9604-158 (RPL)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
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
4r-669 B 17/3119.7
��-/Date Signature of Contract
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:
( ) f 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 py
Section 3700 of the Labor Code, for the performance of the work for which this
permit is` ssTjed.1% workers' compensation insurance cAWier�& policy no. "are:
Carrier Policy No.
(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' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with+those proVISIO S.
Date: ' '�' �. y Applicant'
it
Warning: Failure to secure Workers' Compensation coverage i 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 & each person at
whose request and for whose benefit work is performed under or pursuanf 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 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 for inspectiodpurposes.
Signature (Owner/Agent] " Z Date {
PERMIT CONTROL#UILDING PERMIT 6�1s8
3235
DATE j G VALUATION 512,000,00 LOT TRACT
JOB SITE 471.50 VCA de,itY.i4+_`,TO FAPN
ADDRESS •
OWNER CONTRACTOR/DESIGNER/ENGINEER
P.O.BOX 1725 ..
i'A,1.E*'! SPHNG. CA, 9220
777.1345
USE OF PERMIT
K1OL.t N1, 101,, Sm
POOL AND ;iPA ONLY
1h1t'1rR(AL SUN c:C3MMt1;;:'1'1C. N
PALM SPRIT °GS Csi 9220
(619).37.9-2177 _ CA- Ls# .17R7
VUSTI:14IA"i`13) COST OF COi'42's"i-RUC",'1'ION'
'PLAN CRICK IT -1f,
V7,75
COMS7TItUC T1t1N,kE%
101-OMA18-000
V35.00
tiO3fiIMNXCAL V8B •- POOL
101-00( ..421-00
$24.00
1FLEC;TIt;fCA1., :F) _v P -00L
1,01 -000 -420 -WO
$45.00
1?T:t"1`40%F 11`r'. '_JP IIM
101_000.419.000
LESS PXV-PAID FEEa
DC PEWNW FEES DUE NOW
996
Qv.�
RECEIPT I DATE 'I By. I DATE FINALED I INSPECTOR
$315.73
$0.00
INSPECTION RECORD s
OPERATION
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
Exhaust Fans
O.K to Wrap
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
Final
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
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
OX.for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
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) -
La�•�Q,c
78-495 CALLE TAMPICO — LA OUINTA, CALIFORNIA 92253FAX (760) 777-7101
TDD (760) 777-1227
December 23,1997
Landau Dev Co Inc.
P.O. Box 1725
La Quinta, CA., 92253
RE: Pool & Spa Permit#9604-158
Dear Landau Dev Co Inc.
The purpose of this letter is to inform you that your Pool & Spa Permit #9604-158, for the
project at 47-150 Via Orvieto, has expired.- In accordance with 1994 UBC section 106.4.4, no
further work may be performed until a new permit has been issued.
Please contact Daniel P. Crawford Jr., Building Inspector I, at (760) 777-7012 to obtain any
information you need regarding a new permit and/or any required inspections. Should you i
choose not to complete the project, we would then have. to pursue any or all of the following
actions:
1) Abatement of the project through the City Attorney's Office and Code Compliance Division.
2) Notice of non -conforming structure placed upon property profile.
3) Action filed with Contractor State License Board. Optional if Owner/Builder.
Please contact us at your earliest convenience prior to 10 working days to resolve this issue, and
for any questions you may have.
Sincerely,
Mark Harold
Buildi & Safety Manager
IL
01
Daniel P. Crawford Jr.
Building Inspector I
cc: file
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MAILING ADDRESS P.O. BOX 1504 - LA OUINTA, CALIFORNIA 92253
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