9601-039 (BLCK)LICENSED CONTRACTOR DECLARATION
1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with
o=) M Section 7000) of Division 3 of the Business and Professionals Code, and my
r� Q un," .Licsaze is in full force and effect.
r-� W^ License # Lic. Class Exp. Date
ZDate Signatureof Contractor
r`
(D H OWNER -BUILDER DECLARATION
WW I hereby affirm that I am exempt from the Contractor's License Law for the
following,reason:
I.— U ( J��as owner of the property, or my employees with wages as their sole
Z co5npensation, 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
M /Date �� Signature of Owner
LO t , v e
N
rn WORKER'S COMPENSATION DECLARATION . J
dQ I hereby affirm under penalty of perjury one of the following declarations:
oZ Je.have and will maintain a certificate of consent to self -insure for workers'
LO H 0 compensation, as provided for by Section 3700 of the Labor Code, for the
X W IL performance of the work for which this permit is issued.
O J J ( ) I have and will maintain workers' compensation insurance, as required by
DoQ U Section 3700 of the Labor Code, for the performance of the work for which this
O U permit is issued. My workers' compensation insurance carrier & policy no. are:
CL Carrier Policy No.
? Z (This sect�ori need not be completed if the permit valuation is for $100.00 or less).
00
0( ,)0i'c'ertify that in the performance of the work for which this permit is issued,
O I sK@l 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 provisions.
Date: ► - Yl ��Applicant 1� I (J �• �t �. ! !
3 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.
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 application agrees to, & shall, indemnify
& hold harmless the City of Indian Wells, 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.
l
�jignature (Owner/Agent) A v ` :. tt n l t ) Dam
ALCM
BUILDING PERMIT
PERMIT*
DATE (/11196
VALUATION SSSj,s,},N
LOT
TRACT
JOB SITE ADDRESS
77-821 CALI.E EWSE1vauA
APN
OWNER
CONTRACTOR
0 %N1 PURI I11,DECt
ROSF.NDO AND TANIE' DW,
94.541 VIA DURANW
(•OM1111.LA CA 02236
CBIA
DESIGNER/ENGINEER
it,10 0)8-5.10?
USEOFPERwT`jENI:RAL BUILDING
160 I..F. O 6% 20 L.F. OF S HIGH, AND 40 LY OIC 4' 11101 OAKI)EN 81,00K WAI.L WI'ffill
WROUGHT fRQN.
FEE DESCRIPTION
FEES
6 HT. WALL RA1.041 Ik'
S Fr WALL 21,00 LF
4 FT WALL su.(WI LF
USTiMATED C0ST OF C0NSTk(f Tli[ N
S.133.00
PERMIT I?RE SUMMARY
(Y)NSTRIIf„T'ION FT- F 101-000-4194W S81.01)
SU iI L CONS Wf_'n0N AND PLkN CHECK
$81.00
✓qN LESS PRE -PAID FEES
so ou
1
Y 11996 TOTAL PERMIT FEES DUE NOW
i
RECEIPT
DATE
BY
DATE MAILED
INSPECTOR
INSPECTION RECORD
`7OPERATION
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
OX 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
BLOCKWALL APPROVALS
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings /7
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
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)
COMMENTS:
T4t�l 4 �-Q"
78-495 CALLE • TAMPICO — LA OUINTA, CALIFORNIA 92253 - (619) 777-7000
FAX (619) 777-7101
December 21, 1995
To all Contractors/Builders:
The New Year is upon us and as we enter 1996 we would like to update you all on some
forthcoming changes in our department.
The most notable change will be the Uniform Building Code cycle to reflect the 1994
requirements. Beginning Tuesday December 26, 1995, all new construction will be subject to the
provisions of the 1994 Uniform Building and Plumbing codes, and in February, the 1994 Uniform
Mechanical Code.
Another notable change will provide a consistent time on a daily basis for builders to contact our
inspectors. Beginning Tuesday January 2, 1996, field inspectors will be available for one hour
each day in addition to the 8:00-8:30 a.m. time frame before heading into the field. This hour is
intended to provide builders with a reliable contact time for questions about inspections or code
issues. The times for each inspector will be as follows:
Bruce Pelletier
1:00 p.m. -2:00 p.m.
.777-7018
Kirk Kirkland
2:00 p.m. -3:00 p.m.
777-7016
Danny Crawford
3:00 p.m. - 4:00 p.m.
777-7027
When calling an inspector, please use the phone numbers for each as listed above as it is a direct
line. If the inspector is on another call or at the counter, these numbers will go directly into voice
mail. Your call will be returned in the order in which it. is received, during the coverage hour.
For questions about the status of any particular inspection, please contact the inspector during the
coverage hour or call the Building Department after 4:00 p.m. as the inspection logs by their will
have been updated for that day.
Questions or information regarding plan review or status of plans in review should be directed to
Mark Harold at 777-7015. Once again, this is a direct office line, and as with the inspectors, calls
will be returned as quickly as possible.
Thank you for assisting us in providing better service to our building community
�dMAILING , ADDRESS - P.O. BOX 1504 - ' LA QUINTA, •CALIFORNIA 92253
Fri
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