9906-091 (RPL)LICENSED CONTRACTOR DECLARATION
U I hereby affirm rlinder penalty of perjury that I am licensed under provisions of
H Chapter 9 (comf:nencing with Section 7000) of Division 3 of the Business and
N W Professionals and my License is in full force and effect.
O =) ch • . License #ZI Lic. Class Exp. Date
d:Lo ;ti920S C-53 j 07/31120
LIJ
��.a`te �' ''�� 1Signature of ContractorCID 0
U C:) OWNER -BUILDER DECLARATION
FW- WW I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
Z_ ( ) 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
Gudu). .
( ) I am exempt under Section B&P.C. for this reason
LO.
N Date Signature of Owner
ON
a Q WORKER'S COMPENSATION DECLARATION
�p Cc I hereby affirm under penalty of perjury one of the following declarations:
Lin � O () 1 have and will maintain a certificate of consent to self -insure for workers'
X W LL compensation, as provided for by Section 3700 of the Labor Code, for the
O J Q performance of the work for which this permit is issued.
m QU (,J) I have and will maintain workers' compensation insurance, as required by
O C)Q Section 3700 of the Labor Code, for the performance of the work for which this
rn permit is issued. My workers' compensation insurance carrier & policy no. are:
v Z 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 provisi/ons of Section 3700 of the Labor
Code, I shall, forthwith. comply with those provisions.
,Date:,
Warning: Failuretosecure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
%* application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I.have read this application and state that the above information is
• correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City ,to enter upon
the above-mentioned property for inspection purposes. ,
Signature (Owner/Agent)
BUILDING PERMIT PERMIT"06-0911
J
DATE / 1 v /^ // VALUATION SZ$,000.00 LOT TRACT
JOB SITE
ADDRESS 47f-5525 VIA UONT"SA
APN
OWNER
CONTRACTOR/DESIGNER/ENGINEER
�
MR. 1ROBER,T SCIILIC'K
C IKUHL,L 1 POOL C�f��r��`�:U�"3."�U�lf, YNC.
47-_V25 V14A AIClNJ'kSSA
78--
M 0 Ltk PAial.dA DR.. LA QUINTA
LAQ U1N',rA CA 92253
PALM DESERT CA 92261
{760) 10 1(i!)2 CBLe?- 1844
USE OF PERMIT
POOL AN LWOR. SPA
k'OOL & $`PA GINTLY, iU A121vi ikkDiOk BAM-L-tit, QU rR [i rOR
tMi
PPLASS•t'.FR INSi f i'JON
POOL ANIXOR SPA
ESPAIIIAVED COST OF CONS= UCTIO.N
23"
FEE Si3Nt1W1,RV
PLAN CHECK T09E 104-000-439-319 S176AS
C()NS''M (xi" IT", F ORf ; 1011-000-418-0M 5271 yfl
AIMC'l.iMICIA4., [?1s' —IFICIOL IM -000-42i-000 $24.00
V1LE(r4WCA -1-11 'r -- PCK)L 101-fl0(?-�i2G-UGi) $�1S tsi►
PLUM3114C. fi'KE --:4'00L 101,-t!(0AV)-0(X) 527,00
SUR-t'O'r.ALf. ONS'1R jC)0.;�,r AND PLAN (';F•!.fflf<
$54.199
LESS lift; -PAID FEES
$0.00
TOTAI, PERMIT FCES DUE NOW'
RECEIPT
DATE
BY J
DATE FINALED
INSPECTOR
1
INSPECTION RECORD
GPE!3ATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
' BUILDING APPROVALS
MECHANICAL APPROVALS
Set P,auks
Underground Ducts
_f & 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 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
Steel
POOLS - SPAS
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping Arftdoref
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
—zo.now
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. U of Power
Final
Utility Notice (Perm)
COMMENTS:
Ci
U, A c ,
CAux0 A41) sAID
p2oceZ - VW axl T�
47-526 .Vlq
WmJc.t7 GIKE as.. GQ AW AD ft1)
I3OAK & SHAH ASSOCIATES, Inc.
CONSULTING ENGINEERS
3920 E. Coronado Street, Suite 203, Anaheim, CA. 92807
Phone: (714) 632-1865 Fax: (714) 632-1314..
September 17, 1999
Department of Building & Safety
City of La Quinta
78495 Calle Tampico
La Quinta, Ca. 92253
Reference:' Framing Inspection @
Lot 237, 47-525 Via Montessa
Lake La Quinta, Ca. 92253.
To Whom It May Concern:
On the morning of September 17,1999, Hoak & Shah Associates, Inca _Wade a visual
observation the above referenced site. This observation was made in the presence of the'Mr.
Mike Bergin, contractor. The structure appears to be completely framed and was found to be
in substantial compliance with the contract drawings.
If we can be of further assistance, please contact our office at any convenient time.
�0 QR�PESS/O/V `
E . w F2
Co
Q� y
Qj Q m
Respectfully .
._�._.� —1 No. 34803 _
Hoak"&.Shah Associates, 19c.
ZVI. �� 3
W•
Lawrence W. Hoak, (PTgTF OFv1 �F p��\P
President C A�