0305-181 (DEMO)U)
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LICENSED CONTRACTOR DECLARATION
I hereby 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
746760 BMC 0313-1/2( f
Date
to �,r ^� Signature of Contractor J.
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.
( )iln.have and will maintain workers' compensation insurance, as required by
Secti n 3700 of the Labor Code, for the performance of the work for which this
perm
it is issued. My workers' compensation insurance carrier & policy no. are:
Carrier� r.MID
Policy No. 1342489-03
(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 I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code,:I shall forthwith comply with those provisions. a
ateT Applicant
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Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representative, s of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) .1 ��! 0ate �'���
- PERMIT PERMIT#1.
BUILDING r _
��' t��
VALUATION LOT TRACT
DATE 1/20C
JOB SITE
APN
ADDRESS 78-M CAIAX ES T"O
OWNER
CONTRACTOR / DESIGNER / EN (NEER
RtT.PMZ YSSA'YIM4
B & M CONYaAtliMON
78,023 C.P 1 ZJ CARO
51 -?66 AVENIE3A AUARV..
.LA QURgTA CA 92233
LA (1'C3l.TITTA CA S'2253
(760)337-5478 CP.1,0 5941
USE OF PERMIT
lDl:il4.0IVOOJ)YN PATIO COVER' &0, i. fMIIIIUM STORAI[IZ SHED
ESI<'IItrL,.$,7M COST OF @::ON117A.$d17C�,.. DR
DEMOIATION FFR 1Ci'1�000�4Z3•(�00 S4S.Oa
PLAN CMCK
$3.5.00
.CIXON3TRUMONAM
LROS PRE -P.7 W k'IM
$0.00
NIP . 2 -27V&P IMME-ESD TE OW
SOAR)
art OF LA Quit`:TA
FINANCE DEPT. 4.
RECEIPT
DATE
BY
DAT FI ED
INSPE
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. i
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
POOLS - SPAS
BLOCKWALL APPROVALS
steel
Set Backs
Electric Bond
Footings
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
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) Z 0-0�
N
P.O. BOX 1504
78-495 CALLE TAMPICO
LA OUINTA, CA 92253-1504
PUBLIC WORKS/ENGINEERING
LEONARD R. ST. SAUVER
ASSISTANT ENGINEER I
DIRECT (760) 777-7048
CELL (760) 275-2143
FAX. (760) 777-7155
EMAIL:Istsauve@la-quinta.org
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R E A L E S T A T E
City of La Quinta
Building Department
La Quinta, CA 92253
To Whom It May Concern:
Please be advised that B&M Construction has permission
to demolish the patio cover on the east side of our
building at 78-023 Calle Estado as part of.the work
authorized by the.City of La Quinta Commercial Property
Improvement Program (2003-022)
Sincerely,
Rupert/?essayian
REALTORS
(�78-023 564-4218 ll( Esta Quinta,FAX (4#9) 564-4328
Same location for over 30 years ---Across street from Post Office
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