9703-092 (BLCK)LICENSED CONTRACTOR DECLARATION
T' `-eby 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
Date 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:
as owner of the property, or my employees with wages as their sole
co pensation, 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 m,isignature of Owner A%
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).
Nall
certify that in the performance of the work for which this permit is issued;
I Nall 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 thosg�provisions.
Date: a _ k� 7: j
`^,Applicant //VIA .,o < 'e.
.4 / t��s,• Vs%,..r. s..Nf iy SI V✓
Warnin : Failure to secure Workers' Compensation coverage is, unlawful and
shall subject an employer to criminal penalties and civil fines up to $1.00,000; 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 FI
application. d
1. Each person upon whose behalf this application is made & each person at
whose request and for whose -benefit work is performed under dr 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
e above-mentioned propeNt
tforinspectionpurposes.
Signature (Owner/Agent)f%td : - �' 0 Date � �• �L-1 t'/ '
BUILDING PERMIT PERMIT# CONTROL#
;> tiz 4852
LOT' TRACT
DATE /241.97
VALUATION S324.7
JOB SITE ADDRESS 40- 75 WASH�i�iG ON STREET
�
APN '
OWNER
CONTRACTOR /DESIGNE.R ENGINEER
'P ziqe irp
C 11UeWER.
46775 WASFC[.NVrON V
-A QUfNTA CA 92753
CBI;N
USE OF PERMIT
ISLF'..5'CfM2CENtWALff; 6111.5(AQVAeP
•
s
'ENT".1AT.E D COST OF d>C:DNS3'RIX-31ON
32IS
t.
t
9 %
R-11AAL Ca'0IMSt"Rt.ECTION AND P1,,AN C11El,;KY.
LE ��Y,.�-PA I) FE �<�
MAR 2 4 1997
'.D°O'!'A Pil.RsN11'r NOW
ITS*10F P 34 l uIIN!T
RECEIPT
DATE - 8
BY1
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 Wail 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
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
Final
Utility Notice (Perm)
A1.
. ..
... .. ........
....... .
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......... ... . -
ty*
Ci of La Quanta ,1
. ... ...
......
B6ilding 61 Safety Division ,
.........
..............
P.O. Box 1.504
Pe
V.
78 -495 Calle Tam
. ....... .... ......
La,Qui6ta, CA 92253
. . . .... . ...... .................
Suilding. Permitand-Tracki Sheet
'Ang
pplication.
.1 /J—)'.''
ProjectlAddress
-
S
Owner's Name:
A. P. Nu�iber: -LAddress:d4
LJ -A�8
-
•
Legal Description:
QICity.,ST'Zip: , (J
-A h +A-
ContractorTelephone:.
;
*. ...... ..... .
................................. ...........
'A -
Project Desc p't iori:
i ST
C ty.
Telephone'
... . ......... ........
................
.....................
State Lic. #
City Lic.'#:
A;c -�ngr- Designer:
J,
Address:
7�
CityST, Zip:
T�lqh�one*
...............
...................
................... ...........
................
.......................
..............
Construction .0
Type: ccu ancy:
p
. .
..................
...................
State Lici 9:
.................
....................................
...................................
'Pro Jecit�oe-circle one): New air Demo
Add'n Alter Rep.
Namf Contact Person:
Sq. Ft.. 2 v
# Si6ries.:
Units:
Telephone # of Contact Person:
-Eitimatid Value
-Estimated of Project:`
A1.
. ..
... .. ........
....... .
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~ CONSTRUCTION
.Si F!.
*ND FL.
POR.
GAR.
CAR P
WALL
ESTIMATED CONSTRUCTION
ESTIMATE
SO FT .ir E
NO. ELECTRICAL FEES
UNITS
N0. PLUMBING FEES
SO. FT.
YARD SPKLR SYSTEM
SO. FT (W
BONDING
SO. FT. 4 POWER OUTLET
ROOF DRAINS
j0 FT .;Z
DRAINAGE PIPING
SO, FT .Z
DRINKING FOUNTAIN
50 PT. Yt
URINAL
VALUATION S
WATER PIPING
NOTE: Not to Ge :.sea as prooeny :ax .a;uation
OTHER APPJEOUIP.
FLOOR DRAIN
MECHANICAL FEES
TEMP. POLE
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTONOISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR" SUSPENDED
WATER SYSTEM
LAUNDRYTRAY
AIR HANDLING UNIT CFM
KITCHEN SINK _
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE. TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT.:, c .
BATH TUB
SO. FT. 0 c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SU. FT. RESIO IN I!/. c
SEWAGE DISPOSAL
SO.FT.GAR 0 >..c
HOUSE SEWER
SPARK ARRESTOR
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
OBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING A AIR GOND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL AREA
SLAB GRADE
ROUGH PLUMB,
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL).
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
ca Yd.
f Plusxs
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
REMM MS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUNO
FINISH GRADING
FINAL INSPECTION
CERT. OCC,.
FENCE FINAL
rnarrec i �R a awww � vww�w� � rwa.a
GARDEN WALL FINAL
r--
78-495 CALLE TAMPICO — LA QUINTA, CALIFORNIA 92253 – (760) 777-7000
FAX (760) 777-7101
TDD (760) 7.77-1227
December 12, 1997
P Smith
46-775 Washington
La Quinta, CA., 92253
RE: 151f 5' Garden Block Wall Permit #97037092.
Dear Mr. Smith
The purpose of this letter is to inform you that your Block Wall Permit #9703-092, for the
project at 46-775 Washington Street, has expired. In accordance with 1994 UBC section
106.4.4, no further work may be performed until a new permit has been issued.
Please contact Daniel P. Crawford Jr., Building Inspector I, at (760) 777-7012 to obtain any
information you need regarding a new permit and/or any required inspections. Should you
choose not to complete the project, we would then have to pursue any or all of the following
actions:
1) Abatement of the project through the City Attorney's Office and Code Compliance Division.
2) Notice of non-conforming structure placed upon property profile.
3) Action filed with Contractor State License Board. Optional if Owner/Builder.
Please contact us at your earliest convenience prior to 10 working_days to resolve this issue, and
for any,questions you may have.
Sincerely,
Mark Harold
Building & Safety Ma ger.
Daniel P. Cra or Jr:
Building Inspector I
cc: file
dpc
MAILING ADDRESS P.O. BOX 1504 — LA QUINTA, CALIFORNIA 92253 �sJ '