0010-086 (SFD)• LICENSED CONTRACTOR DECLARATION'
I'Ne' reby 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
✓
/' -?70 10 B 1,,A/31/2(
�a e }` Signature of Contractor
1-.
,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. employee's 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).
O I am exempt under Section' -B&RC. for this reason
Date Signature_.of Owner
WORKER'S COMPENSATION DECLARATION .'
I hereby affirm under penalty of perjury 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.
( } I have and will maintain workers' compensation insurance, as required by
S&iion 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 ` 1 0. •rn? ffl�yg �tle y7 xcf tt4�9� Policy No. c Q, . q . .
.--f41T.t4�,TR . 4.pG77.P R61e2 9',u,F • - ...` :di:^9�•aJ a-.00 '
(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 notemploy 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, f hall rthwith comply with t se.pro i'ons. ~""
<- ..
ate: Applicant��
Warning: allure 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 proJided for in Section 3.766
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 & eachperson at
whose request and for whose benefit work is performed under or pursd9int 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 isnot 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 Qty.to enter upon
the. above-mentioned property for inspe Ion purposes. x
,Signature (Owner/Agent) -„ . ��r Date A
BUILDING PERMIT [ PERMIT #
DATE FJ VALUATION LOT >ie> tip TRACT
1
171Q.
JOB S17E j
APN
ADDRESS
47-024 VM olzvm)
3-16G-047
OWNER
CONTRACTOR / DESIQNER / EN (NEER
77-,'s64 AMOWRY CLUB DR
77.564 A C"WHYRY CLOD DR
:;'AIN 1�•E'sMI I' C.A. 912211
PA:;i+d DEM, T CA. 92211
(7,,5Y)408.3495 CIBL4 x;33
USE OF PERMIT
't.l; L-1JT 17? --PLAN )A -, PERMIT DOES NOT )1VCLUVE 81,OCK.
19A9..UPE.1L?%d.StMAPPRt4.ACH DRiVEXAY - ` %,kE,DiTi",TION FOR Mt.7Z.Z'g4121
PERMIT iJSiIANC-P OF SAAffE PLAN TYPE
f
` RAM' ` CaNST UCTION ZJ&DO 31
! .0k1CPV.P.A.T.10 4100 SP
0APAWC,AIZPtYRT (39} HU0160
MST= TKIP C0917 OF C01".^b�+�'�:'.�&K-71a3t7 - .
12CAA100
nm MADISARY
0140-T13UC'`•7'1o1+) n. E 101 •QCV-41 &�000
PLAN CHECK, F!3Et)1-Cti#�?Ow�#���
:�9tu'.B?A3 if3*t,P+i -. 101.000-421-00(%
1,LX,dT-R.1S��ab,;VXB: Yt : 011 001,X2(3<.000 1)8�
PL13MBINGV%Z 101.000.4.19.000 S169.1S
:,rs15tQW0!MOTION ",Z 101-000.243-t3W $1'3.63
ORAD1140 RF. 101.000, � 22.000 $20,00
DV1 0Pr_E! IMPACT rrrz$),iii%OC
a/.q�
f ;
,1
�ry'j•� /�v. py �q�Qc�yy�ip�y�e ``' .{, �,7�, $ y y �yy�/�O�
1�J1.AX7-,ro SJ"1.4sV.:o'.0tlky,I.xi:LJ1..iAb�.I'.C'7.['!E`4J.J PIL C'F�3.Y.".A..K
yl y k
�y.�,,rL22.58
$3,222.58
3. � :PRE �', � 3'F�;;
$0.00
9512221f*
-ES DILT
11,071JEJ IM E NOW
~+
OCT
.10
X" Vir
RECEIPT
DATE
FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
Slab Grader
_ _ _/_
_ "l/, �- �]'
�(J w
/
/n�
�rE(�JJJI
Underground Ducts
Ducts
Return Air
Steel
Combustion Air
Roof Deck
O.K. to Wrap
DI
Exhaust Fans
F.A.U.
Framing
Compressor
Insulationi
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath `r Q�
_
Final ��-"r
Za,
BLOCKWAL,IL A' PROVALS
Final
'
POOP -S - 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
Waste Lines ��
Gas Test
Electric Final
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral '
Sewer Connection
/ /
`/,,,
Pool Cover
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 1000,
Exterior Receptacles _
G.F.I. 100,
Smoke Detectors A�6�J
Temp. Use of Power
Final
Utility Notice (Perm)
N
Feiro Engineering, Inc.
Civil- Engineering- Land Surveying
P. O. Box 12980
Palm Desert, Ca. 92255
.(760) 346-8015 ,
. FAX (760) 346-2548 {
� r
Oct. 6, 2000 ,
1
City of -La Quinta r
78-495 Calle Tampico
y .
La Quinta, Ca. 92253 t
ATTN: Building Er Safety. r
• RE: -Lot 173a S Vl b V `
Tr. 26152 ;
q-7
APN: 643-160-047'
LY r=
This letter will'serve to state•that'we have field -checked the pad ,
elevation for the above project and found them to be; as follows:
- High: Low: . Plan: .. -
Pad = 62.3 .62.2 62.2 '.
Sincerely,
®f[ ®s/oy,� times D. Feiro,'
�5 FF,�F� . Vice. President
RCE 24176
F' OF CN