9801-042 (MISC)LICENSED CONTRACTOR DECLARATION
,I,hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 9 (commencinq 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
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).
(�) I am exempt under Section B&P C.gfor.this reason s
Date — /! _Signature of Owned. , (
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 provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.
Date: Applicant
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 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^Inspect io� poses.
Signature (Owner/Agee �rZ--Y ✓ Date
BUILDINGPERMIT - _, PERMIT# CONTROL#
DATE VALUATION LU Isu1� TRACT"
1/'7/98 5.00 �•'
JOB SITE
APN
ADDRESS
77-211 CALLE SONORA
OWNER
CONTRACTOR/DESIGNER/ENGINEER
SAItfUFL WDLEY
77711 CALLF SONORA
LA QUINCA. CA 92233
CELy#
USE OF PERMIT
SPEACIAL INSPECTION PO{t Pim-EXCIS T ING UWM41-1 M P0MODEL
HOUSE PURCHAS'�fJ, 9 �WI'1`I•I ENCLOSM OANI3 ROOM IN 3R0 CAR
0MACE. GAA, RO0A1 NOT IMM -MED FOR SLEIIIING OR AS AD MROW
C, ST COST OF CON$1'[I4lC'['iON
1i.liti
PERMIT FEE SUMMARY
SPECIAL INSPECTION fU1-1 12 OUO 110004
�
PAID
JAN 0 8 1998
I 1 Y ®F [A Q Z.JI NTA
suf3-'I'Om COM;a'TRUChON AND PLAN CHL•'CR
.1 $10011k
TOTAi. PE MIT FEES DUE Now
$100.00
1�
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
l
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE , I
INSPECTOR
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
Main Drain
Bond Beam
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:
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- '-7 7 211 :CALLESONO
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78-495 CALLE TAMPICO — LA OUINTA, CALIFORNIA 92253 - (760) 777-7000'-
t'OF rN� FAX .(760) 777-7101_.
TDD (760) 777-1.227
January 12, 1998 L
Mr. Samuel Godley, r ,
77-211 Calle Sonora
La Quinta, CA., 92253 '
Re: Un -permitted remodel/garage conversion Special Inspection
As requested a special inspection was conducted on 1/12/98 at 77-211 Calle Sonora to verifya ,
un -permitted remodel garage conversion. The following was observed. ,
1. Provide a set of plans reflecting the as built remodel.. State on plans that the room is not
intended for sleeping or fora bedroom. This room, because it exits directly into the garage' may
not be used for a bedroom or for sleeping as constructed.
2. Remove closet pole & shelf in room addition.
3. Provide 1 hour rated self closing garage doors for both non -rated garage doors installed.
4. Repair garage firewall ceiling to maintain firewall integrity. r
5. Provide firewall verification for non-bearing interior garage wall constructed.
6. Garage overall width observed at 19'5"+/-.
If you have any questions please feel free to contact me at 777=7027.
Sincer ly,
a,
r . Daniel P. Crawfor Jr.-
Building
r:Building Inspector I
cc file..
dpc
MAILING ADDRESS - P.O. BOX. 150.4 - LA,QUINTA, CALIFORNIA .92253 `"'~