0010-035 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjurytthat I am licensed under provisions of
Chap!,pr 9 (commencing with Section 7000) of Division 3 of the Business and
;;Proi2ssionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
t'
q +�F
jA, , ,,
�te^ f•1 Signature of Contractor
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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).' '
() 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:
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
SeZ%on 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.
91MMICOMP IND F101 154 24 57- LTO
(This section need not be completed if the permit valuation is.for $100.00 or less).
() I certify that in the performance of•th,e 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 orkers' compensaboy provisI9,ns of Section 3700 of the Labor'
Code; 1 sh- II 6 'th comply With 1�igSe p�rodisions.' * ^ - w•
Date:rr thly Applicant ` 4- 4,L-'Xml.= �•
°Warning: Failure to secure Workers' Compensation Coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to•$100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees. -
IMPORTANT Application is hereby made to the Director of Building and Safety
for, a permit .subject to the conditions and restrictions set forth on his
application. '
1. Each person upon whose behalf this application is made A each person at
whose request and for whose benefit work is performed under or pursuant to
,any permit issued as a result of this applicaton agrees to, & shall, indemnify
&,hold harmless the City of. La Quinta,. its officers, "agents and employees.
2. Any permit issued as a result of this application becomes null and void if
,work is not commenced .within 180 days from date of • issuance of such
permit, or cessation of work for 180 days will subject permit•to cancellation:
I certify that I have read this application and state that the above information is
correct. I agree tocomply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this,City to enter upon
the above-mentioned property ffo i `Specti mpurposes
`+ -S gnature (Owner/Agent) �� .. Date
BUILDING PERMIT PFRMT#
DATE i,,,, VALUATION LOT j ii TRACT
1 iJ . 47_5'7e . M 17 5 76,11 r�
JOB SITE
APN
ADDRESS
474M'VI A•QR.V.W7.T.)
OWNER
CONTRACTOR/DESIGNER/EN INFER
monwimr-souni,WEST DE'VEI.t7,PWN T
77-564 564 A C01324FRY CIT AYB DR.
77-564 A C90-MYCL, B
,I)JILM DEPI •r CA 92211
PALM DIM, f i CM 92211
08-3495. ML9. 6133
USE OF PERMIT
w=4,0'r t15 PIA11 art 4IN 1.UEMI irti..00K
WAIIIia001APAdAPPI3.O,+A,C: 1`5% )RItD1,➢Ci':IOM FOR M�d134`f'?PM.
1tiSKMIT ISSUANCE OF SAM :pi411424 TYPE:
TRACT 4O1'1SfiHUCTION 2,409.00 OF
PORC•iA)A T'IO / QUO tip
-
00,144 °3'RUCF ON FEE 1011-000-418.000 MIN
1Pi,,.AW CF1E'.CA: rSE -101 -000 a 9-'x318 Wisp
:Ffi;l�•;°k1.�,�?91C�'oG�r�� z�$,�°1a��1���U, - $96,9�C+
1~Isi:li L°m.:rut? : TC91-C)1J9-Q�CZ-1Zlit3 $F:f�.3�1
PLUTAD1'Hc3li T° d 7•w Ori��`1s3 (i �3 1�i7.5� .
STROi+iOMMONM-RESID 101-000-241'�000 �i4,lrfi
0i?,fP-190 FEE .fOPOM-425_000 SM60
3}•i4!OYM,0Pw_R,%0ACT FES 141,3(t7.00
t.. n
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spa �u !v �,q�{�ra�, 17,a�rr5�•. y�,'^� �}�,/•� S qty y�7�7y
r`F•' � l/$."L�:�%�rAl a�.:�igih--.[T�C%�w �.C�.,f:'",f ,X''e.[l[JLd ,�c�.E.r�t'SG`t +.CiX.l..CiV Si K.
g
$3,283.41
`,v�'pL�.,�a
rr rr��y.�ry�� 9 }7F�7q�s,T���y,+�7�5�
.. .,'A��.1+.SF.$tl:1SS'!'3.d.L.ro3•'a,'GaL�il.lG _J.'fV VY
A"h�71Fe�t7i!
RECEIPT "`
T%i
DATE ( j
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
I INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs )/ p UU
Forms &Footings j _
Slab Grade j -fid—
Underground Ducts
Ducts
Return Air
Steel -
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap - ���0 / GoF.A.U.
Framing —t�� p
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 - W e
BLOCKWALAPPROVALS
Final
POOLS - S SAS
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 3
Gas Test
Electric Final
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral �Ur)
Sewer Connection //_f_/_� (0
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
'
Final.
Utility Notice (Gas) e �
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)
ti MOUNTAIN =
611%111.ARCHITECTURE •
r ARCHITECTURE & ENGINEERING ,
• '' Y 1316BEAR CITY AIRPORT • 5UITE A-1 -
PC. BOX 6167 • BIG BEAR LAKE, CA 92315
(909) 58545311
1/24/00
�r. City of La Ouinta
Department of Bonding and Safety _
PO Box 1504
La Quint.a CA 92253-1504 ` • .
RE:. Lot 175Lake La-Ouinta Plan 42
Gentlemen:
This letter will indicate that a structural observation has been performed on the above. referenced
residence by myself, or, under nay direction, and that the building is in c6nformance with the
approved plans and engineering.
If you have any questions, -please call. ,
rsedY ;
ARCIUTECTURE
ARCy�T _
a, AIA.
3
itect JOHN F, ACOSTA. U1
A.I.A.
t.
NO. C24055 =
REN. 4-30-01 Q.
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4 MM
CALIF. LICEN5E #C24055 • ARIZONA LICEN5E #28023• CALIF, 6.E.5. REGI5TEREP EARTHQUAKE DAMAGE A55E550K #5A1373
T
• Teiro Engineering, Inc.
- - Civil. Engineering- Land Surveying
P. 0. Box 12980 _
• `Palm Desert, Ca. 92255 '
` (760) 346-8015
FAX (760) 346-2548
' -Oct. 18, 2000 '
City of La Quinta F i
78-495 Calle Tampico
La Quinta, Ca. 92253 a
ATTN: Building Er Safety-
RE:
afety RE: Lot 175
Tr. 26152 _
APN: 643-160-049
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:
H Low: Plan:
Pad = 61.8 61.7 61.7 ,
�r
. Sincerely,
oeSOVEss/o��
o amen D. Feiro,
No. C-24176 Vice President
RCE 24176
d� CIVIC
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