9711-050 (PAT)U)
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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
016-73.15 B 3131{49
VDate ?� T Signature of Contractor / I ` �'
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 issued.. My workers' compensation insurance carrier' & policy no..are:
Carver Policy No.
E`CIlimp'ION ON FILE
(This section need not be completed if the permit valuation is for $100.00 or less).
(A)� 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:
VDate: /�'1 "✓/'v 7 Applicant -9L
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.
Z. 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.
s,•
Signature (Owner/Agent) Dateff�='
BUILDINGPERMIT PERMIT# CONTROL#
DATE VALUATION LOT 9711-050 TRACT 627-3
l
h , S2,899.40
JOB SITE 1
APN
ADDRESS
50-115 DORAL, STREET
769-651-003
OWNER
CONTRACTOR / DESIGNER / ENGINEER
JOHN & MAUREEN SKEESE
NUMMIIF CONSTRUCTION
50115 DORAL ST
39060 I{rUMANJARO CT,
LA QUINTA CA 92253
PALM DESERT CA. 92211.
(7610345-7998 C81fi 3798
USE OF PERMIT
ux •t�tr�
2i.is S:E. PATIO COVER
PORCH/PATIO 218100.%F
ESUMATED COSTO .00NS1'13UC1'10N
1,899.40
'PERNIff FEC SUMMARY
PLAN CHEMX rEC S35,10
COMSTRUCTION,FEE 101 -(x}0 -4118-000j $54.00
ELECTRICAL �'FF tot -4130-420-Of10' 9 $13.00
ti3'{'RO'N•GA1011ON fEM-'RE81b t01-004-.241-000
�
'I
J PAID
N(
SUB -TOTAL CONSTRUCTION AND PLAN CIUCK
$104}ii0
CESS PPE -PAID FEES
50.00
TOTAL PERMIT FEES DUE' NOW
�1fl4.�:fl
RECEIPT
DATE
BY"
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR.
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings Z- _
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
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 Lines
Neater 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 77 wt—
t -Utility Notice (Gas)
Utility
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring 7 2 -
Low Voftage Wiring
Pictures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
CITY OF LA QUINTA
SUB -LIST
n
CONTRACTOR k U IF j k 6rple L. (+j ?)I4 ADDRESS L vi PA11h?
N/:zr
'
OWNER t te u1K e.c, St. JOB ADDRESS 50 11A_4)wbq^
This form shall be-iDOStecLon the iob_with the Buildina InsDection Card at all times in a consDicAms Mace.
It is the responsibility of the General Contractor or the Owner/Builder to monitor the sub -contractors that
are on this list are the same persons performing the work. Any changes to this list must be approved the
City of La Quinta Department of Building & Safety pfm to work being performed by a changed sub-
contractor. Failure to comply will result in a stoppage of work and/or the voidance of building permit.
TRADE:
SUB=CONTRACTOR':S
NAME:
TYPE=;OF
LICENSE
STATE
CONTRACTOR'S
LICENSE
NUMBER
<WORKER'S
:COMP. NAME/
NUMBERON FILE
CITY
BUSINESS
LICENSE
NUMBER/
EXP. DATE
GRADE/
EXCAVATE
A/C -12
PIPELINES
C-34
CONCRETE/
FOUNDATIONS
r
N Cis
C-8
` C
5 Ra
ASPHALT
A
FRAMING
B
33510041P
_qj 0o0o %66
STEEL/
STRUCTURAL.
C-51
MASONRY
C-29
PLUMBING:
C-36
LATHING. -
C-26AJ_Ad019
tAuX*7a8w- 00
4&f2-
&42DRYWALL
DRYWALL
p 1 P
C-9
PLASTERING
C-36
HVAC
C-20
ELECTRICAL
(General)
L L G+
C-10
(^ �
51
6X9 3010gccl
5`� 2�R8
G Z 1 U
ROOFING j
SHEET -METAL.
ADVAdSGE
C-43
I 3i
STATe M 1,406
0-11(002-3-qa
sb 3
FLOORING:
C-15
GLASS/
GLAZING':
C-17
INSULATION
C-2
SEWAGE DISP:..
C-42
PAINTING/
DECORATING
C-33
TILE:`
C-54
CABINETS/
INSTALLATION:.
C-6
FENCING
C-13
LANDSCAPING.:<::.
C-27
POOLS .C-53
OTHER
H..,.H I L F'RCGF r1G1.1T
619-#-,5680324
VAI.L PROPER'rT N i-V?'GE: EVr
P. o. Box 1.03292261.
PA,L;i AEJERTI 563-27�L7
(760)
October 18, 1997
john & Maureen Skeese
10856 Morrison �SSt 9601
N. Hollywood,
RE: r 50=1i..5�Db al .
Dear Mr & Mrs Skeese:
Your Architectural variance Request for a rear yard patio
iewed by the Architectural Committee.
extension was rev
The Committee approved your request with the foll'ow�ng
conditions:
All necessary city. permits are received
�- No construction debris/materiad
will be visible
to the street at the end of they installation
-- Any damage to the common area during
will be your responsibility
Thank you for your cooperation.
Sincerely,
cam Anderson
Project Manager
F•. !-I