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LICENSED CONTRACTOR DECLARATION `
hereby affirm underpenalty 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
590643
Date Signature of Contractor-'`"� x•.
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 fo(,which this permit is issued. '
( )0 1 have and will maintaln,workers' compensation insurance, as required by
Setion 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.
STATH FUND
(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.
Date: n'g 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. _T--
1. Each person" upon whose behalf this -application is made & each person 46
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•resuft 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 purrpojses.
Si nature /Owner/Anent)'r r'/• ; t'/,+Date • •-
PERMIT PERMIT#
,BUILDING
DATE VALUATION LOT �s�+f>>'t.�i TRACT
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JOB SITE d
ADDRESS
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OWNER
CONTRACTOR/DESIGNER/EN (NEER
$ IrT HOilU&N, �,7 "> .
P. T .IN ar. I `"�il, INC,
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(602-)257-1656 cn "Ut 4.990
USE OF PERMIT
MINGLERAVILYENA NG
SFDA J'1"rZ PLAN SITIBC5. PFIRM17' lion NOT INC:E..tiJYip; Bliooi; K
WA1AL$,P001Aj9PA OR DRIVEWAY APMOACH
"1 RAC:`f cCONSTRUCTION 4,:146,00 fid'
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(.101��3"9�Rt.1t01-10If FRE 101.300-418.000 $1,23-Y.00
PLV -4 CHECC F630 101-000-439-3'18 sb, .r.,00
.MFIVaIANICA11F -9 lEll. 000.471�f10(?
X1,91UTRICA1,'I? 101-110 0-420-003 12: d7
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SEP 06 2001 I
CITY OF LA QUINTA
FINANCE DEPT.
RECEIPT
DATE r .
/ ,, f
BY
DATE MIS
INSPECT
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
`
�/ - U �(
Underground Ducts
Forms & Footings
Ducts
az
Slab Gradep
ReturnAir
Steel
l! I S
Combustion Air
Roof Deck
O.K. to Wrap
Framing_
I -0�- _
_,o
Exhaust Fans
F.A.U.
Compressor ®�
Insulation
7- a L/
Vents
Fireplace P.L.
Grills
Fireplace T.O.�'i—
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath�j�
_
Final - 2� S
Final
/— Z — 3 S
_
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
pL I
Plumbing Final
Plumbing Top Out
_
Equipment Enclosure
Shower Pans_
_
O.K. for Finish Plaster
Sewer Lateral
_
Pool Cover
Sewer Connection-�d
`
Encapsulation
Gas Piping
Gas Test
Appliances
•
Final .
COMMENTS:
Final
Utility Notice (Gas)
_
— —
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
=�7=
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
_
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
P.0. Boz 1504 t
78-495 CALLE TAMPI60 '(760) .777-7000
BrBrighter i ' '
��S S T�►�Ever LA QuINTA, CALIFORNIA,92253 FAX '(760) •777-7.101
,
April 11, 2002
RIVERSIDE COUNTY ASSESSOR
Attn: Mapping Department ,
' P.O. Box 12004 '
Riverside; CA 92502-2204 -;
Dear Mr. Hargis: - -
Please be advised of a correction to' a street name for the •following structures =x'
. ,The structures formerly addressed as 79-710, 79-730, 79-750, 79-770.and�79-835*
Via Sin Cuidadi the construction for which building, permits #0106-407, 0106-404,.
0106-402, 0106-398 and 0109-019 were issued, will now_ have a street name of
.. VIA SIN CUIDADO.
-
Please note this change and -contact me directly -at (760) 777-7019•if I may be of,further
assistance.
ou.
Thank you.-
Sincerely,
Sincerely,
'
z Diane Aaker
Building & Safety Department
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INSULATION CERTIFICATE
This is to certify that insulation has been installed in conformance with the current energy `
regulation, California Administrative Code, Title 24, State of California, in the building located at:'
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79-835 VIA SIN CUIDADO, LOT 72,LA QUINTA, CALIFORNIA
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CEILINGS:
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TYPE: BATTS MANUFACTURER: CERTAINTEED THICKNESS: R-38
WALLS:
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TYPE : BATTS MANUFACTURER: CERTAINTEED THICKNESS: R-21
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GEN L C NT CTO RJT ES LICENSE #C�710
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TITLE:
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A ON SCHMID BUILDING PRODUCTS, A MASCO COMPANY LICENSE # 632072
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Y: TITLE: ADMINISTRATIVE ASSISTANT.,,DATE: 11/13/2003
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