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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
r -3—f
1 C- Utz 10131/97
r�_ Date,Signature of Con't'ractor }r —"'�--
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.
�C) I have and will maintain workers' compensation insurance, as required by
Section 3,7,00 off'
f the Labor Code, for the performance of the7)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 Californiadan� gree that if I should become
subject to the workers' compensation provisions -of Section 3700 of the Labor
Code,�l.-shall forthwith comply with those,provlslons.
V Date: Y�L -1 7Vf; . Applicant ' w:d
'Z Z w
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 authorizei representatives of this City to enter upon
the above-mentioned property forJnspection purposes.
uSlgnature (Owner/Agent) J� t/ J- >"`� Date-
. /
yw R°`"
BUILDING PERMIT PERMIT J/ °°NT�-1 52 412
,9
DATE 9/2j/#() VALUATION $1.4500100 LOT TRACT ya
JOB SITE
ADDRESS SM 7 AVE' Dt ,
APN 773411 t-020
OWNER
CONTRACTOR/DESIGNER/ENGINEER
&10.4 P RJ C
fiCONO SEWER SE1t� I E
52927 AVENIDA I7.lAL -
PO BOX 021
L,A. CST. INT'A CA. 92253
PAIAM DESERT RT frS 92261
USE OF PERMIT{{
qq 'r( SS s Y1
iAi.sl.I �'1.1'�if •i�
sECync ABANDON, •S33MUZ (70NN'L?G' MON
•_-?n t �.5' 111 . t A
FAgTMIA• C1) COST OF CO NS'i•R1JCTIG,IN
.d,m0.i111
tIIstaKMIT1 0,SUMMARY
!4 #,r1 RIN f'F'.fiT - EWER. 101-000-419 40) $30.00
"Y'
530,00
1.4SS PKK -PAID FEES
0000
n
1 ` 'TOTAI, PERMIT MRS DUE NOW
S:3[I.tT11.
�g96
.
tav A
RECEIPT
DATE
BY
DATE FINALE D
INSPECTOR
.
i'1../
INSPECTION RECORD
OPERATION
T77;ATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms 8 Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air ,
Roof Deck
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills ;
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final '
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection 4yr
Encapsulation
Gas Piping
Gas Test
Ap liances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring.
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
F nal
lklily Not' _(Perm)
�LATE/q ESTAKISHED.IN 1918 AS A PUBLIC AGENCY
°�srA►c�
COACHELLA VALLEYWATER . D.1 STRICT
POST OFFICE BOX 1056 • COACH ELLA, CALIFORNIA 92238 • TELEPHONE (619) 3982651
DIRECTORS
TELLIS CDOEKAS, PRESIDENT
RA'ih+Pdic n. RUMMM03, NCE PREOMUrf
JOHN W. WADDEN
DOROTHY M. NICHOL$
THEODORE J. FISH
September 19, 1996
Department Building & Safety
City of La Quinta
post offiGe.Box 1504
La Quints, California 92253-1504
Gentlemen:
THOMAS E. LEVY,
OWEN Mc
ANDSHERRILL,
OFFICERS
INGINEER.•
File: 0772.
Subject: 52-827 Avenida Diaz
Assessor's Parcel No.. 773-311-020
We have reviewed an inquiry regarding the sewer service to the above property,
Account No. 606122,213.0.0.
In researching.our records, payment for 'the sanitation capacity•charge was.pa
on January 3, 1992 on MCR No. 36814.
This parcel has met the sanitation capacity charge and annexation.requiremen.
of this district. A building permit may be issued.
If•you have any questions please contact Richard Shonerd, water service
representative, (619) 398-2661, extension 236.
Yours very truly,
oor Tom Levy
Generai' Ma#iager-Chief Engineer.
RES:rs
TRUE CONSERVATION
USE WATER' WISELY
+::+; TOTAL PAGE
900NO SEWER SERVICES
P.O. Box 192
PALM DESERT, CALIFORNIA 92261
jam 0ma O ffim
47718
PHONE 328-7760 346-2793
CUSTOMER'S ORDER NO.
PHONE
MEC IC
HELPER
STARTING DATE
E COM D
WO DERED BY
TOTALAMOUNT
$
BILL TO
ORDER TAKEN BY
^
ADDRESS
Q DAV WORK
CONTRACT
CITY
Y
EXTRA
JOB NAME AND LOCATI
JOB PHONE
ION OF
PAYMENT TERMS NET 10 DAYS FROM DATE OF SERVICE
1%% PER MONTH CHARGE AFTER 30 DAYS
TOTAL MATERIALS
TOTALLABOR
121 -E ASP PAY FROM TWIS INUOICIE
NO STATEMENT WI BE MAILED TAX
E COM D
WO DERED BY
TOTALAMOUNT
$
/ V
Signature
PNOM0 25&2 E'es Inc
Grd. Mm 01111.
f% No one home [:] Total amount due
for above work: or
I hereby acknowledge the satisfactory completion
of the above described work
Total billing to
be mailed after
completion
of work