0010-089 (SFD)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
PrCfession Is Code, and my License is in full force and effect!
License # Lic. Class Exp. Date
770 3 1- 12C
,/Date _N' .1 i .
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:
( ) 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).
O I am exempt undef 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:
I have and will maintain a,certificafe:'of consent to self -insure for workers' orkers.-
compe*nsatio'n, as prov . ided I for by Section 3700of.,,the Labor'C6de, for' the
performance of the work for which this permit is issued.
),el have and will maintain workers' compensation insurance, as required by
Section 3700 of the Labor Code, for the perforrhanc6 of the work for.which this
permit is issued. My workers' compensation insurance carr'ier.& i5oliby no. are:
Carrier Policy No.
STATE CCIMP'lNeS PU
(This section need not be completbd 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 h I e
workers' compensation laws of California, andagree that if I should become
subject,to the workers'bom'pensati?9 provision . s of Se6fion"3700 of the Labor
sp'ns'..
Code, sh 11 with comply witl��'6 6 pirolel,,
Date' Applicant
/Warningf Failure to secure Workers' Compensatiorii coverage is unlawful and,
shall subject an' employer to Criminal penalties and civil fines up to $100,000, in
addition to the cost of compensatibn, 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 a'4Safety'
!or a permit subject to the conditions and -restrictions set forth on his
application. -
1. Each.person upon whose behalf this application is made &.each pe . rson at
whose request and for whose hose benefit Work is performed under,6r pursuant to
any permit issued as a result
ult of this applicaton agrees to, & shall, -indemnify 14
& hold harmless the City of La Quinta, its officers, agents and employees. ZY
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.'l agree to comply with all City, and State laws relating to the building i",
construction, and hereby authorize representatives of, this City. to enter upon
the above-mentioned property f1pr insp -tion pur oses.
Si6nature' (Owner/Agent) J'A I",
V- . A, . 40.. 11
BUILDING PERMIT PERM T#
DATE. VALUATION LOT., TRACT
,
171
JOB SITE' APN
ADDRESS,
OWNER CONTRACTOR/DESIGNER/EN (NEER
77564ACOUKRYCLUBUR' 77-564A COUN17RY (71XB DI 1
PA1:.nMURMW117 CA 92211 IAUA DEM0' (!A 92211
(.760)498,5 .49 61335
SVO-LOT 171 -PLANI LAR.. PERMIT DOPS NOT INCLUDE HL=
WAU00011SPIVAPPROAV
_ H DRIVEWAY- 7550/6 UVArPIOH FOR
MOVIPILZ 139111 .NCE OF I&MV, FLN14 TYPE
71120,00 101?
aw sy
10,505A
YMS PRF -PAD) FEES
'
io1A.AiE,,, Prigman, AmsmE Now
�Za
RECEIPT I DATE`. c (, A I BY DATE FINALED I INSPECTOR
$3,222.56
$010,1
Vax,945? ,
PMAIN F".. SUMMARY
WNSMUCT3014 FRE
1Cbl-0'00 418-000
M4,00
PLAN CHECR FBE-
101-000-X09-31 a
$155.141
14 WHAN tow, FEE.
$10.5.0
1,1LXCTR1C.AL FEZ.'
PLUMBIHO FRE
101.000-419=000
:YPR0140 MOTION FU - RESID
101-000-241.X000
ORADINO
]DINV3.01PER IMPACT Fft.
gY,9fYT (W
YMS PRF -PAD) FEES
'
io1A.AiE,,, Prigman, AmsmE Now
�Za
RECEIPT I DATE`. c (, A I BY DATE FINALED I INSPECTOR
$3,222.56
$010,1
Vax,945? ,
INSPECTION RECORD
OPERATION
0
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/-3/-0�
�'�J
Exhaust Fans
O.K. to Wrap'
Z —�j'=D
��
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
4� vv
Final
POOLS - SPAS
BLOCKWR
��.L .A(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
Waste Lines
�Z ,ly v
�a
Electric Final
Heater Final
Water Piping
/
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
��� 6�
Pool Cover
Gas Piping
Gas Test
Encapsulation
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)
�?✓/C�
J
Feiro-Engineerin'g, Inc. A '
' Civil.Engineering- Land--Surveying '
P. O. Box 12980 « '
• Palm Desert, Ca. 92255
(760) 346-8015 'N '
FAX (760) 346-25481--
14
• Oct. 18, 2000
-
City of La Quinta
78-495 Calle Tampico
La Quinta, Ca. 92253 -
ATTN: Building Et Safety
RE-" Lot 171 _
Tr. 26152 .
. APN: 643-160-645 `
This letter will serve to state that we have field'checked'the•pad =
elevation for the above :project and foundthem to be as follows:
' i •
High, 'Low:Plan:
Pad = 62.1 62.1 , • ,°62.0
_ - P
• Sincerely,
es D. Feiro,
Vice President
LU , No. C-241760 m _ RCE 24176
s EW.12*11M k
T CIVIL �� X
gP�OF