0007-252 (BLCK)LICENSED CONTRACTOR DECLARATION
I hor:by affirm i inner 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
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 f
DateSignature of Owner
WORKER'S COMPENSATION DECLARATION„/r
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).
( 4 1 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: /r.. r,f r1.- Applicant R;y; : 1J��- ,,4
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, 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 representatives of this City to enter upon
the above-mentioned property for inspection purposes. ;
Signature (Owner/Agent) •f _' '' %f� -' —Z -Date
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BUILDING PERMIT PERMIT#
DATE VALUATION LOT 0007- S1 TRACT
$13,675.00
JOB S-Iyt
APN
ADDRESS 77^M CA.I.IK TA.AMCO
OWNER
CONTRACTOR/DESIGNER/EN INEER
PA11M ZAMM
OWA11 WI31:7R I51;:k .
50.555 VISTA MONUI-TA
LA QI304TA CA Sd2253
�. CBLH
USE OF PERMIT
(MMAL 33UJIMIN'G
347 L.P. 64I (t.AiJ:)ZN WALL , CITY" STANDARD &VAMOVS SITZ
IMPAOVE1u 91 TS AS PER APPROVED PWWR C-iNLY
t
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6 Ia'1. NVALL 347.00 LP
»UR". TED COQ or CONS71RUCITON
%675.€1)
1?ERhff 2i FE gUAWA ZY
C014STR,UCTION FEE 101-000-418-000 E108.00
ELECTRICAL FEE 101-0.00420-000 SZf1.00
t`
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19OB-I AL CONSTRUCI.I.011 AND PLAN CHW11
$128.00
LUSS MI -PATI) F EW
$0.00
WDAL PERMMFEEN DUE NOW
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RECEIPT
DATE DATE
By ! "
DATE FINALED
INSPECTOR
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 DeckExhaust
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
z
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 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
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Vottage 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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Citya u ointa
•
Developers Project Approval Form
ti
Prior to the issuance of•Building Permits for the project listed below, the following Departmental
clearances must be obtained. Please return thia_ form to the Building and Safety Department�y
after approval. Contact applicant for resolution of conditions preventing or delaying approval.
Project: 77-855 Calle Tampico
ments &Landscaping Plan
Exterior Site Improve
Applicant Contact: Patricia Zacker/Bill Hanes: 347-8096 or 564-3847
Application /_Circulation Date: 7/18/2000
Date
Community Development Department
Gtiv`-�Gt�nrr� -,r
-00
Christine di Iorio, .Planning Manager Date
Public Works Department
Steve Speer, Senior Engineer Date
Building and Safety Department .
Greg Butler, Building and Safety Department Manager Date
Health Department
Fire Department .
Schools Fees Paid
Date
Date
Date
City_ oLa Quinta
Developers Project Approval Form
Prior to the issuance of Building Permits for tf-e project listed below, the following Departmental
clearances must be obtained. Please return this form to the Building and Safety Department on
gfter approval. Contact applicant for resolurion of conditions preventing or delaying approval.
Project: 77-855 Calle Tampico
Exterior Site Improvements & Landscaping Plan
Applicant Contact: Patricia Zacker/Bill Hanes: 347-8096 or 564-3847
Application / Circulation Date: 711812000
Date
Community Development Department
Christine di Iorio, Planning Manager Date
Public Works Department
T 7 2.l bd
Steve Speer, Senior Engineer ate
Building and Safety Department
.Greg Butler, Building and Safety Departmen_ Manager Date
Health Department
Fire Department
Schools Fees Paid
Date
Date
Date