9511-096 (RPL)P . I * s� LICENSED CONTRACTOR DECLARATION
N P.
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with
r W Section 7000) of Division 3 of the Business and Professionals Code, and my
oco
� O � License is in full force and effect. oI67i5
r- W Xicense # Lic. Class Exp. Date
rZ n date Signatureof Contractor
H OWNER -BUILDER DECLARATION
W I hereby affirm that I am exempt from the Contractor's License Law for the
CIL following reason:
U) ( ) I, as owner of the property, or my employees with wages as their sole
Z 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
N
rn WORKER'S COMPENSATION DECLARATION
0 Q 1 hereby affirm under penalty of perjury one of the following declarations:
Z () I have and will maintain a certificate of consent to self -insure for workers'
L�O compensation, as provided for by Section 3700 of the Labor Code, for the
X W LL performance of the work for which this permit is issued.
p J J ( ) I have and will maintain workers' compensation insurance, as required by
co Q U Section 3700 of the Labor Code, for the performance of the work for which this
O U permit is issued. My workers' compensation insurance carrier & policy no. are:
d rn Carrier Policy No.
It Z (This section need not be completed if the permit valuation is for $100.00 or less).
co ( )"certify that in the performance of the work for which this permit is issued,
O 1 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 $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, intarest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this application agrees to, & shall, indemnify
& hold harmless the City of Indian Wells, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon the
• above-mentioned property for inspection purposes.
Signature (Owner/Agent) Data -
ALCM
BUILDING
PERMIT
PERMIT+/
DATE II11ZW9.N
VALUATION
LOT TRACT
JOB SITE ADDRESS 7& 81.5 SPYG LGASS UILL DR.
APN 769-654-00
OWNER
CONTRACTOR
NUMMIF C'nN.MLR n0N
MIS I. % DOLORES MORMSON
39060 KILIMANJARO CT
W15 SPYGLASS HILI, UR
PALM DESERT CA 92211
LAOUINVAC:A 9223
(olt945-791.38 CBL#
DESIGNERIENGINEER
USE OF PERWT A 11(_1
FEE DESCRIPTION
FEES
€ ORcC€PPATIO 403.00 Sb
F.,S IMATE1; C ST OF CONSS 1'RUC f 10N
5,346.60
11CHI #1't FHE NUM11$ARY
TILAN CMCK. FEE 101-000.439-3121 $32.65
CONS'I`RUTI(ION ITE 101 -M -118 -OW SS1AJ
sToNG mcg' m 1;m. - RF-sw 100-0M2•I1-000 .sz
FJ.FCTKiCAA, ttPX 101-000.4204M S450)
SUB -"AL CONS'MUCTION AND PLAN CHECK
$149.18
GESS PRE -PAID FEES
$0.00
._
D -n r] TU PERMIT FC, UN 011F NOW
.5149.18
UI
DEC 1 1 TOTAL PRO. EX—. r PFRh117.\FF,1ES
149.18
1995 '
t�
,Ry
RECEIPT,01
DATE Y
By
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings — 01
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:
1f
A% A T.L PF..OP P1GrlT OF. 1'94-5680324� F, � «1
i a
Y_
— — .
{
I� ff
i000 1000 -Mm.
AVAIL PROPERTY MANAGEMENT
P. o. BOX 1032 .
PALM DESERT, CA 92261.
(619) 568-2717
DESERT FAIRWAYS
December 7, 1995
Mr. Otis Morrison
78--815 Spyglass Hill DRive
La.Quinta, Cel 92253
RE: Architecture variance Request
Dear Mr. Morrison:
Your recent' request fora patio cover was reviewed by the
Architectural Committee.
The Committee approved the structure with the understanding
that all necessary permits will be obtained from the City of
T,,a Quinta and their guidelines followed:
Should you have any questions, please contact this office.
J
Sincerely,
(\ n
JL '1
Contractor A jL�
Y V t' LH W"
1 N TH
�E
WORKMAN COMP. CITY BUSINESS
NO. ON FILE LICENSE NO.
L J�� Address,
Owndr Job Address
This form shall be posted on•the job with the Building Inspection Card at all times i
conspicuous place. It is the responsibility of the General Contractor or the Owner/Buil
to monitor the sub -contractors that are on. this list are the same persons performing
work. Any, changes of this list must be approved by the City of La Quinta Department
Building and Safety prior to work being performed by a changed sub -contractor.- Failure
comply will result in a stoppage of work and/or the voidance of building permit.
TRADE
SUB -CONTRACTOR NAME
CONTRACTOR'S
LICENSE NO.
WORKMAN COMP. CITY BUSINESS
NO. ON FILE LICENSE NO.
GRADE/
EXCAVATE
PIPELINES
FOUNDATIONS
CEMENT/WALKS
& DRIVES
ASPHALT
-
42
FRAMING
57r
STEEL/
STRUCTURAL
MASONRY
PLUMBING
LATHING
DRYWALL
PLASTERING
HVAC
ELECTRICAL
ROOFING
SHEET METAL
FLOORS
GLASS/
GLAZING
INSULATION
SEWAGE DISP'
PAINTING/
DECORATING
TILE
CABINETS/
INSTALLATION
ORNAMENTAL
METAL
FENCES/
BLOCK WALLS
LANDSCAPING
OTHERS