9712-034 (PAT)LICENSED CONTRACTOR DECLARATION
Uj I hereby affirm under penalty of perjury that I am licensed under provisions of
H
"Chapter -9 (commencing with Section 7000) of Division 3 of the Business and
N W Professionals Code, and my License is in full force and effect. _
License # Lic. Class �If9 Exp. Date
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oZ rl yDate % Signature of Contractor- ' _
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J U C:) OWNER -BUILDER DECLARATION
W W r- I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ a License Law for the following reason:
Z ( ) 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).
w M () I am exempt under Section B&P.C. for this reason
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N Date Signature of Owner
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a Q WORKER'S COMPENSATION DECLARATION
NI- Z 1 hereby affirm under penalty of perjury one of the following declarations:
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O () 1 have and will maintain a certificate of consent to self -insure for workers'
X w compensation, as provided for -by Section 3700 of* the Labor Code, for the
O J • Q performance of the work for which this permit is issued.
Ib Q CJ ( )shave and will maintain workers' compensation insurance, as required by
O U Q Section 3700 of the Labor Code, for the performance of the work for which this
4 permit is issueed-.'My workers' compensation insurance carrier &policy no. are:
Z Carrier €� .4. f ` _t �.. «w Policy No. f% cj cid, C -,Z_/. • -
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(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-ithat if I should become
sybject to the workers' compensation provisions of Section 3700 of the Labor
ode, I sh 11_foAw' h comply wit those provisions.
Date: l t— �f�1 Applicantr��
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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 This
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
cornstruction, and hereby authorize represenatives of this City to enter upon
the above-mentioned propertytfor inspection. 'urposes.
VS (Owner/Agent)?',��!+.,�1ti.0l.,Datelj7
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PERMIT # CONTROL #
BUILDING PERMIT
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97.1 .„ 32
DATE, c�f�4�'% ,VALUATION�`d���s� LOTi TRACT
ADDRESS l �:! 11�1F 3� LANE'JOB SITE
APN 604-292-1AW
OWNER
CONTRACTOR /DESIGNER /ENGINEER
�R�f * i ir'?it il7it rf �t7r�!
M 1-1101NI f 'S 121011 s. _
HIM
1282W, : r1.K )W i-i1,Y`t
1282 W. AAR0W HW
UPLAND CA 91795
UPLAND CIA. 017815
-9999 C'.l`3L f
USE OF PERMIT
I:STINIX..`ED COSI' OF C''0NMV 'KM
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PAHOW
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. DEC 0 8 1997
� CITY ®F
f ' LAOU I I VTA
So fB T(Y-f ' J Ai`If.) RAN C;14r:' 1;k
LESS ["RE-t'AM PE FS
SO.13I?
TOTA L PER Mf7. it CFS DIX, NOW
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J-+�•jtl �
RECEIPT
DATE
BY'
DATE FI LED
b
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
I 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
Framing aC ba f
F.A.U.
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 C�_
BLOCKWALL APPROVALS
Final
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. 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:
NG AND SAFETY DEPARTMENT
PATIO, YARD SALE PERMIT
Applicant's Name Sale Address
It is unlawful for any person to conduct, or participate in the conduct of sales of personal property to the general public by
means of a "garage" sale, "yard" sale, or other sale primarily conducted on any residentially zoned premises, except as
permitted by Chapter 11.88 of the La Ouinta Municipal Code.
Any person (herein the applicant) intending to conduct a "garage" sale, "patio" sale, "yard" sale, or similar sale of per-
sonal property to the general public on residentially zoned property shall file an application with the Community Safety
Office. The applicant does hereby declare under penalty of perjury, or by affidavit, that all items to be sold are lawfully
possessed, owned, utilized and maintained by such applicant in connection with the use of the premises and have not be
acquired, possessed or consigned for the sale. Each sale must have a new permit.
Two sales may be conducted at a particular place in any twelve month period. No sale shall continue more than
seventy-two hours. Sales shall be conducted between the hours of seven a -.m. and seven p.m. only. Merchandise
offered for sale shall not be displayed or stored in public rights-of-way.
Signs advertising the sale are subject to the following provisions:
(1) Three signs are permitted (they are provided); one at the residence, one at the nearest intersection, and one at a
major cross street.
(2) The on site sign must be located on property where sale is being conducted.
(3) Top of sign shall not exceed four (4) feet from ground level.
(4) Signs shall be on private property with owner's permission.
(5) Your copy of this permit must be posted and visible from the street during the sale.
(6) Signs are not permitted in rights-of-way or on any utility poles or traffic control sign posts.
(7) Sign shall be displayed only on permitted days of sale.
(8) All signs shall be removed by applicant at the conclusion of the sale. FAILURE TO REMOVE YOUR SIGNS WILL
RESULT IN A CITATION BEING ISSUED TO YOU.
Any person, firm or corporation violating any of the provisions of this Chapter is guilty of an infraction punishable under
the law.
DATE OF THE SALEy C T' a 3 . C)-00HOURS OF SALE
I have read and understand the above stated provisions regulating garage, patio, and yard sales. I also understand that I
may be cited for failure to follow any of these provisions.
Applicant Signa r ' Date '
I.D. TYPE: I.D.V�d VERIFIED B
EXPIRATION DATE:
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