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0304-0164 (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 1101539 BIM_w� 1r.41105 Signature of Contractor OWNER -BUILDER DECLARATION' .\ I hereby affirm under'penalty of perjury that I am(exemptfrom the Contractor's License Law for the following reason:f�T`� ( ) 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). ( ) 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. (Ie )`• 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 .& policv no. are: Carrier ;�7:I ty'.E'Y3?F 1 Policy No. €II �2 �O1�-tJ"l (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 provisions. Date`w� Applicant !``�:-'- Warning: Failure to secure Workers' Compepsation coverage is unlawful and shall subject an employer to criminal penaltil, 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 s application. w 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursudot to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agentsand 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�� BUILDING PERMIT PERMIT (I 1 DATE VALUATION $V1y1 1 50 LOT 14 TRACT 3 3 JOB SITE 49�_ [8.3,�f�: C".t.3gi,WX APN �S l «52U-010 ADDRESS OWNER CONTRACTOR / DESIGNER / ENGINEER LX QUWA - "!;,�"iaA1.+1IS LLC, T , '4TH`NO 10Y 19C' 99ros 1`MER.T a'AG.ME "I 117M. 1021 "�'r3�i 3 i41��' �'. ' x � ��, f 2 CBV� 4972 USE OF PERMIT •-••a -4e Ji'N!v d,N.1II �9 ra.ro�w-r a16.. d"5;.;`c. V� s E, 11 ray.vT 0 POOL, 0R DR.JV TM R1;I'sIa'C` 190 TO PIAN CHISCK 1,134. TrcA � j WNSTRUCTION 'All"IW, V PO C.C. N:fi ATID WWII II wp rlARAOUCARPORT 101F Ok• CORMAXTION RAM ITEM-31MURY. T�i„e'•i�! C)i'1>'�F: "t�'s� i `J1-l�R��39-$ t s5 � ����.r".psi 01.4�- Y gaIt?�.ifl) 1�i.�Ii�F3TG1(S IBK 301-000-419-000 n JANIS .1 '+e.y�l , A �y {{r shy � •�w,y a�t� +� p �` a .L.;4.��rn .i: T£�.'nl`�AV..id it Il'S 11 Dta ei� I4\J W 4TP'ilrvi"hJ MAY 2 7.2003 CITY OF LA QUINTA 11111111 IIIII III III I IIII 26 FINANCE DEPT. IE RECEIPT =y' DATE 1 ' F , BY DATE FINALED/ INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings - - S Ducts Slab Grade / Return Air ' Steel _ - 3 Combustion Air Roof Deck = ,� Exhaust Fans O.K. to Wrap _ 2 F.A.U. Framing - 2 — F__7A Compressor Insulation _ S - 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 BLOCKWALL APPROVALS POOLS - SPAS 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 - 3 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) COMMENTS: Certificate of Occupancy 4 s(P InwroanTrn ron 9 OFT1 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: 49-785 ALTHEA CT. Use classification: SINGLE FAMILY DWELLING Building Permit No.: 0304-164 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 Offici POST IN A CONSPICUOUS PLACE