9510-104 (PAT)LICENSED CONTRACTOR DECLARATION
I hereby affirm 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. 421101i 13 ?'3106
License # Lia Class Y Exp. Date - �-
bate Signatureof Contractor
y
OWNER -BUILDER DECLARATION
I hereby affirm 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:
Carrier Policy No.
(This sjon�dirj�b�ier�pLerted if the permit valuation is for $100.00 or less).
( *I carr* 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: 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 application agrees to, & shall, indemnify
& hold harmless the City of Indian Wells, 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)
LLE-Gw^,/A-
ALCM
BUILDING PERMIT
PERMIT
DATE • 11f411119.15
VALUATION $r'SJ2q.Oti LOT TRACT
JOB SITE ADDRESS
49-128 V'V x A C[ELO
APN
OWNER
CONTRACTOR
K,T C0N;� k('"if"'('(0 V
49128 VISTA CIELO
LA Ql1(N`I'A CA Q233
LA �QIAAt7'A CA 9225;
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
07
1
Final
Final
POOLS - SPAS
BLOCKWAL
A ROVALS
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
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)
Ratter ilea s Special
_,'7 V 6 321 0'G �M�x
goof h tch
Sao iaofias iota selar
-Irecift soeflaa a sheethlwa aw Drat Lattice
---aPE146tTL Pf?T1(2
tk
2x4 0, 15 V -C.
1,00 Cottise,oue kdgtr
16ex
24.
11.2
164 -7.11
26
4-o.c�
12,-
C1.7.,10 i
S! �O L
Site
Y "d vgif Strop.
•-at"sl-nlw Win 00
2l
•
13-2
13� � �a�
4-10 d Mil@ ow bolt
q
softer Spaa _--3 ,__
-�' _ �iA1- --
Mt &pacing- MA i
- :'�i�
bed
45-352
Overall 1etst%1-1Q_
Y
i
u•�
2s•
17�
32•
11
f
ria+. ese pats
TE
2000 o.S.i. Clh cmu • J
Itis.
S/6'•s!- lag screws sato etwu at As" •.e. l low
selew
Oaatiame" Ledger
Ilk
� � 11 "t•,.
vt -
12•sir
12' . F0 5r �5c 13y
gale &" dim P;,/;Oa " DK- FRUA-L..
sMtrep or
4hglf
f ' Ascher
1 refs-eerrastiw.' bolts
1 plate
� • `� ..•' � - •�''' ISI
I wig
4.
L 14
.. • t Crate
T ,
WA= MeaJsi� .
rol>q�.s to v0.1
Si: Spall S sA1�
614. So 409 �'-
• ,
• .
-14, lta,c I&
.. .17• y!A ti'
.�.20•
�• ett R
itl ....11' bt10 Iy'
Provide 1"
learanc
ost To
ncret
F— Joist mouser ear Solid slockleg-A
rau Saltat to Slftkilhs
�eIse 1s bills
9).XL CD: W- 70
7d'= Y mrcR4 lIm=c lobes Antlers r Is case.
CEM
�• ,ice ��� � �•
p3��
et 4 �Lhas)�
bct
16ex
24.
11.2
164 -7.11
26
4-o.c�
12,-
C1.7.,10 i
S! �O L
~ 10-0
2l
•
13-2
13� � �a�
•�• ,�7,
2
10.10
1~11 7�•`�
- :'�i�
bed
1e•Adi�1
� s,
r.10
u•�
2s•
17�
32•
11
%A
-TENT
N
iC2$0 14 3 (V -2,87, &
Rao' voce
a• Wakes 4112 pitch 13/12 stir. pitch w, -Js 309
tel trde:as
layl Cls A
D. . caysitiar. e=-Kles 4,112 ch 2 pit13/12 tri..
Pi Ir.th 159 lilt trdr- Ly) . Class A
ao
C. It LT rolled r! supe to dra_..
4YPIQIL i' -ATM = R
fat Laguna De La Paz
P.O. Box ,-74`�g�
Rancho'Mira ge, CA 92270
(619) 564-8864
FAX (619) 564-8867
ARCHITECTURAL VARIANCE REQUEST
44
ct
UNIT DATE 0 L2 3195
NAME--Fe-r*11a'r`& t\ e 1,
STREET ADDRESS 12,?
e /0,
LOCAL PHONE V /Avo OTHER P�ONE(,Vj) .222
'Committee:
To The Architectural
We, the,undersigned owners, request your approvdl*of the
modificationsproposed on the
e reverse side of 'this form'.
Attached are drawings.of the work to be done; types of material
to be used are indicated on the drawings. We understand that
building -;permits for home improvements are required by,the City
of La Quinta and that•the 'cost of the permits and responsibility
of obtainingpermitsand subseque,nt.inspections-will be borne
,by us.
We acknowledge that all.�approved cha ' nges in"the'origInal design
will be at our expense; that any 'damage to or relocation of.
existing sprinkler systems,underground utilities, building
...structure and exterior landscaping or other damage resulting
from construction of -these permitted improvements will -be at
our expense; and that m - aintenance of the. permitted improvements
will be at our expense..
SIGNATURE OF ALL OWNERS:-