9512-088 (PLBG)P .__ LICENSED CONTRACTOR DECLARATION
I hareby 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
o C3 Lo
nLicense is in full force and effect. 681864 A 12/31/95
r; wn Licens # ' Class_ Exp. Date -
K cc ^'� Date >� 2 - /4(-chSignatureofContractor -/ ., ,,..� , .: , T,
�Z^
p OWNER -BUILDER DECLARATION
IU I hereby affirm that I am exempt from the Contractor's License Law for the
LLJfollowing reason:
~ (n ( ) 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).
( ) 1, 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
toN
rn WORKER'S COMPENSATION DECLARATION
d Q I hereby affirm under penalty of perjury one of the following declarations:
Z () I have and will maintain a certificate of consent to self -insure for workers'
Lo cc compensation, as provided for by Section 3700 of the Labor Code, for the
X W LL performance of the work for which this permit is issued.
O J J ( ) I have and will maintain workers' compensation insurance, as required by
00 Q U Section 3700 of the Labor Code, for the performance of the work for which this
d U permit is issued. My workers' compensation insurance carrier & policy no. are:
CL m FF< Carrier 4- r +T nID4 Policy No.
Z (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,
d't 1 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, II shall forthwith comply wi". ose provisions.
?,..Date:f./-` 1?— °/7 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.
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 appal ca ion agrees to, & shall, indemnify
& hold harmless the City of Indian-1M1%ells, 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
• Sys above-mentioned property for inspection purposes. r
Nil
ignatrlre (owner/Age Data 1
ir
ALCI
BUILDING PERMIT
PERMIT953�0 ,
DATE 12118f95
VALUATION Si,Gt3lI.1BU LOT TRACT
JOB SITE ADDRESS
51-446 AVE. H E PtItERA
APN '
OWNER
CONTRACTOR
JIM .?<1II LER 7R. INC.
EIEN R01UQUE
73633 PACHETT'A. #5
SAiIME
T14OUSAND.PA:LMS CA 922276
LA QU.fMfA CA. 92253
(619')143-3276 C13L# 3602
DESIGNERIENGINEER
USE OF PERMIiJI,L[MIR1idCD
FEE DESCRIPTION
FEES
CON"l R AC P AMOUNT 1.600.00 LS
ES11MATED CVST OF Cd3:iti: TRUC•CION
PERMIT FEE SUMIkUlkRY
PLUM131NG U,•- S1 WER 1.01-000.09-0) $ 0.00
SUB -TOTAL CONS71RU•C170N .AND PLAN CHECK
$30.00
LESS PRE -PAID FEES
$0.00
TOTAL PERMIT F:EE.S DUE NOW
$30.00
l�
RECEIPT
DATE f
BY
DATE FINALED
INSPECTOR
C
Rmeik,
!. .• ..
i ? 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
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
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
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
ces
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:
COACHELLA VALLEY WATER DISTRICT
CASH RECEIPT DETAIL
Received From.
Address:
//-
Account No. /
�, �' -� Lot(s)
Service Address SV�+(
/��!� `{ �� -•�---��-n /J +�
❑ Meter(s)
Money
Order
❑ Service(s)
❑ Backflow(s)
❑ House Lateral(s)
❑ DetectorCheck(s)
❑ Meter Surcharge
X'Sanitation Capacity Charge
❑ W.S.B.F.C.
❑ Temporary Construction Meter
❑ Turn on Charge
❑ Uncollected Account - Name
❑ Inspection Fee - Tract -
Fee -
❑ Plan Check Fees Water I Sewer -
Tract -
❑ Bond Payment - A.D. - Bond
❑ Customer Deposit
❑ Other
r
Remarks:
r
Ne g6t6 f
TOTAL
❑Copy to:
Cash
Water Service
Check
�"
.`
' Cashier
Money
Order
r CVWD-438 (11189)
0
%V 1.7) JV V -/ TTV
(619) 321-7448
'
CUSTOMER'S ORDER NO.
DATE ORDERED
It 4 -a o -Crs-
ORDER TAKEN BY
DATE PROMISED 0 A.M.
0 P.M.
;SILL TO - ( _
r h
PHONE
ADDRESS
.
M ANIC (i
n
CITY
HELPER
'B NAME AND LOCATION /� J /!, �,•f
A
B'DAY WORK
i;RIPTION OF W K + +�
U
0 CONTRACT
EXTRA
SN.wT o
UANT.
DESCRIPTION OF MATERIAL USED
PRICE
AMOUNT
Z Zj
Gallons
�Q (�
Pumping Fee per 1000 gal.
b Q Q
Dumping Fee per 1000 gal.
S�Q pe
s-
ni
Out of Area Fee
t
Locating / Opening Fee (per hour)
Size System:
A SERVICE CHARGE OF $20 WILL BE DUE
ON ALL RETURNED CHECKS.
A FINANCE CHARGE OF 11/2% PER MONTH, 18% PER YEAR
WILL BE CHARGED ON PAST -DUE ACCOUNTS OVER 30 DAYS.
HOURS
LABOR AMOUNT
TOTAL
MATERIALS
MECHANICS Q
HELPERS Ca?
TOTAL
LABOR
I hereby acknowledge the satisfactory
Co of the above described work:
TOTAL LABOR
TAX
SIGNATURE
DATE COMPLETED
! ;1.. U Q Sr
TOTAL
Ti4 4 4 a"
78-495 CALLE TAMPICO — LA QUINTA, CALIFORNIA 92253 - (760) 777-7000
FAX (760) 777-7101
TDD (760) 777-1227
December 16,1997
Belen Roriguez
51-446 Avenida Herrera
La Quinta, CA., 92253
RE: Plumbing Permit #9512-088
Dear Mr. Roriguez
The purpose of this letter is to inform you that your Plumbing Permit #9512-088, for e project
at 51-446 Avenida Herrera, has expired. In accordance with 1994 UBC section 106.4.th4, no
further work may be performed until a new permit has been issued.
Please contact Daniel P. Crawford Jr., Building Inspector I, at (760) 777-7012 to obtain any ;
information you need regarding a new permit and/or any required inspections. Should you
choose not to complete the project, we would then have to pursue any or all of the following
actions:
1) Abatement of the project through the City Attorney's Office and Code Compliance Division.
2) Notice of non -conforming structure placed upon property profile.
3) Action filed with Contractor State License Board. Optional if Owner/Builder.
Please contact us at your earliest convenience prior to 10 working days to resolve this issue, and
.for any questions you may have. ,
Sincerely,
Mark Harold
Building & Safety Manage
l
Daniel P. Crawford Jr.
Building Inspector I
cc: file
dpc
MAILING ADDRESS - P.O. BOX 1504 - LA QUINTA, CALIFORNIA 92253 ��