0306-368 (GRES)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
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
b 111110 re+r2(
bate o°� Signature of Contractors �+�+ A
OWNER -BUILDER DECLARATION V w
I hereby affirm under penalty of perjury that I am ekempt 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).
( ) 1, 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 A.
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:
Carrier STATE FUMD Policy No. IWI18-0
(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,Sectio 3 700 of the Labor
/Code, I shall forthwith comply with tho"�e•prouisio s.
Date: Applicant `i �✓
� _ m
Warning c—
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 inspection purposes.
Signature (Owner/Agent) Id, �t lm / r, Datelot
�'"�i•+�
PERMIT#,,,
BUILDING PERMIT
r,
DATE I __VALUATION LOT ''" �°`"-' TRACT
JOB SITE';.
ADDRESS:
APN
OWNER '-
CONTRACTOR/DESIGNER/EN (NEER
1VVM.BUZ GORD0K .
S.C. CoNsn yC Tdom
PMM J.)T S t.T CA 92261
060776t16085 mi# 5971
USE OF PERMIT
OARAOF, OR CARPORT
REMYVE UNPE:RMITTED ADDITION AND.RESTOTv,>r' TV CARPORT PPR,
AP1s2tafED PLANS, DEMOLITION SHALL ONLY BE DONE ON THE PORTION
MODIFIED TREE Y'1'.AM A00-
(0.VA
UATION : ,000.tat► IX
VALUATION
_V9MgA°A.'PJJ COW Or CONSIIWC71ON'
PERMI'.VEE 901AWARY
REQ! CI•-MCK FEE 101 -0 60-439-3 $35.10
CONSTRUCTION FEE 101--00-41.$9-000 $34.00 .
DXMOLITION AEE 101-000-423,000 $450
_Q.
.$134.10
rC' iC3;*3 A 3 Pi i CU
D �
U1,58 FRri.-PAM':n.
$0,00
JUL. 17 ?O 1 ' mrir ns wit WOW
CITY OF LA {NTA
FINANCE DEPT
RECEIPT DAT-E�j J/ BY .. '" DAT F NAL INSPEC
• �R� f S'! .� .-.!"ter. �/\/)
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�1
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 p
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 Unes
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:
-
I
#
-
City of La -Quinta ®R A
Building 8L Safety Division - A5.51&AI.
P.O. Box 1504, 78-495 Calle Tampico
Quinta, CA 92251 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
'I -La
0
Project Address:
Owner's Name:
Owner "s Name:
A. P. Number:
Legal Description:
r IIr
P71'.
Project Description:
NA
State Lic.#:-
City Lic. #:
Arch., Engr., Designer:
D 0
Address:
/4 -Z -D I 7—r o A--, 7j,,ar Z>ovr— 4v -A ,,-r
City, ST; ip:
P 6q,4, '7'-5
Telephone: eve
.Stlaic. #:
— of
Name 0 Person:
Construction T pe:
Y Occupancy:
Project type (circle one):. New Add'n Alter- Repair Demo
X Sq. Ft.: I # Stories: # Units:
Telephone # of Con Person:
stimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
Submittal
keq'd
Rec'd'
TRACKING
FEES
Plan Sets
Plan Check submitted
/PERMIT
6 Zp
Item'
. Amount
Structural Calcs.*
Reviewed, ready for corrections
Plan Check Deposit
Truss Cales.
Called Contact Person
Plan Check Hal ance
Energy CaIcs.
Plans picked up
Construction
Floodplain plan
Plans resubmitted
Mechanical
Grading plan
2"d Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
H.O.A. Approval
Plans resubmitted
Grading
,IN HOUSE:-
Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
f o�
(I
LI
,y OF
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,
To: Greg Butler; Building & Safety Manager To CDD: 6-23-2003
From: Oscar Orci, Planning Manager!Due date: 6-30-2003 w
Status: 1 ST review
Building Plans Approval
(This, is an approval to issue a.Building Permit)
The Community-Development-Department has reviewed the Building Plans for
the following project:
Description: Non-conforming, non-permitted addition Reversal ?
Address or general location: 51-133 Avenida Vallejo
Applicant Contact: Michael Sidenfaden 341-3157 ,
The Community Development Department finds that:
❑. ...these Building Plans,do not require Community Development
Department approval.
...these Building Plans are approved by the Community Development
Department.
❑ ...these Building Plans require corrections. Please forward a.copy of the
attached corrections to the applicant. When the corrections'are made
please return them to the Community Development Department for ;
review.
Oscar Orci, Planning, Manager Date
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