0304-160 (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
P-essionals Code, and my License is in full force and effect.
License # tL�ic. Class Exp. 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;__ 1}
( ) I, as owner of the property, or memployees 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
Si ction 3700 of the Labor Code, for the performance of the work for which this
permit is 'issued. My workers' compensation insurance carrier & policyno. are:
Carrier � ;`;A` B PWO Policy No. � *10^048W-012
(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, grid -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: X" Vim—/ Applicant—
Warning:
pplicant Warning: Failure to secure Workers' CortIpensation 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 hiss
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 pursua
any permit issued as a result of this applicatonn-agrees to, & shall, inde
& hold harmless the City of La Quinta, its officers, agents and employ
2. Ariy permit issued as a result of this application becomes null and v if
work is not commenced within 180 days from date of issuance of
permit, or cessation of work for 180 days will subject permit to cancell ion
I certify that I have read this application and state that the above informati n is I
correct. I agree to comply with all City, and State laws relating to the 6u
construction, and hereby authorize representatives of this City to enter,,.upon
the above-mentioned property for inspection purposes. I ".
Signature (Owner/Agent)
�r
BUILDING* PERM,IT PERMIT .
DATE VALUATION jTlnTO°g,,, LOT P TRACT
J' V-) as
JOB SITE 49-740 C{iUR-1.7
APN If1 Sb wlyG3 0��
ADDRESS
'OWNER
CONTRACTOR / DESIGNER / EN (NEER
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USE OF PERMIT
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2003Q111NTA
DEPT... 4
20
IE
RECEIPT
DATE S
BY
DATE FFINALED
INSPECT
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
jr BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
►Forms & Footings
-
Ducts
Slab Grade
Return Air , -
Steel
Combustion Air
Roof Deck
x•02- pj
Exhaust Fans
O.K. to Wrap
- 10 -
F.A.U.
Framing
Compressor
Insulation
Vents
FireplaceP.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
I
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
2 -
Appliances Appliances
Final
COMMENTS:
Final _
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring -,�i✓3
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
.,Temp. Use of Power
Final
Utility Notice (Perm)
- ; �..-',- . _
��- Certificate of Occupar)cy
'4
OF Building & 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: 49-740 ALTHEA CT.
Use classification: SINGLE FAMILY DWELLING Building Permit No.: 0304-168
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
Date: 11/18/2003
Building Official
POST IN A CONSPICUOUS PLACEI
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