0206-019 (RPL)LICENSED CONTRACTOR DECLARATION
I hereby affirm under pe,talty of perjury that I am licensed under provisions of
Chapter 9 (commencing with Section 7000) of Division 3 of the Business a662
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
Date *'1/ 40' `1--' Signature of ContractV,
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
O I am exempt under Section B&P.C. for;this reason
DateSignature of Owner }A_ ,V,
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 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 $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions., set forth -on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant *to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date .of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) •,.�.-� `` Date Ah 1%1=
' PERMIT N
BUILDING PERMIT,L_�
_
DAhc VALUATION ! LOT TRACT
vAPN
JOB SITE j,
ADDRESS
OWNER
CONTRACTOR / DESIGNER / EN (NEER
0id!1kUKTuBUTLD
79-030 1JOITA-ADFUDE
LAQUI •IA CA 9212,53
USE OF PERMIT
PLtiOL .,�'�Tlfcyk .A
PCyPUSPA., AA1_A1UAS#°$A1,1RIVRS St4A1 L BE IN PLACI? r ID1.1. TO
;r OOL Azo Eat ROTIA t
d:b GlTUFde` 1,M)CW/S OF RaO :3M1�!UTI[ON
27h3ltltioM
�l�l�i3;�i ��� fii'ilt� .its•
k'1.A14 (34SM REX, 101.000-439.338 V117100
COAI.I'fia,',UCTION MR 101-t' W-41810(4) $180.00
McWlICAL FRE — POO"t.r 1014000 4211.000 $24.00
i�pp.$X�a `"�fTtRIC'.A,L PRE. — k',Ui OI„ -.000$45.00
11.�o?
1'�1et�dY��c/�M0 PA.�'r POOL J.M1. 1-000-4!'�i-�i�00 $27.0
G
-TOTAL C�f7 �i iS "�'�O �114D t"':TJW C�l;��,(y.
M. 3 PRE-PAIT) 17,630
�':$� ;.CSC
V1,00
DUE NOW
IV!
f
JUN 0 7 1001
cmrOFLAQUIMA
[RECEIPT g c n:
DAFINAL2ED
INSPEC
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
steel
POOLS - SPAS
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
Watbr Piping
Plumbing Final
_
Plumbing Top Out
Equipment Enclosure
Shrper Pans
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
- �Z
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:
CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
DAT& -L'0-2-- BY
0. ? /Lv?;
A
CITY OF LA QUINTA SUB -CONTRACTOR LIST 049lo i (IDI/
JOB ADDRESS�79030 PERMIT NUMBER OWNER BUILDER l
This form shall be posted on the job with the Building Inspection Card ous lace
at all times in a conspicu. Only persons appearing on this list or their employees are authorized to work
on this job. Any changes to this list must be approved by the Building Division prior to commencement of .work. Failure to comply will result in a stoppage of work and/or the voidance
of buildino permit. For ear_h annlicable trade_ all information rPrniPctPrl hpinw miict ha rmmnlPtPri ht. tanndinnnt °nn Mac° ic nit nn
Trade / Classification
Contractor
State Contractor's License
-- -r-
Workers Compensation Insurance
City Business License
Company Name
Classification ,
(e.g. A, B, C-8)
License Number
(xxxxxx)
Exp: Date
(xx/xx/xx)
Carrier Name
(e.g. State Fund, CalComp)
Policy Number
(Format Varies)
Exp. Date
(xx/xx/xx)
License Number
(xxxx)
Exp. Date
(xx/xx/xx)
EARTHWORK (C-12)
0-1:2
,71
CONCRETE (C-8)
FRAMING (C-5)
STRUCT. STEEL (C-51)
MASONRY (C-29)
f
PLUMBING (C-36)
/
z
LATH, PLASTER (C-35)
—C-5'3
Q_ 99
5 4eati
Ml�-0(060
LM
DRYWALL (C-9)
HVAC IC -20)
ELECTRICAL (C-10)
js
LOU
ROOFING (C-39)
SHEET METAL (C-43)
FLOORING (C-15)
GLAZING (C-17)
INSULATION (C-2)
SEWAGE DISP. (C-42)
PAINTING (C-33)
CERAMIC TILE (C-54)
CABINETS IC -6)
FENCING (C-13)
LANDSCAPING (C-27)
POOL (C-53)
i 71C
21,
57�-7`E ,✓
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JUN,-06-02,04oa6 AM TOOMBS 925 462 0692 P.01
June 6, 2002
City of La Quinta Fax 760 777-7011
Building and Safety Department
C/o Rd Randall
Dear Ed:.79030 Ladera Drive - La Quinta
This is authorization for Marcello Terrazas to purchase the pettnit to install the swimming pool at the above
address.
If there is anything else you need, please advise,
Thank you,
�ki
n ✓
Kathy Comerford
D & K Comerford Family Ltd. Partnership
Email, Donkathcomeilb (Amsn.com
Cell 510 5048653
F