0010-037 (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 .
64 U) Professionals Code, and my License is in full force and effect.
C) Licenie # Lic. Class Exp. Date
r, CY U.)
LLJ
Z r- ,pi'te IQ Signature of Contractor _v— Al
ca 0.
_J to L)
1.- 0 OWNER -BUILDER DECLARATION
W W I hereby affirm under penalty of perjury' that I am exempt from the Contractor's0-. License Law for the following reason:
U)
Z 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).
r of thert
as owner, , 1prpp'e yj am exclusively contracting, With;- licensed
contractors to construct the project (Sec. 7044, Business &-Professionals
Code).
cO O I arri exempt under Section B&P.C. for this reason
LO
C\I Date Signature of Owner
0 C\I
L N:
< WORKER'S COMPENSATION DECLARATION'
C)
Z I hereby affirm under penalty of perjury one! of the. following declarations:
Cc
Lo <
0 O, 1 have and will maintain aCertificate of consent to self -insure for workers'
UL' compensation, 'as -provided 0 r he
X LU for by Section 3700 -of the Laboi C de,.-fo:-'t
01 _J performance of the work for which , this permit is*issued.
CD -i <
< U. )/1 have and Will maintain workers' compensation insurance, as required
eqUired by
O r Se tion 3700 of the Labor Code, for the performance of the work for which this
13� LO F- permit is issued. IVIV workers' mer.
0) Compensation insurance ca & *policy no. are:
Z' Cartier Policy No.
ob'5 STATE COMP Hsi 'M
0 1.. . . .
< (This section need not be completed if the permit valuation is for $100.00 or less):
_J O 1 -certify that in the perfarman66 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
Subliectto the workers' compensa,tion'provisiofis of Section 3700.of the Labor
Cod'61'sh I o0hwith comply With iD%bdirp*rovisio
'Applicant fy
/Wairning: Failure to secure -Workers' Compensation coverage Is Unlawful and
shall subject an employerto criminal penalties and civil fines upio 4106009, in
addition to the cost of compensation, dam6ges as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the. Diractorof Building and Safety
for a permit subject o' the conditions and restrictions set, forth .on his
application.
1. Each person upon whose behalf this application is made & each persoh .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 and1void 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 enter. upon'
the above-mentioned pr pVertyfr �ispbection purposes.
Signature (Owner/Agent)
Date V
I Al,
ii BUILDING PERMIT PERMIT#
DATE - 'VALUATION LOT 0010-037 1HAU1
I f� It of r n bi A.5 19.811
JOB SITE I
APN
ADDRESS
4? -14S VIA 0JRV",.0
OWNER
CONTRACTOR/DESIGNER/EN INEER
DEWSLOPMENT
ki(-iR.rti*'FZr-SOUIWVMgrl)1!74rL,'LOPI"f
PALM DMZZT CA M I
PALM DEMT. CIA 92211
60)408,�-3495 (MLO 6113
USE OF PERMIT
5M -1,0T 1?7 PLAN MR*- PFRIMIT I)OF-S' 1401" MCIZME BLACK
WALIP001JOPMAPPROACH DFUVZWJ%Y
TRACT CONXTRUCT1011. sp
PO-RCHIPATIO
43ARAOM-ARPORT (U)
'Egf
DIAM COST OPCODISTRIMMON
14 .80
25"
CONS'TRO CTIONFRE '101 000418-000 M010A
PLAh CHM"K Y?14 -000-4,39-319 $661.53
MR.C.M.NICALIE9 101-000-421-000 $90,00
kid FE' 1127 _W0.420-0010 $128.30
101.0s 00.41 91-000,
37RONO MOTION FEE ",!ND 107. -OWU 1 -000 S14.26
0XV, ELO"Pri A. I MUCT
7ERDEP0911 -8250.00.
OTAL COMMUMON M, PI-AhMCMC
A
$3, 179.61
LENS- PR&PAIDK FWO
4- 250.,00
JAVIA P M 0 M IT X F, N D UE K 0 W
$1. 15i
RECEIPT
DATE
Y
1B
JDATE FINALED
INSPECTOR
.
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
_ _ _
Underground Ducts
Ducts
Slab Grade
_ _
Return Air
Steel
Combustion Air
Roof Decklz�.zg=
p�
Exhaust Fans
O.K. to Wrap���
OT `
F.A.U.
Framing
�_����
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wali Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
2— /! 07
Drywall - Int. Lath���0%
G�
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Waste Lines
� ��
Electric Final
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure '
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Jl���(/v
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
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
MOUNTAIN
oil%hn ARCHITECTUPX
r ARCHITECTURE & ENGINEERING
BIG BEAR CITY AIRPORT • SUITE A-1
P0. L30X 6167 • BIG BEAR LAKE, CA 92315
(909) 585-6311
1/24/00
City of La Quinta
Department of Building and Safety
PO Box 1504
La Quinta CA 92253-1504
RE: Lot 177, Lake. La Quinta Plan #2
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.
If you have any questions, please call.
S' ce Y�
M TAIN ARCHITECTURE
0 An
ohn . Acosta, AIA
�,�►
kens d Architect JOHN F ACOST& iR
A.I.A.
No. Mo55
REN. 4.30.01
Feiro Engineering, Inc.
Civil Engineering- Land Surveying
"
r •4 P. O. Box 12980
- -
Palm Desert, Ca. 92255
(760) 346-8015 '
r FAX (760) 3416-2548,
Oct. 6, 2000
'
-
•
• City of La Quints
78-495 Calle Tampico ,
La Quinta, Ca. 92253 -
ATTN: Building,Er Safety _�
}
RE: Lot 177
q7 V
V! .�
Tr. 26152.
.
APN:643-160-051
-
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' _ 61.1 60.9 61.0
Sincerely;
• r
s
a jfESS/p
Qtt
=
-
���o �5 ®.
aures D. Feiro,
o
Vice President
No, 024176
i.
RCE 24176
Exp. Mi/01
F OIF C
-