0102-186 (SFD)LICENSED CONTRACTOR DECLARATION
1 hereby affirm under penalty of perjury that I am licensed under provisions of
Charter 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
r-te i Signature of Contractor�y.
`r
r 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:
(') 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. -
,S,) I 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:
Carrier Policy No.
STATE P:f;ND fsC ���iy 01
(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 i
Code ,I"shall forthwith comply with those provisions. p'
Daie: n .t Applicant = .,5 Z
Warning: Failure to secure Workers' Ccmpensatio'f coverage is unlawful and
Shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code', interest and attorney's fees.
' IMPORTANT Application is hereby made to the Director of Building and Safety
for 'a permit,'subject to the conditions and restrictions set forth on his
application.
1. Each person upoli:whose behalf this application is made& each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify.
& hold harmless the City of La Quinta, its officers, agents and employees. '
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180' days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation`:
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
rthe above-mentioned property for .inspection purposes.
2-�, t
Signature (Owcer/Agent) ra +`" /`% Date
tiK;. BUILDING PERMIT PERMIT#
DATE VALUATION LOT 0102486
JOB SITEI APN
ADDRESS
I OWNER I CONTRACTOR / DESIGNER /
TRACT
f
r",:aTAIITS-1 HOMO IJI &0,
74,01 SIX4'11-TWAY 111 81-900 AVENUE1usIP-10
PA-14DF*K 'CA -02260 IND.1•O CA 92201
Vt+C,Y 2.2848 C". of 1451
I USE OF PERMIT
SU PFXJ:F:t�P`'3�f1'AL a'-,1 f<%,9 MT 0W?4fA TO i2911,ECT
O. LNa1 i�1? On CONTRACTOR
E k�.'1'. S COST CiF CCaNSIRILe1;;'Ii3N
.S
i I ix n1:31n D i�1�k";�e11v11`F )$k�: 101 -000 -423 -WO TA50
FEB 22 2001
.011 U LFa
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IF(yr-ALMIMITYEANDUKHOW
RECEIPT I DATE/'I
I BYr I DATE FINALED I INSPECTOR
O.W
S4M
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
_ ,
S
Underground Ducts
Forms & Footings
�%y'�
��
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
�_6- O (
el
Exhaust Fans
O.K. to Wrap
(�. p (
j'�-
F.A.U.
Framing
_
[�`.,3y
SZ
Compressor
Insulation
.n
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
_
Drywall - Int. Lath
Final/�%�/
Sr
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
Electric Final
Waste Lines
_
(�
.T-
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
` O (
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL
APPROVALS
Temp. Power Pole
�.,� - D(
C✓�
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G. F.1.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
Ren iP
' A.
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February 21, 2001 ;* ^
r . " '�' i . �'1 � , pyx d. 1 d [ • -
City of La Quinta �. y
Building & Safety Departments '
La Quinta CA 92253 a a
Gentlemen: `
Please accept this letter as your authority"to change the contractor of record on 53 -8 10 Avenue
Villa, lot 22, La Quinta from B & M Construction to Alex.Torres.
f fry' , • '
Thank you for your cooperation a .+
Yours truly, w r}
4
.. .`�... .-.fir -_„^. -_ _-•-. ,r _..,�.'�.. c„,,.y .�:w,.r',\�p'v�r"'•'w-'��SC'^"'n..-:i'.y :'w�.,' -••�'' �✓ •'.+�+�+^y w .•„g'x..r •L�:�:s rC��w'�:r _..,'C,p^'"":::_. .� .-..Fa "_•;;�.r?_.. _
Estate Homes, LLC.
` .. to � ` •+ ' � � • `
74041 HIGHWAY 111 - PALM DESERT, CALIFORNIA 92260
TELEPHONE (760) 836-3377 • 8007338-9895 • FAX (760),836-3379
r.�
City of La Quinta
Building and Safety Department
This •Certificate issued pursuant to the requirements of Section 109 of the Uniform Building Code,
certifying that, at the time of issuance, this structure was Iin compliance with the various ordinances
of the City regulating building construction or use. For the. following:
BUILDING ADDRESS: 53-810 AVENIDA VILLA
Use Classification: SFD Bldg. Permit No.: 0102-186
Occupancy Group: R3 Type of,Construction: VN Land Use Zone: RC
Owner of Building: ESTATE HOMES LLC Address: 74-041 HIGHWAY III
City: PALM DESERT, CA 92260
By: STEVE TRAXEL
Date: 08-22-01
Building Official
POST IN A CONSPICUOUS PLACE
1 I