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i LICENSED CONTRACTOR DECLARATION
I h ° reby affirm under penalty of perjury that I am licensed under provisions of
C*lpter 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
6341oi Ilk
t.
Date ���G 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
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(isM4'609q?workers' compensation insurance c&W'0006l cy. 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 orkers' compensation provisions of Section 370.4 of- the Labor
C-iJe, I sh I fh�vith comply wit t ose� ovisio �!
ate: / /> C� APPlicanrr9�.1 f' �.
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 fo Insp ction p3?/nature
es.
(Owner/Agent)/a'� Date
BUILDING PERMIT PERM' 9604 44,4 3217
CONTROL#
DATE (j VALUATION $41.48(8.00 - LOT TRACT
JOB SITE APN
ADDRESS 51-05 AVENIDA 01eV. 773-28,14123
OWNER CONTRACTOR/DESIGNER/ENGINEER
,'r`�llt.f? �-1�:i7r �crr�r lj�js;(srwjr+Ir��o1,C'1� E , to ".1.C)+1�r1
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6337:1UEsLCY RIJ.
LA. Oi RTfA CA 92233 C ATt1R[)RALt;ITY CA 922.34
(61'))3x8-17,17 CItI.ls 1!."
USE OF PERMIT
P1.11;1MI'AIN6
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PLIUM"FNTG }Villi. — SE"Wfli R 1,01-tNEtW10-000
suB-'f OTAL coNs'1'kAja!'ION AN,D PLAN CITE:CK $10.00
RECEIPT ✓� �' 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 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
POOLS - SPAS
BLOCKWALL APPROVALS
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
p0-yv IY6
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole "
Underground Conduct
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)
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SANCO -
PUMPING SERVICE ( '
2502 Morongo Trail
Palm Springs, CA 92264
(619)327-8859
N'_' 10250
SOLD TO JJ
SA/7LLESSMAN
SHIPPED TO L �%
STREET NO.
q STA E
STREET NO.
CITY STATE I/ ZIP
CITY STATE zip
y�
CUSTOMER ORDER
SA/7LLESSMAN
TERMS
A
PAYMENT DUE UPON RECEIPT
05/07/92
Charlotte Ellison
RE: Citicorp Loan #:
Property Address: 52-695 Avenida Diaz
La Quinta, CA 92253-3319
Dear Charlotte:
We received an incomplete assumption package for loan number
0009272508. Please send us the documents indicated below as soon as
possible in order to ensure your closing date.
Flood Insurance or Proof Its No Longer In A Flood Zone
Fax
Your prompt attention to this request is appreciated. We would like
to encourage you to send these documents by express mail. You may
contact your nearest U. S. Post Office or any of the private postal
services listed in your Telephone Yellow Pages Directory under Mailing
Services. For express mail, the address is:
Citicorp Mortgage, Inc.
15851 Clayton Road
Ballwin, MO 63011
Attn: Assumption Department (MS 302)
The seller remains responsible for the mortgage, including monthly
payments, until the transfer is complete and the buyer has been
notified at which time the seller remains liable in the event buyer
fails to make future Davments as required.
If you need further assistance, please call our Customer Service
Department toll free at 1-800-283-79- . When you call or write to us,
please refer to IZSari nutnber: 0009272508. Thank you.
Sincerely,
J
Tammy Hasekamp
Assumption Department
92050700000178
CITICOWO
MORTGAGE
Citicorp Mortgage, Inc.
Mail Station 429
P.O. Box 790029
St. Louis, Missouri
63179-0029
T H E C 1 T Y 0 F
AL
La Uinta
1982 - 1992 Ten Carat Decade
May 14, 1992
To Whom It May Concern:
The structure located at 52-695 Avenida Diaz is located in
an "X" flood zone (Areas of 500 year flood; areas of 100
year flood with average depths of less than 1 foot or with
drainage areas less than 1 square mile; and areas protected
by levees from 100 year flood) per the revised F.I.R.M.
(panel 060709 0005 B, effective August 19, 1991) for La
Quinta.
If you have any questions, feel free to contact me.
Sincerely,
BUILDING AND SAFETY
Tom Hartung
Director of Building an Safety
TH/lc
City of La Quinta
Post Office Box 1504 ♦ 78-105 Calle Estado
La Quinta, California 92253
Phone -(619) 564-2246, Fax (619) 564-5617
Design 8 Production: Mark Palmer Design, 619.346.0772