0011-235 (SFD)LICENSED CONTRACTOR DECLARATION.
I hel:^,by affirm under penalty of perjury that I am licensed under provisions of
Chapter 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
Date Signature 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
(,) 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.
�(t!), I have and will maintain workers' compensation insurance, as required by
SeS6n 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.
t �
(This section need not be completed, if the permit valuation is for $100.00 or less).
(s.) 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 sol forthwith comply with those. provisions. ,;
Date: f ' -fit Applicant -1'_ �"-�—
,A
V 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.
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.
Signature (Owner/Agent) �'%= Datef�
�l
BUILDING PERMIT PERMIT#
DATE VALUATION LOT LUQ A: $.• TRACT
JOB SITE
APN
ADDRESS
OWNER
CONTRACTOR/DESIGNER/EN INEER
USE OF PERMIT
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sT£t1:}NO ,MMOT1014 PAZ • RESID 101 -000-241 - 00 $34,36
19RADINO WE 101.000-423,-000 520.00
()1?VZk,Citi:K'4d.IMPACT 13..E ;� $1907.00
ART IN PUBLIC: PUl;f;.'0 • P0SIE 701' 000-255.000 $358,99
1IT.-�,.. DEP001 f' 4111000.00
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RECEIPT
DATE t !
BYry
�l
DATE FINALED
y
INSPECTOR
�-) °) � 1 i hl
,r
—e,0
�e
- INSPECTION RECORD
OPERATION
8`1— 1 16- X -
BLOCKWAL�L APPROVALS
DATE
INSPECTOR
OPERATION'
DATE 7
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set BacksC_
Forms & Footings
O ST
Underground Ducts /g _
Ducts
Slab Grade
�} —t —,ZReturnAir
Equipment Location
Steel
Roof Deck
_8 - O / �.�=
Combustion Air
Exhaust Fans
O.K to Wrap
Smoke Detectors
F.A.U.
Framing
Insulation
`� S?
Compressor
Vents
Fireplace P.L.
PLUMBING APPROVALS
Grills
Fireplace T.O.
/
Fans & Controls
Party Wali Insulation
Equipment Enclosure
Condensate Lines
Party Wali Firewall
O.K. for Finish Plaster
Sewer Lateral
Exterior Lath
8 / 7 r.3( s�
Sewer Connection
Drywall - Int. Lath
77 0f IX57
Final
8`1— 1 16- X -
BLOCKWAL�L APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Low Voltage Wiring
Main Drain
Bond Beam
Approval to Cover
Sub Panels
Equipment Location
Exterior Receptacles
.�
Underground Electric
Smoke Detectors
Underground Pibg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Water Piping/3
/
Heater Final
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piaina
COMMENTS:
Utility Notice (Gas) I v( — I
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)
J
1
o�
CITY OF LA QUINTA .
CFn�oF94� BUILDING & SAFETY DEPARTMENT
777-7012
INSPECTION I �u`i
F
777-7153
Owner ANNIE CROCO FEB 2 7 2001
Contractor OWNEWBUILDE11NANCE DEPT.
a
Permit Number 0011-235
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 52-880 LATROBE LANE
SFD - PERMIT DOES NOT INCLUDE BLOCK
WALL/POOL/SPA OR APPROACH
TYPE OF INSPECTION
DATE
INSP.
FOUNDATION & SETBACK p✓t;7,L
- 3 -O !
S.?,
FOOTING STEEL
MAIN GROUND SYSTEM
GROUND PLUMBING
/ p
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE SLAB
-3- D l
ST
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST
HEATING & VENT- A/C
FIREPLACE
ROOF _
_ p /
�.
BOND BEAM
O.K. TO WRAP
• 30 — p
S77
GROUT ❑ 4' ❑ 8'
FRAMING
INSULATION
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
FINALS
ELECTRICAL c®57
PLUMBING
FINAL GAS TEST j cel
HEATING -A/C
HOUSE NUMBERS
JOB COMPLETED
TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING
a
07/25/2001 02:43 7608360286 SCHMALE PAGE 01
e7/25/2001 11:.39 7601252e6.3 GOUVIS PS PAGE 92
GQ UVIS ENGINEERIN__G
• C A L 1 F 4 R N I A. •,;;�::
a-MAIL 70 • XPP0X7@M/MWVFCOA! s�le�oouvlscaOt�.G+aw ;;, ' ;;j
July zs. 2001
Adam J. Booth y
42-575 ,Melanie Place, Suite S
Palm Desert, CA 92211
Follow up to walk. through'(lot 27, Tradition 90 . -
O.F—C. Job No. 21196
Dear W. Booth:
pursuept to your request regarding the above captioned project, we submit the following:
On 7/14101 a wWk through of the a*ve project wase conducted in wvmrdawe with the
uniform build code (UBC) chapter 1702 and • list of eorrectiom was ptPH pokd to the
home ow Der representative.
Our walk through covered gtructural items visible at the time, oxcludiag the roof
sheathing and top plates nailing and all suW sand clips above the top plates.
If you have auy questions, please do not besitale to contact this OMM
Sincerely,
` Ida. 038274
.yjF C1V1LO♦?�� f� w �.
Saeed J. Bekam Or C!►011. Hans Viooys
President Project Mama
SJB;RF,ig ,
21196
GOUM ENGINRXRING GROUP OF COMPANM W= OFFM 1N.• WzP%=' o0U1AG1M.P.CAV
440CAWWDWM &=A • NOWMArR&KV, C LFURM Wag • (040) 73246/1 • PAX ( 0) 713.$3?1
2150 UT rAM=ZCAWAW Svrar9 • PAW C"VJM WQ • (760) 323 -MO • PAX (W) 321-M
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