9511-015 (PAT)rLICENSED CONTRACTOR DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with
W Section 7000) of Division 3 of the Business and Professionals Code, and my
co
o O Lo License is in full force and effect. 511107
r- W License # Lic. Class Exp. Date
rnZ Date // _ �; . Signatureof Contractor
coo 0 OWNER-BUILDER DECLARATION
JJ LU
uQ I hereby affirm that I am exempt from the Contractor's License Law for the
following reason:
~ U) ( ) I, as owner of the property, or my employees with wages as their sole
Z 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
C0 Date Signature of Owner
LON
O rn WORKER'S COMPENSATION DECLARATION
L)
Q I hereby affirm under penalty of perjury one of the following declarations:
C) g Z ( ) I 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 W performance of the work for which this permit is issued.
p J J ( ) I have and will maintain workers' compensation insurance, as required by
CO Q U Section 3700 of the Labor Code, for the performance of the work for which this
p U permit is issued. My workers' compensation insurance carrier & policy no. are:
dLO H Carrier Policy No.
Z (This section need not be completed if the permit valuation is for $100.00 or less).
00 n Cy() I certify that in the performance of the work for which this permit is issued,
Cy
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 provi ionsrof Section 3700 of the Labor
.�..:
- Code, I shall forthwith comply with tho®ep[ovrsions.1'"`______1
Date: /�- ; rye " Applicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and shall
subject an employer to criminal penalties and civil fines up to $100,000, in
0 addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this application agrees to, & shall, indemnify
& hold harmless the City of Indian Wells, its officers, agents and employees. /7
2. Any permit issued as a result of this application becomes null and void if V�
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation. ' s
I certify that I have read this application and state that the above informatio I is
correct. I agree to comply with all City, and State laws relating to the bu4ji ng
construction, and hereby authorize rept 'sent Ives of this City to enter upon hu"
• above-mentioned property for insp Eo 4' rpgses`
Signature (Owner/ erit)' : > :, ...-.J Data/"
i Ast f � .
A"'
BUILDING PERMIT
PERMIT�$�`I��
DATE -W9.1
VALUATION LJt. .i7 C LOT TRACT
JOB SITE ADDRESS 48-611 C %LLIE ESP1' RAPiZA
APN 646-121-o"
OWNER
CONTRACTOR
NIC0 cmWRCr�r� om
DAVID &k NANCY CHMAS
2319 ',,.w_ S,'XN AN`1 N10121).
,-13611 CALLE ESPE RAN&k
1'°rlI,M SSR NGS CA 42262
LAQUfNTA CA 42253
(019)32-i-8791C'11WIP
(619)5611-17M
DESIGNERIENGINEER
USE OF PERIAV.Ai'Itj
FSG `•;�f1 / ,� .>G-"i'�'a/1�'/; � �f z,.:,�;}l.t C, r ✓ ter%•<„� r r� :� `�'C;r"'.�.' ..`a..='�....�-:,;�
FEE DESCRIPTION
FEES
POR 011P :I1iy 510.W SF
EST$a1'1ri..CE D €".OST O CONSTRUC`? ON
7,182.00
PFRIMIT %'Cel!. SUMAVARk
PIAN CHECK FIE -1E 101-M1 0-139-318 5&4.35
CONSTRUCTION E 101-000-11$-000 $99.00
STONG AMOT1014 F:'EE - iiiw;SM 100-00()-211.••000 1.72.
SUB-1WAL CONSTRUCTION AND PLAN CHECK
$164.07
LESS PRE -PAI D PEES
$0.00
TtaT.i►i.. ['Cd1:LMit'D' f�;N�,'� i)iJ�� NOW
S164.07
NOV r.'
Q T0;EV, PROJECT�i��ki'1�1� j FRES
��.t a
� �
164,07
7995
RECEIPT ®�
•D�A�TE
BY
DATE FINALED
INSPECTOR
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
Exhaust Fans
O. K. to Wrap
F.A.U.
Framing 47,
Compressor:a
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 44aT
POOLS - SPAS
BLOCKWALLAPkOVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final I
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)
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-� Laguna De La Paz
P.O. Box 799
Rancho Mirage, CA 92270
(619) 564-8864
FAX_(619), 564-8867 -
ARCHITECTURAL,VARIANCE REQUEST
UNIT # DATE �O
-NAME D11 E 9j N kN C Y `, 04AMALS _
STREET ADDRESSIt�• FLLE,.rt�I'� :�4 , ~,
LOCAL PHONE OTHER'.PH6NE
To The Architectural Committee:
We, the undersigned owners, request your approval of the
modifications proposed on the -reverse side of this form.
Attached are drawings of the work to be done; types of material
to be used are indicated on the drawings. We understand that
building permits for home improvements are required by the City-
of
ityof La Quinta and that the' cost of the permits and responsibility
of obtaining permits and'subsequent inspections will be borne ;
by us.-
We
s..We acknowledge that all` approved changes in the original -design
will be at our expense; .that. any damage to or relocation` of.-.
existing sprinkler systems, underground utilities, building--
structure
uilding -structure and exterior landscaping or other damage resulting'
from construction of t erm rovements will be.;'at
our expense; and t maintenance f the.p itted improvements
will be at our a ens j
Y ` •
i
SIGNATURE OF ALL nwidft S -
41
f
Please provide as much detail as possible so that the committee
may consider approval without delay!:
SEE NTTkCR'MK'rNTS, PLEASE .
The. above- proposal- has: been•reviewe&' by- they Architectural
Committee -and has} been-: -
APPROVED'" REJECTED .= PENDING: FURTHER
INFORMATIOW
_. ..� _--. _ :_sc_�a�.'".�'�'�}';.'_",JC9 •.7i -e--+ ��,.p_-.*.�'.,J;••_,x,+n;.�m^"""'.-.•r:�.,., .. ... - .— +... ..j._�.......-
Comments:
Committee Member
Committee�Member
Committee Member
UNIT 0
NAME
Laguna De La Par
P.O. Box 799
Rancho Mirage, CA 92270 _
(619) 564-8864
FAX (619) 564-8867
ARCHITECTURAL VARIANCE REQUEST
DATE 0_L_-7
STREET ADDRESS 4$" (&I_ CAL%E PE -fin% ?�►-
LOCAL PHONE #_ OTHER PHONE'
To The Architectural Committee:
We, the undersigned owners, request your approval of the
modifications proposed on the reverse side of this form.
Attached are drawings of the work to be done; types of material
to be used are -indicated on.the•drawings. We understand that -
building permits for home improvements are required by the City
of La Quinta and that the cost of the permits -and responsibility
of obtaining permits.and subsequent'inspections.will be borne- .
by us., -
We acknowledge that all approved changes.in the original design
will be at our expense; that: any damage.to or relocation of
existing sprinkler systems, underground -utilities, building
structure and exterior landscaping or other damage resulting"'
from construction of,.t erm rovements will bq:'at
our expense;_ and t maintenance f the p fitted improVements-
will be at our a ens
SIGNATURE OF ALL O S:
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