9706-061 (BLCK)LICENSED CONTRACTOR DECLARATION
ti,I=hereby affirm under penalty of perjurOhat 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:
(Nr)' 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).
(7) I am exempt under Section B&P C_ for this reason ,
Signature. of Ownera __., '� �: �fZs € - v
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.
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).
(?�yI 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: ..r
ate / '•� ' 77 Applicant P 'e f'• '� a. C, r•a..
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 herebymade 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 persori'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, in
& 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 ' t
Signature. (Owner/Agpnt);/e"t�' "%..—"P /'3- ' Date �r
PERMIT # CONTROL #
BUILDING PERMIT 9706-061 5321
DATE VALUATION LOT' TRACT
• 4i/ 61y7
JOB SITE
ADDRESS 7 -725 Y4A &ONATA APN
8i
OWNER CONTRACTOR/DESIGNER/ENGINEER
7b-715 VIA S�'iNATA'
LA QIJINTA CA 15-Y22-53
USE OF PERMIT
13fs g rdlot WWI city Secy
6 F WAIL1
Cdt3?E!S't'fti1G'l''ft a{+)
111"Ex 101-000.418-000 V43..00
1,3'q'rAf_. CON AND i?LAN CFMCK $43,00
MI—PM)�a!SE' S P. KCffJ ..
JUN 0 6-11997
%►'l'sU4.�'f~a.�tfl�'rr'n"'F8 amcNc:aav:
01TY OF tom, QUINT
RECEIPTr< DATE . di BY DATE FINALED INSPECTOR
INSPECTION RECORD
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
OX 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 7
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APOROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Piaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
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:
PARC LA'QUINTA HOMEOWNERS"ASSOCIATION
AVAIL .PROPERTY.'MANAGEMENT . '
P.O. BOX 1032
PALM DESERT, CA 92261
x(619) 568=2717 .
r%ar,c la quinta
To: City of La Quinta `Date: February 20, 1997
From: Cam Anderson
Project Manager
-y yarai,
- �- n�,. `-Bank sldeo.yard,'wail'-<instaiiation�'
TO WHOM IT MAY CONCERN:.
The Parc La Quinta HOA does not have restrictions on residents
constructing block wall in their rear/side yards, "_"provided- they
receive a building permit from the.city, follow your guidelines,
do not leave building•materials/debris in the street over night,
and the wall DOES NOT EXCEED PAST THE FRONT OF "THEIR{RESIDENCE `
IN THE FRONT YARD.
Should you have any questions regarding this policy, please
contact"this office.
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