SATT (9906-223)78469 Magenta Dr
9906-223
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.
sanse # Lic. Class Exp. Date
-m
341111 09;3,00
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).
( ) 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.
( • 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 & policy no. are:
Carrier STATE FRI1.1-41D Policy No. 1422.57699
(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.
Ya'te: Applicant—
Warning:
pplicant Warning: Failure to secure Workers' Como n ation coverage i nlewful 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
theabove-mentionedproperty for inspection purposes.
,Slg" nature (Owner/Agent) a / '° 'rt" "-`r Date -7 1 r%'i
BUILDING PERMIT PERMIT#
DATE« VALUATION ,I .10.9(1 LOT TRACT la's't%1 t
I
JOBS , 78.4 9 I1A Il +tN .A DRIVE
ADD
ADDREEr SS f
1
OWNER
CONTRACTOR/ DESIGNER ENGINEER
BA(CITi - iqS [ RIZIIC)NA) f".X.
' N lytI ON1sANT GF
N CON RCI R
16.1C* 11Piz f'iSICLE
74-S83 iC)R UNIT 1,
RANCHO Mild,A(M- (:'.A 92270
PALM DESERT elk 92260
0601?79-.135 CP3114 3i8;
USE OF RMITrr
P E,
t gq [ n A * t Epy
,3F,A, Pi; i 3U, PEANJ T T. OES NOT ztdC.L 7J .fiil.C' +:;[ : W - i L OR POOL.
PLAN CHLCk.,rrX,lti Di;.CI-D 7!V-14 :OR.MUL11PLE l.33U.AJ4CHO $AME
PLAN °f "' E.
7?,1AC 1 4l+!'FS IRUC A ION Jig
E.S'4'JAJ,1k'1'ED 41T leNiSf P -
PERMIT FEE SU M Ath"
(:'ONS' 32'(FCTIONFE16 1.0.1-0.00418.000 5302.50
PIAN (114C' ';"f f(1i-000-430-:31C g77,7
N C IANICA1: F U 101-000-421.000, $3%50
EI.Ri(;'JR AL EEE J01-a')1i 420.OW %82.111
>: LUMHINO 01 to 1,-000-419-000 $83,1N)
STROrfC MC)TION FT, r, - RRS1IJ 101.01MD 241-000 S4.114
GKJk0iJ`dGJ' E' 1.01-000 -423-000 $20.00
4td1'RAS'1`ICUCTUREFO,2125-003-443- 4d S9R.20
X121•;c;ISi::fg1 1Jv 10.1-000-441-345 $25.00
' 171-11.) AI, COINKIRUCMON AND PLAN t;:k{:a(X.
$1,629.33
I ESS Y'ltl:TALII 1 FXS
$0.00
"I'01".Al, PERMIT IFEEN DUE N(ii'(r
RECEIPT
DATE
BYE "
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
—
Exhaust Fans
O.K to Wrap
—/ OU
F.A.U.
Framing
/ —Gp
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. LathA-9
14
Final _
Final 14 Z2— [r?J 4
BLOCKWALL APPROVALS
PO 'S -SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final I
I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Finalrr�
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS: ,
t'. t
i(CertificatePanqy L
City of La Quinta Qt
Building and Safety Department OF, E `$
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: 78-469 MAGENTA DRIVE
Use Classification: SFA Bldg. Permit No.: 9966-223
Occupancy Group: R3 Type of Construction: VN Land Use Zone: RL
Owner of Building: BAY CITY ESTATES (ARIZONA)
INC.
w"iY l Si
Address: 16 CADIZ CIRCLE
City: RANCHO MIRAGE, CA. 92270
By: GARY HARTMAN
Date: 6-22-00
i