0304-0168 (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 --,.Exp. Date
Date; 'eti'., 2:_(,� �Signature
OWNER -BUILDER
I hereby affirm under'penalty of perjury that I am exempt from the`Contractor's
License Law for the following reason:,A l
( ) I, as owner of the property, ,or my employeesfwith wages)as their sole
compensation, will do the work, and the stFucture isnot 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 81A`1CSFMO Policy No. 0*464VOIX02
(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, I shall forthwith comply..with-those:provlsl6ns`
Date: tADDlicant Y �� ' �� "' &
Warning: Failure to secure Workers' Compensation/covarage is unlawful and
shall subject an employer to criminal penalfies`and+civil fines`up to $100,000, in
addition to the cost of compensation, danAiaged as provided foe'ilSection 3706
of the Labor Code, interest and attorney'Afee§.
IMPORTANT Application is.hereby.mad'e to the Director of Bwlding and Safety
for a permit subject to the conditions and "restric_tions sWforttiion 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, inde
& hold harmless the City of La Quinta, its officers, agents and employ
2. Any permit issued as a result of this application becomes null and v
work is not commenced within 180 days from date of issuance' of
permit, or cessation of work for 180 days will subject permit to cancella
I certify that I have read this application and state that the above informatitng
correct. I agree to comply with all City, and State laws relating to the bui
construction, and'"hereby authorize representatives of this City to enter
the above-mentioned property for inspection purposes.
Signature
(Owner/Agent�-Date ,5
BUILDING PERMIT PERM�(004- .34
DATE /� VALUATION j0` d'� s' ' LOT TRACT '
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JOB SITE..d•somiAy
APN
ADDRESS .6.t+R.`+i
OWNER
CONTRACTOR / DESIGNER / EN (NEER
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00=00 CA 92131
(MW 402
USE OF PERMIT
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MAY. 2 7 2003. ,---- - -
CITY OF LA QUINTA IIIIIIIIIIIIIIIIIIIIIIIII 23
FINANCE DEPT. IE
RECEIPT
DATE (1
BY ( e �
DATEE)FIINALE/DD
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
Set Backs
Bond Beam
Forms & Footings
Slab Grade
Steel
- 9 -
Roof Deck
Final
OX to Wrap
PLUMBING APPROVALS
Framing
— -
Insulation
Water Piping
Fireplace P.L.
Plumbing Top Out
Fireplace T.O.
Shower Pans
Party Wall Insulation
Sewer Lateral
Party Wall Firewall
Sewer Connection — . 3
Exterior Lath
Gas Piping
Drywall - Int. Lath
Gas Test / i7 - i — -t
Final
OPERATION DATE INSPECTOR
MECHANICAL APPROVALS
Underground Ducts
Ducts
Retum Air
Combustion Air
Exhaust Fans
F.A.U.
Compressor
Vents
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 5
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 / i7 - i — -t
Utility Notice (Gas)
ELECTRICAL APPROVALS
TemD. Power Pole
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G. F. 1.
Smoke Detectors
Temp. Use of Power
T
e�
COMMENTS:
Certificate of.0ccupancy
4
c 9w Y
OF Building & Safet 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: 49-745 ALTHEA CT.
Use classification: SINGLE FAMILY DWELLING Building Permit No.: 0304-165
Occupancy Group: R-3 Type of Construction: V -N Land Use Zone: R -L
Owner of Building: LA QUINTA TALANTE LLC. Address: 9968 HIBERT, STE 102
City, ST, ZIP: SAN DIEGO CA 92131
By: GARY SHOWALTER
Date: 11/06/2003
Building Official
POST IN A CONSPICUOUS PLACE