0210-189 (MISC)r 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
782550 F, Inc � � (A.1.1 I 1121C
Date `WV 7 Signature of Contractor ��✓- -' °''�/�-' `T�-'"�-
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) 1, 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
Date- ... _ Signature of Ownwi
WORKER'S COMPENSATION DECLARATION
l 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.
{ti) 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 SpAr it ts.1l r: Policy No. tb1 1 2.01
(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 proyi ions. -
-• Applicant
of -
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 ori; 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.
nature (Owner/Agent) T, Date. f
BUILDING PERMIT _ PERMIT#
DATE VALUATION LOT TRACT
11.411/141M 16
JOB SITE_ APN
ADDRESS 54-8,71 1Ar�Sr�•A'J�rD Tip'OW 769"447-0 s9 i
OWNER CONTRACTOR / DESIGNER / EN (NEER
I QUIL `.iAO -Irl LAS.11X CYPRINWT,t Y TNC
21939:5 ASGURAR AD 0204
AGt.3JRA d + .,`3 CA 91301I:GOUR A.H(.I..1_S CIA 911301
USE OF PERMITS y
OCT
AYMMUO
S"J'Pkl Mh%N: Kt:.'f0 PE!PY,1't 40.1 ,01 -149 ,RZAC-P A''i'gni,t'I mr)
0.00
WNW RUC TION PUR 101-000-418-000 MIA)
MWkl.iaNICAL FEE 101-000 -421-000 119406
Pb13'-M11f•j'•1C1 YU i01 -CM -410.000 W13639
P'T�AWC:�3£A"'�C
OCT 1 2902�c�p�.�LPklp: a n"EsDUEOW
CITY OF LA QUINT►
FINANCE DEPT. i
RECE11PT DATE BY DAT F LE �� INSPE R
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 Wali Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final _
BLOCKWALL APPROVAI S
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
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:
LA QUINTA VILLAS, LUQ
1651 E,Fourth St., Suite 228, Santa Ana, Califonia 92701-5142
Phone. (714) 540-5403 Fax: (714) 5401818
10117102
Greg Butler
City of La Quinta Building Dept,
78-495 Calle Tampico
La Quinta, CA 92253
Re: Building Permit extension request for Corinthian Model, Plan 20AR Lot#.6 Tr.29121
Greg: I discovered that our Plan 20AR Corinthian Model home N as never final inspected
according to the building permit. The home has been sold and is r;ady for occupancy. We are
requesting an extension and a calculated fee to reinstate.the building permit to q" cilitate a final
inspection ASAP,
The home has been used as a furnished model for the past 16 months. We need to conduct a final
inspection ASAP for the Final Gas Test, Plumbing, Heating -AC and House Numbers. The
Electrical, Landscaping and Engineering (curb & gutter, street)1 ve already been inspected and
approved,
We are prepared to remit payment immediately to reinstate the following permit:
Pemrit #0101-142, Lot#16 Winged Foot Tract#2912155-871 Winged Foot Plat 20AR
Thank you f oryour time and consideration,
Sincerely
Robert I Castro