SATT (9906-222)78467 Magenta Dr
9906-222
LICENSED CONTRACTOR DECLARATION
I) I hereby affirm under penalty of perjury that I am licensed under provisions of
H Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
N W Profe Isionals Code, and my License is in full force and effect.
O =) M License _# Lic. Class Exp. Date
I,- d LO .1I IS I3 09./Yr20i
LLJ
CS Z r- /ate / Signature of Contractor-
0
ontractor O
UC:)
OWNER -BUILDER DECLARATION
W W r1_ I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ a License Law for the following reason:
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
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).
c'') () I am exempt under Section , B&P.C. for this reason
O N Date Signature of Owner
rn
FL Q WORKER'S COMPENSATION DECLARATION
p Z XI hereby affirm under penalty of perjury one of the following declarations:
Lo H O () 1 have and will maintain a certificate of consent to self -insure for workers'
X W u- compensation, as provided for by Section 3700 of the Labor Code, for the
mJ Q performance of the work for which this permit is issued.
Q U (X)I have and will maintain workers' compensation insurance, as required by
Q Section 3700 of the Labor Code, for the performance of the work for which this
fi - permit is issued. My workers' compensation insurance carrier & policy no. are:
Z Carrier { YR 1 ♦♦ Policy No.
cb/-y v1lflL f iJIY}.I }ie hJ ltrl7
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(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
3 sub 'eect to the workers' compensation provisions of Section 3700 of the Labor
C dde, I shall forthwith comply with the pr9visi - ns.
6at
e: % Applicant /
Warning: Failure to, secure Workers' Compensation covergg s nlawful 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 inspecVW purposes.
ignature (Owner/Agent) may. Date,
BUILDING PERMIT PERMIT#
c)'11N►-2 Z2
DATE VALUATION 541.430.90 LOT I TRACT I Xg I S
JOB SITE'T9-"i! 1 ' e {iF,.i l VA DRIA '
APN (11,3-7%. -x 15
ADDRESS
OWNER
CONTRACTOR/DESIGNER/ENGINEER
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7.I.99-5 iONI OR UNI ► I
RANCHO MIRA61, CA 92270
PALM rJESFR'C ('A 9220
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(7(101771)-11)S4 ('Nl,# 17I3`?
USE OF PERMIT
SIN(AX FAMILY A'i`tAl HED
SFA. KLAN 31,. , 1'tfWIT DORS W_)T 1NCLIA7610.c.X"b: WALL oR PO4jL.
PLAN CkiiiC K VIih )t1sWC 11) 75*,* f•'s t'1t fv ULTIP).E ISS'UANC h O {ANIH
PLAN
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PECOUT FEE SUtr'iiti'MARV
C(.)N.Tt'KUC 1'IC!N P'LE, 101 -000 -411!( -OW 5361,Y)
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i SI.CYr'iAliOril.IT1: ;01-i►(}0••1!'.s 000 $31.50
ELI SC i'Rh AL FrUt 101-000420-000 S82,71
PI.t1XIBINo rES 101 -OW -419-}W S.9S.50
I.R "ftr)W(l MOTION FFV - RF3111 1011-nru'►-)414M V 14
CRAVING rfLIC 101-000.423.000 V.0.00
1NI-tA>"1'RLl FU1$, FEE 225-000-443-342 S91It. N)
PRFCWH PLAN 101-000w44I _W5 S2ti.t►+!
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TOTAL PERM IT FEE'; FAW NOW
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RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
ti BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
8 2 _/,9 9
Ducts
Slab Grade
q
Return Air
Steel "
Combustion Air
Roof Deck
C® 6
Exhaust Fans
O.K. to Wrap
l _ C D 4L
F.A.U.
Framing
— _�,� 6
Compressor
Insulation
Z
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
6
Drywall - Int. Lath
, Z,/ e-1. 0 64
Final , 01D
Final — ti'd
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. 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 ' 7�
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)
COMMEOMMENTS•
tee: ,,,,, oK 2 -2$ --Ho 6to
ea t i `6cate' f Occupancy
City of La QuinM
Building and Safety Department
This Certificate issued pursuant to the requirements of Section 109' of the Uniform Building Code,
certifying that, at the time of issuance, this structure was in compliance with the various ordinances
of the City regulating building construction or use. For the following:
BUILDING ADDRESS: 78-467 MAGENTA DRIVE
Use Classification: SFA Bldg. Permit No.: 9906-222
Occupancy Group: R3 Type of Construction: VN Land'Use Zone:
Owner of Building: BAY CITY ESTATES(ARIZONA)
INC.
Building"Official `
Address: , 16 CADIZ CIRCLE
RL
City: RANCHO MIRAGE, CA. 92270
By: GARY HARTMAN
Date: ' 6-28-00