0304-0161 (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 t `--Exp. Date
7010 9 3 Edi" `. 11`.31/0,
rl- I-
6 Z t` ,.,Date 9' " _'ZSignature of Contractor- � —
co O r _ `
J U OWNER -BUILDER DECLARAT+ION/
W W I hereby affirm under;. penalty of perjury that I am exempt'from the Contractor's
~ d License Law for the followingreason. %
Z ( ) 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 f6f
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).
LO M O I am exempt under Section , B&P C,..for this reason
O N Date �w»r `p Signature of Owner..._-...��'---�-�=
ci ✓ �'4ai M`"
ZWORKER'S COMPENSATION DECLARATIOON° Ay�
o Q Z I hereby affirm under penalty of perjury one of the),ollowing declarations:
r F- O () 1 have and will maintain a certificate of consent to self -insure for workers'
X W compensation, as provided for by Section' 3700 of the Labor Code, for the
O J Q performance of the work for which this permit is issued. i`'
M K () () I have and will maintain workers' compensation insurance; as required by
OU Q Section 3700 of the Labor Code, for the performance of the work for which this
F- permit is issued. My workers' compensation insurance carrier & policy no. are:
Z Lanier N' ATE U4O Policy No. ODS" -1154M30
Ib
J (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 agree4hat if I should become
3 subject to the workers' compensation provisions of Section 3700 of the Labor
Code,.l shall forthwith comply with those provisions. ,moi-►w""'"�
Date': �•5 . Applicant
'r Warning: Failure to secure Workers' Compensation coverage is unlawful and
Shall subject an employer to criminal penalties and clviNines up to $100,000, in
addition to'the cost of compensation, damages as proved for in Section 3706
of the Labor Code, interest and attorne�fees.
IMPORTANT )Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
a. 1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
f any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes._,.,__.,:...---
/ gnature (Owner/Agent) ... 1. _"""""" ' �f ""�C �JDate - ":' w�
PERMIT #
BUILDING PERMIT
DATE VALUATION T�r;' LOT' TRACT MyC{.1
JOB SITE
ADDRESS 49 9m KU11H A CGU+
APN
OWNER
CONTRACTOR / DESIGNER / EN (NEER
I _k QiTt, r.1..A. •. TA],.ANP:C'u L L I—
7".t`'FI;it3 WF�''�'I° 110tJMIK-1 LUC
!.',96 + 11DUL .'T Q$° TITL .102
KQ k IE00 . CA z121,"31R
ANJ",i1EGO CA 421 s i
CW 41 4972
USE OF PERMIT
1j4JP.:5 rJ' .;_ssa1,;J,4UT2.t1 s?isl.r.Y. 6Y•.ru.%�
1+004 OP. I-SR.tVlaWAY APPROACH
7.1r6.EiCT CONI iT.`PUC:T1ON in. 00'sF
ORCHIPAM &Y7.00 SY
CONSTRUCTION FER 101000.418 -VA,
PLfl*Ntw.H&.CYM 10;1.01004139•'s1i_;� i1,�0
1+ItY 1 s�2dkC AI. I 101 _0001.42I _00ry 51011;10
— 4 Ltfa�t"�V9ix'l 11
1t«•1pfi:�i,y�.+t'l.ti1 IvE 10 1 -!Vn00-4
�tt,�/�.
MAIN i'1AII`MHO P1S.� I01 f.%00.41 9-000 ��)JAIN
PLUM
TTR-MI i MOT10.4 FEE -1°..IS'SID 101 1 -000- 4 l -WD *1937 .
GRATANCiWFM 101�IIM
MIs DEPOSIT id% -000..:t39-31 d 4earl,tib
CnHRapNt
MAY 2 7 2003 IIIIIIIIIIIIIIIIIIIIIIIII
43
IE
RECEIPCITY OF LA QMlrA ' By DATE FINALED INSPECTOR
FINANCED DEPT.
e.
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
-OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
— _ 3
Ducts
Slab Grade
-- j 3
Return Air
Steel
- — 3
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
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 — - —
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
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines 6
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
}—
`
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
Utility Notice (Perm) / Q.
Certificate of Occupancy
4
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: 49-905 ALTHEA CT.
Use classification: SINGLE FAMILY DWELLING
Occupancy Group: R-3 Type of Construction: V -N
Owner of Building: TRANS WEST HOUSING INC
Building Officia
IN A CONSPICUOUS
Building Permit No.: 0304-161
Land Use Zone: R -L
Address: 9968 HIBERT ST STE 102
City, ST, ZIP: SAN DIEGO CA 92131
By: GARY SHOWALTER
Date: 11/04/03
11111111111111111111111144
IE