SFD (0309-182)49505 Loren Ct
0309-182
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
•pate j!` ' '"'_-/Signature of Contractor
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 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). F
(f 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.
44)r 1 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 Policy No.
$TV_1T8 FUND mnl :3-n
(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, arid 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.
` Applicant
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Warning:` Failure to secure Workers' Compensation coverage 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 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
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, 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:
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;Signature (Owner/Agent) ''+>' '' { - Dater
FrIm
BUILDING PERMIT PERMT/i
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OCT :l 3 200
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C rif OF LA QUINTA
FINANCE DEPT.
V
RECEIPT
•
DATE "
,. ' 1. , s.
BY.
f : 1j,
DATE FIN LED
—
INSPECTO '
INSPECTION RECORD
Y
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
.- 3
Ducts
Slab Grade
/—
Return Air
Steel
-- z
Combustion Air
Roof Deck
- 3 _ y
Exhaust Fans
OX to Wrap
3 —
F.A.U.
Framing
p -
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 —17 —
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
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
,
Appliances
Final ••
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service r
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final `-41
-
Utility Notice (Perm) !o • o -j
COMMENTS:
Ced firca to Of ,Occupancy,,,_
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G 9 11 Buildin &. Safe( -De artment . ,
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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 Tcompliance -'with the
provisions of, the 'Building and the 'various`: ordinances of the . City ,regulating building
:Code
construction .and/or use.,
BUILDING ADDRESS: 49-505 LOREN
Use classification: S.F.D. :; _ {r ` a `Building PermifNo.:': 0309-182'
j
VOccupancy Group: R-3 E}' J Type of Construction: V -N Land Use'Zone: R -L
Owner of Building: PM RENAISSANCE LLC Address: 9968 HIBERT ST STE 102
City, ST, ZIP.: SAN DIEGO CA 92131
By: G.SHOWALTER
,
Date:, 07/09/04
7 Building Offi al
POST IN A CONSPICUOUS PLACE