0010-088 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chepte.r 9 (commencing with Section 7000) of Division 3 of the Business.and
'R rofessjonals Code, and my License is in full force and effect.
License # , Lic. Class Exp. Date
° at } �Y � .
Date e 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:
( ) I, 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).
O I am exempt under Section B&P.C. 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 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.
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:
Cairier Policy No:
ATATI COMP INS PU
(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' compensatloneproviSions'of SBqtIOn, 3700 of ,the Labor
Code,�'s f rthwith comply with ose p[oYd ro s:s
Date: !# APPlicant
Warning: Failun&'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 Applicatiori is.hereby made to the Director of Building and Safety
for a permit subject 'to' the conditio_ ns *and restrictions set forth : on 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.pursdant 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..) 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. or, inspdction pur os s. M Signature (Owner/Agent) >— `' Date G
BUILDING PERMIT PERM T#
DATE�y�'. t VALUATION LOT y'1 TRACT
yq 601 245152
JOB SITE
APN
ADDRESS 4.7MMp •y�,•5,�* +gv0
p• ^t q60 gp rt
OWNER
CONTRACTOR/DESIGNER/ENGINEER
NORIHW , r-nC. TJTHWM DFV6,0i>NL9. J'
Ai GlKt x ie�MM-:iOUrIPS iDE VELi7MMT
77 564 A C OMSI:y RY CLUB DR
77-:564 A z"OLTM:W MI( R, 3 Al
PAXAM' -9f CIA 92211
PALM ; C`.�922/+��(�11
��yy3p%t�'qp [{yy'�'
5. 3
USE OF PERMIT
SMO-J.DT 3'1[+ PLAN IIA- PZRH1T& DOCS 'NOT INC %.I WD9,41,0M
WAUROQrLAWAIAPPRO.►' CH DRIVEWAY -161 1<± REDUCTION FOLk MV LT 1P.L9
fuE3.e93aCF O�':u'L{ &�;b:fiT+t `1'lik'C
TRACT 5:ON: TRUCTION . Z120.00 101
P(AckUPATIG 4&00 SP
_ C'd�.F���3!N".�C'�EtPOi�`1' (�f?� • E4:�D�,dA
;:SM'IC£°T OF t"OM'tZk
�t�;RCb
r � bTs UUMM6'9RY
C0Wi'.RU('-:RION 1T 1014DOO-418-000 MOO
PLAN CHECK ft $_ .. 101-000-439-318- 03,.09
1�i,G'Ps914t1 6} R 101.000.41.94* i
==0 MOVO1• FER - R.ES1D 101-000441.-000. $12.63
r1 ��1 Cr ..101.000.423.001
�,I,0PFBi.MPJR.CT ME
H
Ar
LESS Yki&PAID FEES
$0.00
IDTAL, Vw"_ IT "ITS ME NOW
$31222-58
RECEIPT '@
•r.
[DATE i
BY r '�'
DATE FINALED
INSPECTOR
Iffff" 1
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set BacksJ
/� �,�
/
Underground Ducts
Forms & Footings
(
Ducts
Slab Grade
/7-2- J`—dU
Return Air
Steel
Combustion Air
Roof Deck
_ _
/� 3%
Exhaust Fans
O.K. to Wrap
_
F.A.U.
Framing z ��%
G/
Compressor
Insulation
--7
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
✓ �/6/
Final
Final=�y
O f
���
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
Waste Lines
// ���jU
��
Electric Final
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
Sewer Lateral
_ _
/ U
O.K. for Finish Plaster
Pool Cover
Sewer Connection
1
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice
9
�T�Y
(Gas)
ELECTRICAL APPROVALS
1
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voftage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G11
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
Feiro Engineering, Inc..
Civil Engineering- Land Surveying
P. O. Box 12980
Palm Desert, Ca. 92255
(760) 346-8015
FAX (760) 346-2548,,
., Oct. 18, 2000
5.
City of La Quints r• _
78-495 Calle Tampico
ri
La Quinta, Ca: 92253
•
ATTN: Building Et Safety` ,. r
.. RE: Lot .170 :, � _ • : 3� - :� .. - -
J -'i•6.
Tr. 26152
APN:643-160-044 ;
y
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:
Hi . Low: "' Plan:
Pad = 61.8 • 61.7 61.7 .
Y Sincerely,
5
D. R
C* 1T t mes D. FeiroCMLU,
No: C-24176 0 i _ }- Vice President
' RCE 24176-v CIVIL
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