0307-203 (MFD) "- LICENSED CONTRACTOR DECLARATION PERMIT#
U)
I hereby affirm under penalty of perjury that I am licensed under provisions of BUILDING PERMIT - �
F- Chapter 9 (commencing with Section 7000) of Division 3 of the Business and a,.DATE VALUATION LOT S TRACT 24230.
�y p!{ •S,;G„
W Professionals Code,and my License is in full force and effect.
p ch License# Lic.Class Exp.Date
W 7 3 l E1`:»3;�t�i�: `7/',,1IC13 JOB SITE ADDRESS 7843 7,`i/,,�'C.VKffl:..; 47,,.3�:r:A.i G-.Y1 APN t�*41190•014
ZDate f.•I Signature of Contractor•----•-- ^"^- OWNER CONTRACTOR/DESIGNER/EN INEER
CD o O ri i�.c� r,E.' a,`���r �:° d �r C",W,i'.
U OWNER-BUILDER DECLARATION 5 i 6 MR(IM.11r3fr r' 7S-401 ?ISG XN1 '111 AS:!•;A.QLYMAC'a�,i)24'53
W W I hereby affirm under penalty of perjury that I am exempt from the Contractor's GUMA],,):,,; AC"A, 91203 VAN;{jg' CY0 CIIA 921.3L-01d'
~ a License Law for the following reason: m -a
WA 3687
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 for
s sale(Sec.7044,Business&Professionals Code). USE of PERMIT
( ) 1, as owner of the property, am exclusively contracting with licensed MCR TT-�',Ei,WLY P1 .i(.k TQ
contractors to construct the project (Sec. 7044, Business & Professionals
Code). ; :15. U401'7`io. A7'J ftti+t✓S.0 wr 911, 4J a'a'. L L S e V•^V S L1MV."_
cr) () I am exempt under Section , B&P.C.for this reason PERMIT llrV3 NOTt• C!,,'.F)Z SLOCK i-k1f..IA Vii{.P'001, TiEDVI E-D RE
LON
,r °
Date Signature of Owner PERMIT OF
O0)
Z WORKER'S COMPENSATION DECLARATION
o :2 Z I hereby affirm under penalty of perjury one of the following declarations: :^TP':�l1'l1iL•R 412•:.00 V
r O O 1 have and will maintain a certificate of consent to self-insure for workers' Cli" fMARRVIA.1, 1w
X w �= compensation, as provided for by Section 3700 of the Labor Code, for the CONTRACT Ah'0111-IT .11a,go.vo us
Om � Q performance of the work for which this permit is issued.
Q () (,;r)` I have and will maintain workers'compensation insurance,as required by
O U Q Section 3700 of the Labor Code, for the performance of the work for which this
rn H permit is issued. My,workers' compensation insurance carrier &-policy no. are: c
Z Cartier Uicu Fi12?�!'G"9 Policy No. �+u3 inB29•DO X311:���.',�RO CdJa,01-Y C{7�NI-rf:sZU-..RON 343N4515SO
ob 5 PFIR�:x"T�"`k rev fFG11Qlt Y
Q (This section need not be completed if the permit valuation is for$100.00 or less). GO tK3'( {1C t s43 FFA k Q3-000-13 .()(}p lj j'g{M'W
J ( ) I certify that in the performance of the work for which thispermit is issued, PL.AX CHECK Milt 101-CM1 's-P-318 0ACk
I shall not employ any person in any manner so as to become subject to the MRICHANICIA14,VVY, 101-:00.4`,1,001► �%S�FC:Gif
workers' compensation laws of California, and agree that if I should become e119C1'.%4 1 ` 11FLt 11011"yfil(3✓i?G^.�f3f; r�+t1,p9
3 subject to the workers'compensation provisions of Section 3700 of the LaborR.I�, 3� y
P�.L1�d�1'�f�;�� !13..�{?»��'i�-{7CY( ��,.1 5!t ;
Code, I shall forthwith comply with those provisions. * ,,,�„,,,•_ ST'RION0 M(1 ION Mr,<R�31) 101. 0100-W_00ru 934,65
Date: �{' � "jApplicant ,'" _ �.�.-•_a •---=-�
.�.I ' �- '' (1Ft1.''IMICf RIF? 101-000--42,3.001). 's',ln,ntl
Warning: Failure to secure Workers' Compensation coverage is unlawful and •f?Z%FZ1,+e F&R{MPACT pP,E. 3s7,fii0011
shall subject an employer to criminal penalties and civil fines up to$100,000,in ART) ,F[}i�x�1G 1,1��aC" '�q`1y {/. t0,GpE1.t�.e. G{3{7
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
application.
1. Each person upon whose behalf this application is made&each person at suaa'C va, Am. P.YAtd•C:m—nal:.
whose request and for whose benefit work is performed under or pursuant to1XI � 1?%1-PAff.)n7 111 TO,00
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. { .b�r.�' t�'1+TL 3�T, NOW $15, 1'+,S`
2.Any permit issued as a result of this application becomes null and void if j i
work is not commenced within 180 days from date of issuance of such I 3
permit, or cessation of work for 180 days will subject permit to cancellation. J AUG 1 M3 tI
I certify that I have read this application and state that the above information is IIIIIIII 11111111111111111 80
correct. I agree to comply with all City, and State laws relating to the building C:�~ i;� _
p,. IE
construction, and hereby authorize representatives of this City to enter upon ' ' --
the above-mentioned property for inspection purposes. -
RECEIPT DATE BY DAT FIN LED INSPEC R
_ r , / IJI
ignature (Owner/Agent).. -� <"-'� Date a
INSPECTION RECORD
OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR
BUILDING APPROVALS MECHANICAL APPROVALS
Set Backs Underground Ducts
Forms&Footings Ducts
Slab Grade - - Return Air
Steel - Combustion Air
Roof Deck 4 Exhaust Fans
OX to Wrap F.A.U.
Framing - Compressor
Insulation - _ Vents
Fireplace P.L. Grills
Fireplace T.O. Fans&Controls
Party Wall Insulation Condensate Llnes
Party Wall Firewall
Exterior Lath -Z
Drywall-Int.Lath
1 til
Final -Q "
Final S 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 3 Heater Final
Water,.Piping Plumbing Final
Plumbing Top Out - Equipment Enclosure
Shower Pans OX for Finish Piaster
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)
e of G cupahcy *Cert►ficat
I.uoavonnm��
'G 9w5 ,Y Department
& Safet De
�oF.� Building p
� Ta
pursuant to the requirements of Section 109 of the California Building
This Certificate is issued p
this structure was in compliance with the
Code, certifying that, at the time of issuance,
Building Code and the various ordinances of the City regulating building.
provisions of the g
construction and/or use.
BUILDING ADDRESS: 78-875 AVENUE47 BLDG # H
Building Permit No.: 0307-203
i Use classification: R-1
Land Use Zone: R
Occupancy Group: MFD Type of Construction: V-N
-L
Address: 516 BURCHETT STREET
Owner of Building: SCPH
City, ST, ZIP: GLENDALE CA 91203
By: G. SHOWALTER
_�- Date: .01/05/05
Building Offi _ al
j POST IN A CONSPICUOUS PLACE d •