9710-173 (ELEC)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
/ - 3u
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).
( ) 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.
( )"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:
Camer ,.-'i p;,.t J Policy No. Jv
(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 thefcabor
Code, I shall forthwith 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.
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./
,S
Signature (Owner/Agent)•�.�G Date 'y -'�
BUILDINGPERMIT PERMIT# CONTROL# ,
DATE VALUATION LOT 9710-173 TRACT G173
10/30/97 53,000.00
JOB SITE L-30_t90s
APN
ADDRESS
VISTA BONITA 'TR
-
OWNER
CONTRACTOR/DESIGNER/ENGINEER
F ]Citi
SOU T WES'1 Pi.1MP &. DRILLING
51240 VISTA RONrrA TRI.
53-401 MY .11 i
fND10 CA 92201
COACHELLA CA 92236
CBL#
USE OF PERMIT
•tvar
100 A" SVC, TRXC.'iRICAi. TO 1; HP %T11, PUMP
VALUATION 3,000.00 L,S
E.S'f-IMNUE, D COST OF CONStTRUCIJON
— 3,000.011
PRRNIff ME SUMMARY w.
518.
FI C'MICAL El) 101-000420-000Cn
SUB-TMAL CONS't'Rl1{,"1'lON AND PLAN CHECK - s.
$48.50
LESS Pk -PAif1 FEES
$000
TOTAL PERMIT FEES DUE NONV
S48.50
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
,- ,
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 Wail Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
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
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
F'rdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm) < <
COMMENTS:
h
April 6, 2005
T-dY 4 4 4"
P.O. Box 1504
LA QUINTA, CALIFORNIA 92247-1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Ms. Esther Sanchez
Riverside County Assessor's Office
3255 E. Tahquitz Canyon Way
Suite 114
Palm Springs, CA 92262-6962
Dear Ms. Sanchez
BUILDIA'G & SAFETY DEPARTMENT
(760)777-7012
FAX (760) 777-7011
Please be advised of an address change for the following property. The parcel formerly
addressed as 51-240 Vista Bonita Trail, APN: 772-280-021, Lot 21, Tract 21176, is now
addressed as: 80-885 Vista Bonita Trail.
If I may be of further assistance, you may contact me directly at (760) 777-7074.
Sincerely,
Therese Vella-Finorio
Senior Secretary