0202-003 (SFD)LICENSED CONTRACTOR DECL'�ARATION1.
I herehy affirm under penalty of perjury that I am licensed under provisions of..
Chapter9 (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
4 yl_2 .L3 1Oi:In(
Date sr ` Signature of Contractor l.r�
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. 7044,413usiness & 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 ofthe 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.
N 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 FXII,.1 PT 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. -provisions of Section 3700 of the Labor
Code ,.l shall forthwith comply with those=procisions.
Date:~ 1 ;%f -+-' Applicant-_" 2 `
I_._.
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.
j Signature (Owner/Agent)_ '" - r f` �. Date `) i
-WILDING PERMIT PERMIT#
DATE ^"VALUATION LOT �Qr' TRACT'
JOB SITE,.
APN ; J
ADDRESS -4W ,I IDA OBJlCitiiti4ON
rj
77411-075-0t.18
OWNER
CONTRACTOR / DESIGNER / EN (NEER
'MCM 1)AVIDSIUM
MIUCRZ;4AjJIDSC?N
53-875 E+.V':�*i'.IDAM-AJ ERE
:53-F75 A)MAINAADEM0
L.k Quaq iA CA 922:53
L.A QUU4TA C10. 42251311
(760)771.3362 LTIJI 5954
USE OF PERMIT
ff9G E- TrAWLY DWELLING
'
S:FU , 11FRInRIT V10CS'NOT INCLLIDF, POOL OR DRIVEWAY APPROAC K 130
Wil" COMBI1'dATION 4' RETA1W(')XV0 (ft,Rpt'A! WALL PEP. CIT
STANDARD. 99 C.:OT)ES,
TRACT C ONSTAU""'TION j,696100 S.F
; . �-
0A.1U_WVC.t.RP0RT . 533.011 S
6 11- J', WAIII. 25:0.00 11F
FFrMX,!`1�.iD ic.081 OF 001491' 'C'1r[t;►N
M'1285)m
PLAN MCK M 101-000-439-318 0X76
PVZ 01{.P05IT 101-00"39-318 -W6.00
�
MEC1. AWMAL- FEE 101-000-421-000 56&$0
,
F1.L,: TR.1CAL F9E 1 CI -000- 2042t 10 3. Se
,1
P1alfMMINO 17s 101-000.419.000 V24,00
TR.ONQ MOTION PER - 221",`311) 1.01-000-211-000 $Zf1 63
ORADINO FEE 101.000423.000 �3U,ii0
r ti''
L"tIXWL OPER IMPACT ",Z s1,947.00
PRE.CIf!€ PLAN 101440-441.345 $100.00
'x•
CONSTR1JCTION FEZ 101-000-h 115••000 $664.
'SUIVT`'7`e�i, 1 2ta C+ At��71'T fll+1' i C;G
3, 530.03
�.,. _._ .. TM:3 PRE -PAID 744.9
425RUC1
. tt�itl T( ' 'Y` ��.1���ua •�.f1.. NCMt??�=ysv
s i:�d� •� i
�
a FEB 21 2002 L
a�� ;
RECEIPTDATE
131-
DATE FINALED
INSPECTOR
s;
INSPECTION .RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
4Underground
Ducts
Forms & Footings
4
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
— -QZ
Exhaust Fans
O.K. to Wrap d —
.O Y
F.A.U.
FramingCompressor
'
Insulation
„p _ _ _
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
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
i, PLUMBING APPROVALS
Gas Test
Electric Final
•iWaste Lines
_
Heater Final
-Water Piping_
,
�Qy?j
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
_
Pool Cover
Sewer Connection
S ps
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
_,/ — G
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice
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 Licens#e is in full force and effect.
License # I Lic. Class Exp. Date
469742 B 10/31/2(
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). r
() 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'tlie following declarations:
O I have and•will maintain -a certificate of consent to self -insure for.workers'
compensation; as' provided;.for by Section 3700 :of the'.L'abor Code, for the
performance of the work for which this permit is:issuedr
( ) 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:
Caiiier EXEMPT Policy. No.-
(This'section:neeci. not be•completed if the permit valuation is'for$100.00 or less).
O I certify that in the:perforrriance of the work for which this' permit is issued,
I shall not ;employ any person in any- manner soas ,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 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) Date
3�BUILDING PERMIT PERMIT #
E VALUATIONLOT 0202-003 TRACT
02/20/20( $106,289.60 8 BLK 187 U-18
JOB SITE
APN
ADDRESS 53-400 AVENIDA OEIREGON
774-075-008
OWNER
CONTRACTOR / DESIGNER / EN (NEER
ERICK DAVIDSON
ERICK DAVIDSON
53-875 AVENIDAWDERO
53-875 AVENIDANIADERO
LA QUTATTA CA 92253
LA QUINTA CA 92253
(760)771-3362. CBL# 5954.
USE OF PERMIT
SINGLE FAMILY DWELLING
SFD - PERMIT DOES NOT INCLUDE POOL OR DRIVEWAY APPROACH. 150'
LF COMBINATION 4' RETAININ&W OARDE`N WALL; PER CITY .
STANDARD. 98 CODES.
TRACT.CONSTRUCTION 1,696.00 SF
OARAOE/CARPbRT 533.00: 5F
6 F T. ,WALL, 150.00 LF
ESTIMATED COSI' OF CONSTRUCTION
106,289.60
PERmrr FEE'SU)yllllAARY
PLAN CHECKTEE . 101-000-439.318• $538,76
FEE DEPOSIT 101-000439-318 •$250.00
MECHANICAL FEE 101-000421-000 $68.50
ELECTRICAL FEE 101-000-4207000. $103:52
PLUMBING FEE 101.000-419-000 $124.00
STRONG MOTION FEE - RESID 101-000-241-000 $10.25
• 4RADINd FEE 101.000423-000 .$20.00
DEVELOPER IMgPACT FEE $1,91r. 00
PRECISE PLAN 101-00.0-441445 $100.00
CONSTRUCTION FEE 101-000-418-000 $664.00
SUB-TOTAL.CONSTRUCTION AND, PLAN CHECK
$3,536.03
LESS PRE -PAID FEF..9'
-$250.00
TO'I_AT PIAT FEES DUE NOW
x;286.03
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
P.O. BOX 1504 APPLICATION ONLY
Building �, , rL - 78-495 CALLE TAMPICO
Address " .'J� ^. rPV,-i.^z1�?Q ^� LA QUINTA, CALIFORNIA 92253
Owner
Mailing
Address :53,-`x`7 rJi MIt DF( 0
City //�11 Zip Tel.
Contractor 6.e
Address ,D� ��, / �•' y.,i4i � ���;�''kJ.,��G�
CityZip t Te,
, .r3��►�2n�.� S f
tA
State Lic. A (�( City _
& Classif. �,'l Lic. #
Arch., Engr.,�f1,
Designer VU1 (A*1� �;)€ 160 C)1?1)1-)P
Address 0 15 Tel.'J 9 v
City (� 1 Zip l State /
qDd ) 3 LID. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter g'(commencing with Section
7000) of Division 3 of the Business and Profe_ssiors :Code, ,and my license Is in full force and
effect. i 1 .. t X• °re r^ 3e� 't f t
�r
SIGNATURE t DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from Ithe Contractor's License Law for the following
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, alter, improve, demolish, or repair any structure, prior to *its issuance also
requires the applicant for such permit to file a signed statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars (8500).
I: 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, Buisness and
Professions Code: The Contractor's License Law does not apply to an owner of property who
builds or improves thereon and who does such work himself or through his own employees,
provided that such improvements are not intended or offered for sale. If, however, the building
or improvement is sold within one year of completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose of sale.)
I l 1, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner or property who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
BUILDING: TYPE'CONST. h` OCC. GRP.
A.P. Number!V 44. — � 7 5 06V„)_ }
Legal Description b 1 t Rtk A
Project Description !moo-iJt
2//./ 'Ai 4 4� ^/ems �%r-�9 C /fit/ 5
ITo LF /50 Co•,A,, 4 L CS
.+' Sq. Ft.'
Size
New`®
t��
0 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
C"1 Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed i/ the permit is /or one hundred dollars ($100) valuation
or less.)
I certify that in the performance of he wor p which this permit is issued, I shall not
employ ny p rson in any ma ePSo D•baco a subject to the Workers' Compensation
Laws PI �I.f rn'a
DateOwner ��
NOTICE TO PPLICANT: 1/, Ker making this Certificate o/ Exemption you should become
subject to the Workers' Compensation provisions o/ the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
Ihereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives -of this city to enter the above -
men t4oned
bove-
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
/ No. t No. Dw.
-s `t14 Stories Units
Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
AMOUNT
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from` roperty Line
FINAL -DATE INSPECTOR
Issued'_ _ �n bte +' 1 Permit
1i
Validated•}by: 0Lur.
Validation:
WHITE = FINANCE YELLOW = APPLICANT
PINK = BUILDING DIVISION
Desert Sands=Unifig,&$' ool District
4795 a
0 Durie' PlmsRoad
Notice: ti Q.ointa, CA6 92253
Document Cannot Be Duplicated 760 771 85'1I5
CERTIFICATE';;OF C,OMPL"NCE'
Date 2/20/02 APN4# 7t74=075-008
No. 22972Jur><sdiction' ".La,Qunta
owner Namel rick Davidson Permit # 0202-003
No. 53400 street Avenida Obregon Log # ,
City La ,Quinta Zip 92253 Study Area
Tract # BLK 187 Lot # 8 Square Footage 1.696 i
Type of Development, Single,Faniily, Residence'!, No. of,Units 1
Comments Tract Construction 1696 s.f.
` At the present time, the. Desert Sands Unified School Dist1ct :doesnot collect fees on garages/carports, covered
patios/walkways, residential additions:under,500 square:feet, detached accessory4structure"s or;replacement mobilehomes..It
f. .
has been determined the above-named owner is'exempt'from paying school fees at this time due to; the following reason:
EXEMPTION NOT APPLICABLE( .
This certifies that school facility fees imposed'pursuant to Government.Code 53080 in the amount of
2.14 X 1,696 or $ 3,629.44 the property listed above and that building
permits and/or Certificate§,of Occupancy for this square footage inthis proposed project iriay now be,issued
Fees Paid By CC/PDNBE.rick Davidson Telephone' 760/771-3362
Name on the"check
By Dr. Doris Wilson
Superintendent
Fee collected /exemoed by Crystalp1Scott Payment Received $3`,1629.44
.. ';: -. '083265 ,
Check No:
Signature
JOTICE: Pursuant to Assembly Bill 3081 (CHAP 549 STATS. 1996) this willlrerveAto notify you that the 90'day approval penod miwhich you: Aayjprotest.the fees orother payment identified
r-.
above will begin to run from the date on which the building o`r installation permit for this project is sssued of on'which they are' paid to,the District(s) or to another, public "entity authorized'to
,ollect them on the Distnct(•s)(s') behalf, whicheie(iis earlier., • v
Collector: Attach a copy of county or,city plan check application form to district copy forrall waivers.
Embossed Original- Building Dept./Applicant . `Copy - Applicant1ReC
ceipt opy -Accounting
JAN -07-2002 MON ]2'40 -PM LAWYERS TITLE FAX N0. P. 02
'RFCO�MG 13itgU6S'I'B11' BY . �
LAWYERS T]Tl..1r COMPANY
AND WHEN RECORDED MAIL TO:'
ERICK A. DAVIDSON AND JACK D . BARK R
53-875 AVBNMA_MADERO
LA QUINTA, CA 92253
.S .3--YOo Ave- o6aEG,ov
. i
S ce Above This Line for Record&& Use Only
A.P.N.: 774-075-M TRA #: Order No.: 40236-17 Escrow No.: 01-23740
GRANT DE:D
THE UNDERSIGNED GRANTOR(s) DECLARE(s) THAT DOCUMENTARY TRAN RTA}C iS: COUNTY r30
fX j . computed on fitli value,of.propp�erttyy conveyed; or; <��
j computed on full valuwlese value:of liens or;:encumbrancea re:r airing at time of sale,
[ ] unincorporated arca;.. [ J Cityof LA 0URgA and
FOR A VALUABLECONSIDERATION, Receipt of. which is hereby acknowiedged,
REFUG10 U. RUIZ'and MARIA RUIZ, Husband and Wife as Join:Ttms>its
hereb RANT(S) to-:<ERICK A. DAVIDSON, A. MARRIED . AS`. HIS SOT E;. AND SEPARATE PROPERTY
AND JACK D. BARRER,.A SINGLE MAN, ASENANTS IN COMMON
the following described property in the City of'LA QUANTA, County if Riverside State of Callfgrnia;
LOTS, BLOCK 187, UNTr :NO. J , TRACT SANTA CARMELTT AT.VALE'LA QUINTA, AS PER MAP
RECORDED IN°BOOK, 19, IPAGE'31 INCLUSIVE OF MAPS, 1N- ,`:.OFFICE OF THE GOLNFY RECORDER
OF SAID COUNTY
r
1 Z 'RUIZ
' I
Document Date: Decxmber 28,\ 2f)QI
STATE OF CALIFORNIA AS ;
COUNTY OF 111 I L�&1 n , ) i
vu 1 r u v � . �iwy fs:are':.rnc, . StiGDG{: Wol:
persoeally pprernd---- --- REFUGIO U..:'RUIz :,AND X
perwWy lmown ,ome;(or proved"w on°the basu.of sansfi6tory a a) to be
ud acknowledged to the mu!n executed die M= m ' a . autho =
the penon(s) or the entity upeo 6eh41 of wtiult ft petstw(s) ectad, 6,eentt3d the iilst:
WITNESS and official seal.
Sig"ture
'FiERECC•A`S.,,Ir10Ha►GI► .
t�orivniaaon 3 9 S76Gd4
PletarltPhDgo�- t3aphrMa ,
..Iiy�Aldo �t:ouMY
M1 j.0artua; 6ispt+am f2d � q:'7®S
Mail Tax Statements tn: SAME AS A
xd to thiwithin instrumot
;nature(s) on the ininufl*nt
i
This area for official ncurtal seat.
I
I
or Address Noted' Below
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VRECEJVED \
2002
RC DISTRICT PLAN'1NING'.REVIEW FORM
C
JAN 5 a
0
This form .is to be used by CDD• staff for review of single family dwellings in the RC (Cove
Residential) District per Section 9.50.090 of'the,Zoning-:•Code. Its purpose is to -determine:
1) that the proposed house. design does not.duplicate -fh-e same architectural style of any
house within 200 feet of the.applicant, and/or 2) if there is a~needJorth a applicant to file for
Master Design Guidelines. If. the-applicant'does need,,e.a toJi)Master. Desigh%Guideline, please
transmitted this information to the Building and Safety Department as part of your correction
list. Please attach additional explanations as,hecessa�y..t
L'
APPLICANT ERICK DAVIDSON
SITE ADDRESS 53-4.00 Avenida Obregon
APN 774 - 075 -008 CASE NO.:. 2002=6,0.7.-_` ,
LEGAL: LOT 8 BLOCK 187 UNff",` :18• "� S.C.@V.L.Q.
CHECK AND APPROVED BY: Wally Nesbit --DATE:
Inform the assigned Building plan checker'iipon ,your`a.ssi'gnm'ent to,this-case. The CDD
Executive Secretar,y,maintains a' log book to track applications and assign case numbers.
REOUIREDITEM
Y
N
`CO•MMENT/CO:RRE.CTION .
Verify legal and APN information
L11
JPfAIley 1tz°Wt/C -r3' o""^/'14<f1-+-7P
Consistent with MDG'on file (as
applicable
PP
�/�., •
MDG filing required (5 filings.since
9/3/98)
E
i✓./�
Architectural variety within 200 feet .of
the surrounding area:
Colb.rs
Materials
Architectural design features
;
`
x
"��,,ls✓n2o✓�..�;�c.M £s
Approved tiyt
Other Re.quirements: 7Planning Co
E7 City. Council,,
A'Communit
Initials
Case Pio..�.—
Exhibit '
his
M
ion
epV
= SO
.....------
'_-
p'
P
_ CITY OF LA QUINTA SUB -CONTRACTORS LIST
JOB ADDRESSJ�'i�� A05, 0 �� PERMIT NUMBER OWNER eZ��-IC. b/�\bSbk►
BUIL �u(— �
This form shall be posted on the job with the Building Inspection Card at all times in a conspicuous place. Only persons appearing on this list or their employees are authorized to work
on this job. Any changes to this list must be approved by the Building Division prion to commencement of work. Failure to comply will result in 'a stoppage of work and/or the voidance
of building permit. For each applicable trade, all information requested below must be completed by applicant. "On File" is not an acceptable response
Trade / Classification
Contractor
State Contractor's License
Workers Com ensation Insurance
City Business
License
Company Name
Classification
(e.g. A, B, C-8)
License Number
(xxxxxx)
Ex:p.,Date
(xk1xx/xx)
Carrier Name
(e.g. State Fund, CalComp)
Policy Number
(Format Varies)
Exp. Date
(xx/xx/xx)
License Number
(xxxx)
Exp. Date
(xx/xx/xx)
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PLUMBING (6-36)
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SEWAGE DiSP. (C-42)
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PAINTING (C-33)
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CERAMIC TILE (C-54)
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CABINETS (C-6)
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FENCING IC -131
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LANDSCAPING .(C-27)
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Certificate of Occupancy
City-ofla Qui, ta54
Building and Safety Department. oFM°"
This. Certificate: issued, pursuant to the requirements of Section 109 of the Uniform-Bui%ding Code;
certifying that, at the time of issuance, this structure twas in compliance with the various ordinances
of the City regu/sting bui/dmg: construction or use. For the following..,. f
BUILDING ADDRESS 53-400 AVENIDA OBREGON
Use.Classification: SINGLE FAMILY DWELLING ;Bldg. Permit;No.: -0202=003
Occupancy Group: R=3 Type; of Construction: VN Land 'Use: Zone: RC
Owner of Building: -ERICK DAVIDSON Address: 53-875'AVENIDA MADERO .
-City: LA" QUINTA CA' "92253x .
By: RICHARD KIRKLAND
Date: 08-15-02
Building Official
POST IN A CONSPICUOUS PLACE