SATT (9906-225)78473 Magenta Dr
9906-225
LICENSED CONTRACTOR DECLARATION
U) I hereby affirm under penalty of perjury that I am licensed under provisions of
H Ch. i:r 9 (commencing with Section 7000) of Division 3 of the Business and
c4 W Professionals Code, and my License is in full force and effect.
O ch License # Lic. Class Exp. Date
LO' y'i Jl4`_i3iii
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i
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! / "Signature of Contractor
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J U OWNER -BUILDER DECLARATION ( ..
HWW r- I hereby affirm under penalty of perjury that I am exempt from the Contractor's
t) 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).
M ( ) I am exempt under Section , B&P.C. for this reason
LO
N Date Signature of Owner
ON
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Q WORKER'S COMPENSATION DECLARATION
p Z I hereby affirm under penalty of perjury one of the following declarations:
LO 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
O J Q performance of the work for which this permit is issued.
CD Q U ( I have and will maintain workers' compensation insurance, as required by
QU Q Section 3700 of the Labor Code, for the performance of the work for which this
CC
rn H permit is issued. My workers' compensation insurance carrier & policy no. are:
,It Z Carrier Policy No.
Cb Z) STATE FUND 1.1".5741119
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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
subj gt'to the workers' compensation provisions of Section 3700 of the Labor
ACode, I shall forthwith comply with those provisions.
te: Applicant
n /
Warning: Failure o secure Workers' C; pens tion coverage i)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. // 33
Sl4ture (Owner/Agent) r ; ' Date 22
BUILDING PERMIT PERMIT"116-x1.5
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DATE VALUATION y . 'x 1,f it LOT 15 TRACT iK'3t5
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ADDRESS J 73 MAGEL A DRW JOB Slid
APN
OWNER
CONTRACTOR / DESIGNER / ENGINEER
RAY CrIT ES -1-N11- S JAPW1 NJ\] :NCS
D nlrl,it,X.i i i?Ait=r1NiY GE>`; cc3r"i l; ticYln:t
Io CAW', CIRCLE
74-£1185 JONI DtZ UNIT i
RANRA40101RAGE CA 42270
PAL.ht DESEWl' CA 92 2t 3
(760)179-1954 r8f.,4 1787
,
USE OF PERMIT
SINc11.,!" FAMt1,V AT'rjVAiED
SFA, PLAN 20. t HIRKHT DOES 140T 1N1'LIX)E BLOCK WALL OR P(DOL.
PLAN CHECK. )1*.' HI-AXJC.ED 7.ii".oF1. R M131,' RILE tS,%UANCh OF ;AN*,
PLAN'rYPI£,
TRACT CO; ,"ynt 17C 1 ON 912.00 ST
%»:1'I'MAT1,0 COST oil, CONI 1U."(741110I'r`
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PEMMIT FEE SilMMARV
CONS11RUC711 N 1-1113 101-0131)-4111-Q110 tri 14.51
Itif AN V; Irrk, 44T,tftl-iNui-.i1 ).i fi xftR
41:CIi.171iCAI. F 13 101 000-4111.000
W.(sc. PRtCA1, I; tfi 101'00()-X120-000 $8/.92
PLUNUONO Fht-' 101-WX11-419-M $97.91
ST1IC)N0kiMil-04 M.T.-i{f Si11 IM-ljiyf0.41-f1(N1 V 4
GRAVING FLf> Wt D00-12-1000 $20 (u)
1NFkASFRUCfUf1Ji 1. U1. 225 -(}thy -443-342
NitF ,41- PLAN 101-000-411-345 b'2 isU
S1 FR -I AI, ("(7i+ KTR1 tC"rff_ V ANT) PIAN t'Ni? `K
BI,R R 67
LES PRETAID FEES
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TOTAL PERM i'E' FENS PUR NONV
S1.8".67
RECEIPT
DATE
BY J
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Bai:r�
Forms & Footings
Underground Ducts
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
OX to Wrap
A7 IA—d-v
F.A.U. oe
Framing
Compressor
Insulation
/ --per
Vents
Fireplace P.L.
Grills 1000,
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
_f__0 ,
Final
Final
POOLS - SPAS
BLOCKWALL
APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground PI . 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
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 —pv
Utility Notice (Perm)
certificate of Occupancy
City of La Quinta
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
ollowing:
BUILDING ADDRESS:
Use Classification: SFA
78-473 MAGENTA DRIVE
Occupancy Group: I R3 Type of Construction
Owner of Building: BAY CITY ESTATES (ARIZONA) INC
r
Building Offic al
VN
Bldg. Permit No.: 9906-225
Land Use Zone: RL
Address:
16 CADIZ CIRCLE
City:
RANCHO MIRAGE,CA 92270
By:
GARY HARTMAN
Date:
7-19-00
POST IN A CONSPICUOUS PLACE