0304-0167 (SFD),\ 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 1`.Exp. Date
'Signature of Contractor
OWNER -BUILDER DEC
I hereby affirm under penalty of perjury that I am exemptfrom the Contractor's
License Law for the following reason:
( ) I, as owner ofthe property, or my employees.:with wages adtheir 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:
Cartier � =`�'4'iE''a}"ND Policy No. Wu-Wes,
(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 tti"at,if I should become
subject to the workers' compensation.provisions of,Section 3700 of the Labor
Code, I shatl"forthwith comply with those''proulslons, u
Date: «r�~'_: n, Applicant
Warning: Failure to secure Workers' Compehsation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines into $100,000, in
addition to the cost of compensation, damlages as provided for in�,Section 3706
of the Labor Code, interest and attorney's,fees:,..y }
_ _ J
IMPORTANT Application is hereby made to the Di ectbr of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1: tach person upon whose behalf this application is made & each peon at
whose request and for whose benefit work is performed under or purs6ant to
any permit issued as a result of this applicaton agrees to, & shall, ind.effiRy
& hold harmless the City of La Quinta, its officers, agents and emplo
2. Any permit issued as a result of this application becomes null and
work is not commenced within 180 days from date of issuance of c
permit, or cessation of work for 180 days mill subject permit to cancell n
I certify that I have read this application and state that the above informat n i
correct. I agree to comply with all City, and State laws relating to the bu ding I
construction, and hereby authorize representatives of this City to enter pon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) .. "`"� �"' Date
BUILDING PERMIT PERMIT # .IA61
DATEr _ VALUATION �:�.t�� LOT 7 TRACT ;•ifs;;? 1
JOB SITE
4.9-700 ALMNA COURT
APN
ADDRESS
OWNER
CONTRACTOR / DESIGNER / ENGINEER
I t.,LACr73�'i��11��';pt Y1{01r�"�{+,�'TU D-11 r11
SANT DIEGO 92 Y :? f
CA 922131
CIVIN 45ri2
USE OF PERMIT
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PC0L, Ott DR.lireveAm APPR0AOM
DVE TCA it U1,1111, 6.SSVLkl= OF SA.W11Z Pk AV '£'YPE`
YSTMh :DID t:+O&+fT OF
('.,' .iOTRUCTION a-Ff: 10.1 _0011" ? s-000
P111AN CHECK D?'rIE 1€11.00tic 9-3'1
"WWRANIC.A-L 10;1-i30g1 _421.000
1TL'W.'J'ft3E: A1. %=EZ 101 -000-420-&,X �i32 2. Sot
Ufm,9114"VE"t SM,
,*,T riOTdi;, YufO,.'}`Tc:SU.iTZ • REBID 101 0004,41 -000
i"tRdi<WNG Nr, 1051.000423.000 S;30.0 .
TUNALPTUl T1, FZVN:t�:i1`7E i 0 -NV
AY 2 7 2003
IIIIIIIIIIIIIIIIIIIIIIIII 10
ITY OF LA QUINTA
FINANCE DEPT.
RECEIPT
DATE r
BY"�: �- y
DATE FINALED
INSPECTO
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
i BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
A
;F.orms& Footings
- 7-
Ducts
v
Slab Grade
/ 2
Return Air
> _
Steel
7 - 3Combustion
Air
Roof Deck
C9
Exhaust Fans
O.K. to Wrap
- ' 3
F.A.U.
Framing
- 3
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
09
—
Final
/ - 3
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
Plumbing Final
Plumbing Top Out
- -
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
-- 3
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 -
Udlity Notice (Perm) �..
" 1111111111111 III mill uu
12
IE
�I II
,- Ce'dificate of Occupancy
F
.
Inca �NTID4,
G OF'TBuilding & Safety Department
This Certificate is issued pursuant to the requirements of Section 109 of the California Building
Code, certifying that, at the time of issuance, this structure was in compliance with the
provisions of the Building Code and the various ordinances of the City regulating building
construction and/or use.
BUILDING ADDRESS: 49-700 ALTHEA CT.
Use classification: SINGLE FAMILY DWELLING Building Permit No.: 0304-167
Occupancy Group: R-3 Type of Construction: V -N Land Use Zone: R -L
Owner of Building: LA QUINTA —TALANTE LLC Address: 9968 HIBERT STREET, STE 107
City, ST, ZIP: SAN DIEGO CA 92131
By: GARY SHOWALTER
tea' Date: 11118/2003
Building Officia
POST IN A CONSPICUOUS PLACE