0285-116 (RR)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=BUs`WeSS and
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
P'c.:..; .....
Date r - e' . Signature of Contracto��
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.
( ) 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. 295-"2001
(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 .provision's.
Date: • ^" ' Applicant --
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.
;y
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 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 inspection purposes.
r !-
Signature (Owner/Agent)( .7 / •� Date -.M,,
BUILDING PERMIT PERMIT#
DATE J VALUATION LOT TRACT
$3AM.6a 106 2602
4 t7
JOB SITE
APN
ADDRESS .. -540% AVM10A VILLA
OWNER
CONTRACTOR/DESIGNER/EN (NEER
XAM W019EL
.A;.lsD , ROOF
31-30 AVEMA,
F.O. BOX 367
LA Q€,iWA, Cl A. x.25.3
NW—A `4"ALLEW CA
USE OF PERMIT "
CXNRR^A1, kAYJc.DMI(
K&RiJ F CE.A.SS A Yu9ATIMAFS.
.RiciftCFx�L` �oY7�?aSiFiP �Fi
MAW. Fn SUMMARY
s
SUB- 110TAL C0101 Rt "Y10K AM PLAN CHLCK
I ^ LESS IYHE-VAD FEES
MAY. U � 2002
CITrClFtAQUINrA
FlNANCEDEPT.
DATE
BY
FIN D
INSPECTORRECEIPT
w
j .
�
.40
INSPECTION RECORD
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
(p c Z
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
fJnal
_
!
POOLS - SPAS
BLOCKWALL AP 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
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. 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)
Lic.. # 76115-1-P.O.Yucca Valley, CA 92286
Box 167
i
PROPOSAL AND CONTRACT Ar1po ne -3iW1lQQ w&w1 -302.3100
Fax.- 760 369-5099
Hoof Co. Data
I
To, f ok>° 5/5 .� le1adPa, V a
Lr4 a- /! ,L-7 Ca ZZ Zs3 Telephone
Dear Sir
A* wRoo f Proper 10 furnish all mated* and ped m d labor necessary to complete rie following:
e WI V - /c./JUU
r._
4--vVy
AO of the above work to be completed in a substantial and worimmilike manner a000rding to standard practices for the
sum of�l7 y�� % Lio�sQ�d ;?�� ��K� "-7 Dollars (S SSU —)
Payments to be made
as the wort[ progresses to the value of
per Dent,(,__. %) of ak work completed. The entire amount of contract to be paid within
days after completion.
Any alteration or deviation from the above specilimbOns involving extra cost of materiel or labor will only be executed upon
written orders for same, and will become an extra charge over the sum mentioned in thin convac L
AN agreements must be made in wrl".
FAILURE BY CONTRACTOR WITHOUT LAWFUL
EXCUSE TO SUBSTANTIALLY COMMENCE WORK
Wrn*N TWENTY (2M DAYS FROM THE APPROXIMATE
OATS SPEtSFEO ill THIS PROPOSAL AND CONTRACT
WHEN WORK WILL BEGIN IS A VIOLA`n0N OF THE
CONTRACTORS UCENSE LAW.
NOTICE TO OWNER OR TENANT: You have the right to require
Contractor to have a performance and paymW bond.
ACCEPTANCE
Contractors are nKP*ed by law to be kceneed
and regulated by the Contractors' stub Uoense
Board. Any Questions concerning a contractor
may be referred to the registrar of the board whose
address is:
Contractors' State License Board
1020 N. Street
Sacramento, CaNlomia 85814
You are hereby authorized to famish all materials and labor required to ccmpiete the work mentioned
in the above proposal, for which ________ agree to pay the amount mentioned in said proposal, ' and
according to the terms thereof.
ACCEPTED
Date