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9806-085 (SIGN)LICENSED CONTRACTOR DECLARATION •f 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 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). J () I am exempt under Section B&P.0 for this reason ./Date 6/1 e✓ Signature of. Owner X r? t WORKER'S COMPENSATIOW'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. (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, Ishj� 11 fo hwith comply with those- provisions. /Date: 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 f 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 6uilding construction, and hereby authorize representatives of this City to enter upon the above-mentioned property;for' inspection purpose . ./Signature (Owner/Agent) Ya" 1ADate �+ b I,.. PERMIT# CONTROL# BUILDING PERMIT ddd DATE `, 1 �lJ f VALUATION . LOT TRACT i (i 1 $.1,000.00 '� JOB SITE ADDRESS 78-605112 VIA FLORENCE APN OWNER CONTRACTOR / DESIGNER / ENGINEER ,LAKE LA QMNTA Hf N111Zi N",, ERS ASSN OWNER' 8UTLDER 47790 VIA.fARDIN LA QUINTA. CA 911253 CBL'# USE OF PERMIT NIONUTENT SIGN AT INURSEC t IDN OF CALF -0 BAY AND VIA FLORENCE. VAJ.UKr10N 1,000.00 LS Li STIM ATC(l) COST OF CONST.'RU'CTION 1,I)OO.Im PERM [ FEE SUMMARY . . PLAN CHFICK FEE 101-000-439-3111 CONSTRVICTION FEE, 101-000-418-000 Cti SUB-T,%AL CONS�"1'�i C -TION AND PLAIN CRECK 193 4:LS SUN 1 U f,rss PRE -PAW I- %O.t;a Y�` ,,fo AL PrmNif(1 FEES DUE NOW S41.25 . ✓ �� O l i' t1 r RECEIPT -"LED INSPECTOR w�• 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 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 f Approval to Cover Equipment Location Underground Electric Final Underground Plbg. Test Gas Piping PLUMBING A PROVALS 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) LE _COPY c7;1 F1 �..= 78-495 CALLE TAMP,.ICO LA OUINTA, CALIFORNIA 92253 — (760) 777-7000 FAX (760) 777-7101 TDD (760) 777-1227 May 27, 1998 Mr. JM Roberts Lake La Quinta Homeowners Association ' 47-790 Via Jardin La Quinta,-.Calif. 92253 r SUBJECT:Sign Application 98-421 for Lake La Quinta t Dear-Mr. ,Roberts, {' The Community Development Department- has approved your request for permanent subdivision identification signs at your project entries'at' the intersection 'of Caleo Bay and Via Florence and Caleo Bay Drive and Dulce .Del Maras submiaed. The approval 'is.subject to-the following conditions: r } I. A building -permit from the, Building and Safety Department[' shall be' obtained prior to any work beginning. 2. Approval is subject to the enclosed plans. ' 3. Any lighting of the sign shall be ground mounted and comply with City Dark.Sky., Ordinance. All new Light fixtures .shall be submitted to Community Development Department for approval 'prior.to installation. Should' "you have any questions, please call'me at (760) 777-706• Very truly yours, JERRY HERMAN COMMUNITY DEVELOPMENT DIRECTORS ` STAN B. SAWA Principal Planner sbs • " enclosure c: Code Enforcement Building and Safety' Department WAILING ADDRESS - P.O. BOX 1504 - LA OUINTA; CALIFORNIA 92253 - c:Utr app sa,98-421 CITY OF LA QUINTA SUB -LIST CONTRACTOR D����-1 �v��� ADDRESS 4120 VSA JAO.o,,� OWNER L—kILG 1-k QujoZp, i ()A JOB ADDRESS 78-6,05'h- VAR FL�e-e-�et This form shall be posted on the job with the Building Inspection Card -at all times in a co "yicuous place It is the responsibility of the General Contractor or the Owner/Builder to monitor the sub-contractors.the are on this list are the same persons performing the work. Any changes to this list must be approved th City of La Quinta Department of Building & Safety Belix to work being performed by a changed sut contractor. Failure to comply will result in a stoppage of work and/or the vo.dance of building, permit. CITY: SUB=CONTRACTOR'S TYPE OF$TATE WORI4ER'S BUSS;:INE TRADE NAME LICENSE CONTRACtOR'S :COMP `NAME/ LICENSE it ENSE C NUMHR .ON. FJLE_ ;NUMBER/ NU BER EXP; DATE GRADE/ A/C -12 EXCAVATE PIPELINES`::. C-34 CONCRETE/C-8 FOUNDATIONS : ASPHALT: :: A FRAMING B STEEL/ C-51 STRUCTURAL MASONRY. siva: Ewn�GTo� r1P,S. C-29 � '78� 8 ATE �uuP I i 49 096- - 351c9 ti /Lha PLUMBING C-36 FENCING C-13 LANDSCAPING C-27 POOLS C-53 OTHER �1'1Gnl Lr, >r�+a $T SaGrls fiJG. �{, �a �e12 S2 483 22Q oo GNP�teS flesj WCtJo�223 ��iq 3705 II a 98 `47TH __ AVENUE - L Ll y� 17 172 leo lee f4D U4 f43 A214t I i 174 171 leo tai foe 140 ��' -r '—'"`/■-Q�T'1 175 170 lel 156 141 135 !3- 130 176 leo U2 155 14e 138 177 t66 P13 13 151 140134,133 I 7e 1e7 1e4 sea 160 A 132 — - SITE 179 lee lee 102 131 lei 127 128 , lag 130 lel see lee 100 I 167 101 109 200201 19 192 too 202 I , u see � 203 19i W204I 164 tea sea 19e 194 I" 195 Zoe Cly 1 � 206 A LAKE MA w 273 272 271 254 263 I 274 270 252 25 276 260 251 231 20e all e50 239 Z 26e 257 240 O 277 257 749 zee 241 � I (' a76 2e0 249 253 242 Z 276 ass 211 H 260 243 • _ ms4e ae4 251244 244 . 661 6e3 aea otx ' 1�z + se 47 103 104 105 I 1e 17 at az 46 48 toe = lI ss 45 io 73 _• I 4-9 . 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