0010-036 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions•of
Chapter 9 (commencing wi6 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
Ov,Date 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.
(4 ✓KChave 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.
Mf F. MIKP "INS FU
(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 t" workers' compensation provisions of Section 3700 of the Labor
Code, sl7 11 f with comply with oe prsi
Date:I 9 Applicant . e 1 < :
✓J Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal, penalties and civil fines up to $100,000; in
addition to the cost of compensation, damages as provided for in Section3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director.of-.Building, and Safety
for a permit subject to the conditions and 'restrictions set forth on his
application.
1. Each person upon whose behalf this application.is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this'applicator agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
,2. Any permit issued as a result of this application becomes null and void if
,work is not commenced within 180 days from'date ofrissuance of such
.permit, or cessation of work for 180 days will subject permit to cancellation:
I certify that I have read this application and state that the above information is
correct. I agree to comply'.with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enters upon
the above-mentioned properVJbr ins Bction. es,
S'gnature (Owner/Agent) !° �^� Date..
BUILDING PERMIT PERMTk
DATE VALUATION LOTTRACT
S1424%7920 111A 226152
JOB SITE' t
APN
ADDRESS
47-115VIA C37'tV7C3+TO
OWNER
CONTRACTOR / DESIGNER / ENGINEER
A/�7i, 7�'l� "�T-g�yCAiTL�I"[r�`vtT�Vd'Yt£A
�aii
' Xaok��'.Aidwris�t,Iy.'��flei�TT'€}iv�f;ETi'�t'�q�:{t:PmfiwT
A�}�rirz�t:4�Lol�r��SA+Y
PALWL'i1~aEU CA 9,2.211
PAIM TMORT ; CA 92211
11�-34.95 GWIA 6133.
USE OF PERMIT
:1F13.1,.sJ F 1.76 PIAN 2A -R- PERMIT 130M ABUT .INCLUDE BLOCK
WALU1110 )M, P .+'.4PPIsi0ACH ORI FAY-'-rj ff'i RED UCIT19H FOR fr!iULTI P,Li,..
PERMIT 1 St'.9ANC r+, OF SAM 14AN TYPE
TRACT C0144TRUCTION 2,400,003F
k'ORC'1•d3i>. 0110 _ 1.26.00 SF
F
�#ARACIFIC,ARPORT (69) 1t+,00U0
j
HS T'M'A t. CON-17431,'CON&1€'RUC;1TC R
14%5_19.801
SUMATARV
'SON i1.FSMON 1TI R i 0 i -000.418n000' 090.00
PLAN Oi-Irx% € er_, 1+7I-OCttg-d 3'g -9i.$ $164,39
M.) OHAF AMC LRE 101,00042.1,000 90.00
PLIU11fiPINO F'EW 3.01.0(1(T 3 z 9a€?019 MOM .
STR.>O`NKI MOV01111 • RESID 101-000- 1-000.
DEVELOPER ROM, F.RX $1,907.00
r ...
fi11 t� 3'f S CO ..W.3-fG TIC'S` DN .AND PLAN CIM7'.CJ
TY
_33 PRE -PAW FERS
"som
JOT 13 -1 VIE ITOW
a
RECEIPT
DATE
01f
�y I
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
%Underground
/! '3�'
�_
Ducts
Forms & Footings
Ducts
Slab Grade
3d —yy
6'
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
0. K. to Wrap
_
F.A.U.
F �
Compressor
inulatisalad�
�� — p /
Vents
Fireplace P.L.
_
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wali Firewall
Exterior Lath
Z- f f
Drywall - Int. Lath
- -FinalyFinal ��POOL'
1-7—H1
- S 'AS
BLOCKWAL�ROVALS
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
/ j��
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
J / ./g�
/ /�
Poo! Cover
Sewer Connection
-
�
Encapsulation
Gas Piping
Gas Test _
AP
/ L
/�
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)
MOUNTAIN
ARCHITECTURE y
ARCHITECTURE & ENGINEERING
1
BIG -AIR CIT`( AIRPORT •SUITE A-1
k r-' PO BOX 6167'• BIG BEAR LAKE, CA 92315
{ (94 585-6311
1/24/00
City of La Quinta
Department of Building and Safety"".
PO B'ox 1504,E A=.
La Quints CA 92253-1504'.y
RE: _Lot 176,Lake La Quintaa-Plan
• � .ate+ ... -. . .. . � y . _ � +y +�w.'a W el� _ �--f F -r . w^ ..ar.. _ ....y`..'. �..{�":...- s . .. fey _. w— -
Gentlemen:
This letter will indicate that a structural observation has been performed on the above referenced
residence by myself or under my direction, and that the building is in conformance with the -
approved plans and engineering <
` `rel � 'r• - ` - -
If you have any questions, please call: � jl,
S c e .
UN AIN ARCHITECTURE
BS0 ARC
Jo F. Eicosta, AIA v �Ct.�► F �; _ �'
Lice sed Architect JOHN F. ACOSTA, 01
A I;A.AL- .
1110. tI��V�J .
REN; B•30•tt1 �.
.
j <
� + ~• � � � •" ate" - .. k'- ,{ - Y r
CALIF.. LICENSE #C24055 to ARIZONA LICENSE #28023 • CALIF. O.E.5. REGI5TERED EARTHQUAKE DAMAGE A55E85OR #5A1373
e-
Feiro Engineering, Inc.
Civil Engineering- Land Surveying'
P. 0. Box 12980
Palm Desert, Ca. 92255' s
(760) 346-8015 a _.
r J FAX (760) 346-2548
Oct. -18, 2000
City ,of La Quinta
sy f 78-495 Calle Tampico
• La Quinta, Ca. 92253;',_'.'
-ATTN: Building Er, Safety,
y
` RE: Lot 176
" a
Tr. 26152 r
= APN:-643-1'60-050 ..r z
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'.
y _ High: Low: , Plan: r.
M Pad = 61.5 .61.4 61.4.
Sincerely, ;
OQOFESs/i .' ~' !
®: ,��� mes D. Feiro, t
Vice President
• W
RCE 24176
No. C•24176 � r
EW. 1241101 �
F CAI.tF� ,
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