9804-148 (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
Protessionals Code, and my License is In full torce and effect.
Lfir2icense # 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. 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.
( ) 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.
(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
fora 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, indemnity' '
& 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 rrepresentatives of this City to enter upon
'the above-mentioned prope `florins .ection purposes./f
/Signature: (Owner/Agent)i� d' Dat/�
PERMIT# CONTROL#
BUILDING PERMIT � . e =
-9904.48
DATE ifa��ra VAWATION LOT TRACTJOB
SITE
ADDRESS 77-211 CALLE SONO
APN ,
OWNER
CONTRACTOR/DESIGNER/ENGINEER
SAMUEL GODLEY
:721.1 CALLE SONORA '.
L.A QUINTA CA 9.253
CBL#
USE OF PERMIT
M1SC'•
EMODEL.
3UPPLENffiNTAL PERAOT 'FOR PR&EYSTING UNPERMT1117 REMODEL.-
HOUSE PURCHASED 1.2 .' W!TH.ENC LO',WD GANIE ROOM IN 3RD CAR
HOUSE
GARAGE. C:1AI E ROOM NOT 'MTENDED FOR SLEEPINO OR. AS A.BEDROML
ESTIMATED COST OF CONSTRUCTION
0.00
PERMIT FES. SUL1TM.hi,RY
SUB -TOTAL CONMUMON AND PLAN CHECK
$0.00
LESS PRE -PAID FE
$0.00 '
T&AL PERMIT FEES DUE NOW
'. S0.€ 6
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
r`F
'
INSPECTION RECORD
• OPERATION
DATE
INSPECTOR
OPERATION
DATE
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:
A_ . jun.........
�.�- 78-495 .CALLE 'TAMP ICO LA QUINTA,- CALIFORNIA 9' - x(760) 77i-7000'.
FAX (760) 777-7101
January 12, I998 Y TDD (760) 777-1227
Mr. Samuel Godley -
77 -2 IL I Calle Sonora -
La Quinta, CA., 92253
Re: Un -'permitted remodel/garage conversion Special Inspection
As requested a special inspection was conducted on I/12/98 at 77-211 Calle Sonora to verta
un -permitted remodel garage conversion. The following was observed. fY
I . Provide a set of plans reflecting the asbuilt remodel. State on'plans that the room is not
Y intended for sleeping or for a bedroom. This room, because�it exits directly`info 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 -
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.
Sincerely,
`
Daniel P. Crawfor Jr.
Building Inspector I
cc file
dpc
MAILING ADDRESS - P.O. BOX 1504 - LA16INTA, CALIFORNIA 92253