0304-0169 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury.that I am licensed under provisions of
Chcpter 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
70`10:.49 '1:�.MC `t 111?1/0
Signature of Contract -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 W ,ages as their sole
compensation, will do the work, and the structure is not intended or„oflered, 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 STATE PW417 Policy No. ajFt!464$81N
(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 Iof- Section 3700 of the Labor
Pode? I shall forthwith comply with)hose provisiorfs.
Warning: Failure to secure Workers' Compensationocoverage 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 as7provided'for in Section 3706
of the Labor Code,, interest and att_orney's fees.
IMPORTANT Application is hereby made to tFie Director,of Building and _Safety
for a permit ,subject to the conditions and restrictions set forth ori`+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, indemnity
& 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) S" Date
BUILDING PERMIT PERMIT 0304469'
DATE /% VALUATION $213,61&00 LOT TRACT
>. 7 �ha
r�,
JOB SITE t} ��RY�iJft,A � :.� ,'�
APN V49_5:111k•010
ADDRESS
OWNER
CONTRACTOR / DESIGNER / EN (NEER
1,A UZITA - `.l":'�:s:.ltuNTE L t_ c . '
'MANS WEST HOLN,2Zrs O rNC
9903..RWRT VREE `, O3 -, 1 OZ
.rJ9681;3T ERT :3'1; -wn, - 31N,
V�Aw IYD-700 CA 921 1-41 1
31W K?g.G10 CA 9.2131
.e . 3.3003 C-Bllf 4912
USE OF PERMIT
11
-7
ON '
J.tpLi.,'�ii .J .'yfy. tt1, 5 C4lstwf6 MIL &1/16•J�:+iayl lYy\e'��t l�lyYYdbYA�d�6tJ.fd.}4!+/�J�A1�f.+I�C,.ral/p �Y�ln, tatnl/dp/q
tri 7y�N {,y�T
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DUL:`i'€ VAULTIPLZ 18191.1IICE.Cyr KAYd E PLAN `f" TIT
TRACT i::CyNSTftUe.7)'.�iJ �F
PORCh/eA".'1%� �7ii.60 SP
0AR.A.C4FXAAPORT fiCt ,d'J r'F
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.L.le*•�"•L�.4Ii!
)tA.rr'�C$wAA MIR L11YTJ_AVr&RY
CONS, RUC'.CJON 1•TM 101.000.4113-000 $403-3,50
rgg'0,,AN. C�� l�^�FIC'��14:qj $+'E:��,�, 1(1t2 •�O1i3t/���,4.MQ-t3+/1 S S�*Ifv�?pq
9I3F+4wY'..13..f'�ICAL 7111M 101-000-^321-000 SIA&Wt+
19=11m, ClUI VEL? 10 i -000.-42i)-CQG $193. 67
PLUMB ]NO PIE
S1RCQ40 RfiC+`!7(,. T F7?Z - RM10 101-t1f3f --241-{iL°{ $31,33
'
t3R,e DINO PRE 101-r300.423.003 $15,00
Y3EVZ1.•0-PER IMPACT a?sL ' - $2,405.00
,IRT ilk PUBLIC PLAWEl' i - liESA't 270-000-445-000 $34.5Q
5 � '
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3+SMl7.TtnYON /i1ti:1(3}'J1['.��vj�yL'`'rC:�I{tjry
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$ .00
" MAY
2 7 2003
i
CITY OFL4Qule
IIIIIiIIVIIIIIIVIIIIIII
24IE
,a...
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RECEIX
DATE
BY"�--"""""-";;:::-"'
DATEFINALLED 2
INSPECTOR
3 iJ
f , N
4
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
t.
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
` orms & Footings
6 -/
Ducts
Slab Grade
—
Return Air
Steel
- 3 - 3
Combustion Air
Roof Deck
- o-,3
Exhaust Fans
O.K. to Wrap
_
F.A.U.
Framing
- 3
Compressor
Insulation.�
'S .3 5
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final --5
BLOCKWALL APPROVALS
Steel
POOLS - SPAS
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
I I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
/B—"S
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
Q
Appliances
Final
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) 3
COMMENTS:
,-�Certificate of Occupancy o
44Q
COMIATM
G OFBuilding & SafetDepartment
Y
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: 49-780 ALTHEA CT.
Use classification: SINGLE FAMILY DWELLING Building Permit No.: 0304-169
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 Officiaf
POST IN A CONSPICUOUS PLACE