agent) Date
BPERMIT# CONTROL#
BUILDING PERMIT3838 �$'►���� 3 8 3 8
DATE VALUATION ��+�< LOT TRACT
JOB SITE 52-:":S AV,I;NIDA VELMSCO
APN 773-311%.1ilixi
ADDRESS
OWNER
CONTRACTOR/DESIGNER/ENGINEER
C11FRY1, VAN CiA&LE
OWNER BUR -DER.
5290 XV Nt'0A VM;AgiS O
LA QUIN T'A, CA 92253
01 IR
USE OF PERMIT
P,A i O
1,,A371CF, PA'I'10 8 X 40
J!'XIINIATE'D COSI' i"3I+ (".C3N:+r"'1'litfiJCfION
$x,256.04)
N.i+;.it11' IT <$1.l1l4MARY
PIAN CREC K, VVC,- tOI-OW-4391319 <S46.60
C' 101 -ON -118-000 $72.114
S'1'��`'1+ic'E T�:1.C,`t'i01V f�t�:E-It1i41.fa ltif-(NIS-l�SI�iD4)� $.50
S1,113 -119M, (.'0'1h4STRLfC`T0NN ANDPLANCTIECK
$119,30
LI,SS PRE -PAID FTES.
1$0.00
TOTALt PERAHT FE&S OVE 1vOW
SI19.30
RECEIPT
DATE
BY �, s
DATE FINALED
INSPECTOR
V /,
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
E*RM& 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
Final I
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
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)
78-495 CALLE TAMPICO — LA GIUINTA, CALIFORNIA. 92253 (760) 777-7000
FAX (760) 777-7101
TDD (760) 777-1227
December 18, 1997
Cheryl Van Gaale
52-905 Avenida Velasco
La Quinta, CA., 92253
RE: Patio Permit #9608-026
Dear Mrs. Gaale
The purpose of this letter is to inform you that your Patio Permit #9608-026, for the project at
52-905 Avenida Velasco, 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,
an
for any questions you may have.
Sincerely,
Mark Harold
Building & Safety Manager
Daniel P. Crawfor Jr.. -
Building Inspector I
cc: file
dpc
,
MAILING ADDRESS - P.O. BOX 1504 - LA OUINTA, CALIFORNIA 92253() `+: