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LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
-S,fiapter 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
4323 '_ A B _ . i $/31:98
f
ate �Ignature of Contractor
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.
STATE WND 1103231-97
(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 14 hould become
subject to the workers' comppensatip0 Qrovisions of Section 3740 of the Labor
Code I shall forthwith comply wi those provisions.
✓Date: �'�� '1
Applicant—
Warning:
pplicant 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 applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
I 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 p rope rty`for-iInspection purposes. f
ignature (Owner/Agent)" Dated` `+
BUILDINGPERMIT PERMIT#
CONTROL#
DATE VALUATION LOT .9504-.183 TRACT
7 0
4 a V76 S1,200.00
JOB SITE
APN
_
ADDRESS
51-325 A E..HERRER.A
OWNER
CONTRACTOR / DESIGNER / ENGINEER
1ANET C BILLINGS
:L1U IM, INC.
LA. QWNTA.
CA 92253
f760�5� I3+8
: CBL# 2,526
USE OF PERMIT
0,11 11 AJ R
SEWER CONNECT, SEPTIC A?BANuO1v'1•IR#� I PAIL)
/ APP 29
VAk.ITXT1'O'N 1,200.00 LS
�p 01- TA,
U
✓i -TY OF
U
ESTIMATED C ST OF CONSTfKUM'ION
6,�l114.;411
PI'RMIT FEE Sd1`MM ARY
PLUMBING FF.43 -- SHIWW 10.1-000APS6-1.)00 $30.00
SUB 1}OTAL• CONSTRUCirION.AND PLAN CHECK
$30,00
ESS PRE -PAID I'TES
$0.00
TOTAL PERN"T FEES IDILTE NOW
$30.00
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION DATE I INSPECTOR
BUILDING APPROVALS
Set Backs
Forms & Footings
Slab Grade
Steel
Roof Deck
O.K. to Wrap
Framing
Insulation
Fireplace P.L.
Fireplace T.O.
Party Wall Insulation
Party Wall Firewall
Exterior Lath
Drvwall - Int. Lath
BLOCKWALL APPROVALS
Bond Beam
Final
PLUMBING
APPROVALS
Waste Lines
Water Piping
Plumbing Top Out
Shower Pans
Sewer Lateral
Sewer Connection
Gas Piping
Gas Test
Ap liances
J -
-
Final
Utility Notice (Gas)
ELECTRICAL
APPROVALS
Temp. Power Pole
Underaround Conduit
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
t
Final
Wilily Notice (Perm)
OPERATION DATE INSPECTOR
MECHANICAL APPROVALS
Underground Ducts
Ducts
Return Air
Combustion Air
Exhaust Fans
F.A.U.
Compressor
Vents
Grills
Fans & Controls
Condensate Lines
Steel
Electric Bond
Main Drain
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Gas Piping
Gas Test
Electric Final
Heater Final
Plumbing Final
Equipment Enclosure
O.K. for Finish Plaster
Pool Cover
COMMENTS:
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78-105 CALLE ESTADO - LA QUINTA, CALIFORNIA 92253 - (619) 564-2246
September 26, 1990
To Whom It May Concern:
The structure located at 51-325 Herrera is located in.a "B" flood zone
per the revised F.I.R.M. (panels 060709 0005 A and 0010 A) for La
Quinta. The property was.previously designated as zone AO (depth two
(2) feet).
If you have any questions, feel free to contact me.
Sincerely,
BUILDING AND SAFETY DEPARTMENT
Tom Hartung
Director of Building and Safety
TH/lc
MAILING ADDRESS - P.O. BOX 1504 - LA QUINTA, CALIFORNIA 92253
T4t,t 4 4 Qu&m
P.O. BOX 1504 - LA QUINTA, CALIFORNIA 92253
Janet Billings
76-160 Zumi Road
Indian Wells, -CA 92210