0010-085 (SFD)LICENSED CONTRACTOR DECLARATION
I herd
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
��Dater Signature of Contractor 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:
( ) 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).
(') 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 'ofperjury one of -the, following'declarations:
O 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.
.00 1 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.
STATS W
(This section need not be completed if., the permit valuation is for $100.00 or'less).
O I certify that in the performance of,the work for which this permit is. issued;
I shall not employ any person' in any mariner so as to. become subject to the
workers' compensation laws of California, and agree..that if.l- should become
subject to the workers' compensat' �Jr�proyl5lons of Section 3700 of the,Latior
Code; I h f iwith comply witKose.•��r• • vis' Q ns.'
Date: t' Applican �• rP _� "^-.:•••ti
-
fWarrnng. 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 om-�his
application.t,r
1. Each person upon whose behalf this application Is made& each person.at
S
whose request and for whosebenefit 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 proper' or iAisection purposes. ;
Signature (Owner/Agent)f f ' Date
BUILDING PERMIT. PERM TN
DATE VALUATION LOT:' �(��`j TRACT
���1� � �� 246,452'
JOB SITE i {
APN
ADDRESS
A W8XYWrO
47-
-460-'046
OWNER
CONTRACTOR/DESIGNER/ENGINEER
PALM, D11,42EX9 CA. 02211
PALM. a'JFUR ;CA 9221;
t70,V1C8e3495. CBLO 6133
l ,
USE OF PERMIT
3K)=.L-0T 272 PLAN 133_ PERMIT aYvRS •NCYr IINCLUIDE BUDICK.
WA.'f,UPC�0J,rof,A�.&PPk'O.fWf.t DRIVEWAY
I
'f'12. C-7 CONSTRUCfloN 4120100 3F
48.00 SP
in�C}3{RC(�'Y.�I�d�[.�ip#�fy;'?y��
2y
yyy. p 101$0.60
X UP
00NOTTRICTION FXF 101=010-41&,000' $yA,a.0
LAN C: I I€ l 10.1, -C 00-439-31 B $t579. a d
��taN�t'�� � . � c�a-�i+�u�•� a �c�0o 51.0�:Otl
•
i ,a" I`Xt1�'r i,tr tL; 101�400-:420.000 S2Di�4
PLUMBING FEE'. 101o000-419-000 S16017s
S".'I'0140 MOT10N ME IMAND 101 •.000-241--•000
t3f2ADTH0 ~`ESS 101-000.423.000'.. 120,00
FEE -
101a000 -439-31R, . -x2, as
.. ' 4.'f:: f:l'Si�I&':ii.1�r 11.09 ,a XD 1p�.�LN Ck"� u?=
$ 1,689.'00
'IDLFM Vh.' ",PAiil nP.C1.
4250,00
• OCT i O i�Y�®•. A,'ti'�RYs!V..tro�°l L'J'X�8,,7DT .E ROW
V'7cY,d':s+%9 `W
1161—
.31 Wy r ;
- • • _ : ..
� +'Arl
tit:
RECEIPT
DATE
By/.DATE
�.
FINALED
INSPECTOR
k %
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS*
R MECHANICAL APPROVALS
Set BacksUnderground
Ducts
'Return
Forms & Footings //�
Ducts
_
Slab Grade / w
Air
Steel
Combustion Air
Roof Deck—Z�–�f
Exhaust Fans
O.K. to WrapZ j ��
F.A.U.
Framing y� .�y`
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wail Insulation
Condensate Lines
Party Wali Firewall
Exterior Lath
Drywall - Int. Lath
Final
_ _ _
Final/a%
POOLS SPAS
BLOCKWALL.PPROVALS
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 /f
Heater Final
_�G��
Water Piping /' /
Plumbing Final
Plumbing Top Out
' Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral l n
` - ��`�°/
Pool Cover
Sewer Connection
Encapsulation
Gas Piping / �S
�l/ �,
Gas Test J G%`
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas) I b
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 r/-
Utility Notice (Perm) //
•
Feiro.JEngineering, Inc.
_ Civil Engineering- Land Surveying ;
P. O. Box 12980
Palm Desert, Ca. 92255
y (760) 346-8015,
- FAX (760) 346-2548
. Oct. 6; 2000
City of La Quinta
•
78-495 Calle Tampico,
La.Quin'ta, Ca. 92253 ;
ATTN: Building Er Safely
RE: Lot 172 •b 3 C7
- Tr. 26152 :; -
APN: 643-160-046
This letter will serve to state that we have field checked the pad ,
elevation for .thiabove -project'and found them to be as follows:
• High: Low: -Plan: .
Pad = . 62.3 62.2 62.2''-.1',
r Sincerely, '
,��CoQ OFESg 0, +
.T mes D. Feiro, .
Cz -. ®� Vice President
No: C 24176
RCE 24176
OP CA�O�