SATT (9906-230)78483 Magenta Dr
9906-230
LICENSED CONTRACTOR DECLARATION!
by affirm under penalty of pprjury.that,,l am *licensed under provisions of
er*9:(comme . ncing withhS6ctilon 7000) pf.Division 3 O' the busines's and
;iionals Code, and my License is in full'force and effect.,., ,
nse'#. Lic. Class Exp : Date
.'
8
Z,•
4ie_ _L Sigriature-of-Contractor
(D
0-5
C:).
OWNER -BUILDER DECLARATION
W
exempt '
'W. I hereby affirm under penalty of. perjury, that I am exe' t from the Contractor's
or's
F_
License Law for the following reason:) ,
Z .,I, is owner of. t ' he property, orf my employees. with wages as,their sole
compensation, will do thia 'work, and 4he structure is not intended or offered for
sale (Sec. 7044, Business'& Prof essionals, Code). ,
1, as owner of the.pr6periV, am exclusively contracting with, licensed
contractors. to construct the project '(Sec. 7044, Business & :Professionals
V "Code).11 . . ,
. J I
O I am exempt under Section B&P.C. for this',reason------
LO
..0N ' Date Signature of Owner
C\I
0)
WORKER'S COMPENSATION DECLARATION
z
8. 2 I hereby affirm Linder -penalty of perjury one of?
the fo'116wing declarati6 ns:
,Lo<z0 . i() 'I. have, and- Will maintain a certificate of consent to Self-insOre fo ,-Workers'
F_
WLL, compensation, as'provided for "by Section 3700 of the Labdr Code., for the
0 J '_J performance of the work for which this permit is issued.
L)
I have and will maintain workers' Compensation insurance, as required y
b
Section 3700 of the Labor Code, for the performance of the.wbrk for which this
Ln
permit. is issued. My workers' c'6mpensation insurance 'carrier &, policy no: are:
Carrier Policy No
1422 74%9
< *(This section need not be completed if the permit valuation is for $100.00 *or less).
(: ), I Certify ihat'in the performance of the work for which thi s permit is issued','
..I shall not employ.apy person in'any
'any manner so as',to become subject to the
workers' compensation laws of California, and agree that
t if I should b ' ecome
11r. ' I
he
sweet to the workers' co rnpensatioin pr6visidr s.of Section -3.700 of.1t.Labor
Code I shall forthwith comply with those, provisions. .
Za
te; Applicant—
fl V
Warning:, Failure to secure Workers' Compensation cover a 6eis unlawful and
shall.subject an employer; to criminal, p6naltiesl'andciVil 4 ines, up -to $100,006; in
addition to the cost of, compensation',,. damages I as provided for in Section,V06
of the Labor Code, interest and attorney's fees'.
IMPORTANT Application is hereby made to the Direct6r 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'applicatori-agree§ to; & shall,,inderhn.ify
& `hold harmless the. City. of -La Quinta, its officers, agents and employees.
2. Any permit issued as,a result:of
-this -application becomes,n6li and void if
1 '
f . ' ' - " I issuance of such
work is not commenced within 180, days from date* of,
permit, or cessation 6f.work for 180'day's will subject permit to cancellation.
I certify that I have read this applic.ation and state that the ab6ve information is
• correctA agree,to comply with all City,'and State laws relating to the 6ulildieig
construction, and hereby authorize representatives of this City to eeiter:uoon
the.abbVe-mentioned property for inspecDpn purposes:
vSignat ure
(Owner/Agent) Date
PERMIT #f;.,
.-'8WLb1NG'PERMIT "
4 -
DATE VALUATION S41X4361.%) LOT 1, Y TRACT,
JOB SITE 78-7483-1vilk A DRIVE
ADDRESS
OWNER
CONTRACTOR DESIGNER ENGINEER
VT if I T r, &AoAvy,
P" C0M*,"#AT%AC-1VN.
I
0 A V 1"I fl`y f -,%,T"F F.A &V
J-1. "I'lual 101
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_160AD1171c"i jj.,
7 t 985 i0N1 DR OUff I
9ANCIR0 IIVID "E, CA. 92270
PAJIM DESSEW11 CA 9'2260
CRL# .782
USE OF PERMIT
_'Y ATTAORPO
,Dik_PLA!43L, PERIWT DOE 8 NOT MCLUDE RLOCK-WALL ORPOOL.
4'f. ANISSUANC&OF SAME,
PLAN `(YPF.
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ARADINC FrX_ S10.00
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1WF R A; V f RO 60 (J": ".' FT r- C,'. ;.OW44 ,.42r
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IS T_r8_T G 0 CON ,Z r AK I CHF
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T(TYAL PY3MMAT r4iMS UIVENOW,
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RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
" BUILDING
APPROVALS
MECHANICAL APPROVALS
,
Set Backs
Underground Ducts
Forms & Footings
G'
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
— Q., rr
Exhaust Fans
O.K. to Wrap
Framing
3 / —oz:,
F.A.U.
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wail Firewall
Exterior Lath
Drywall - Int. Lath
e�
Final -BZW
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
r Final
Water Piping
I
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
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)' /
COMMENT .� 79 ed-
'Cergificate - of
City cf La' Quin ta .1,
Building and Safety Department
This Certificate issued pursuant to the requirements of Section .,log of the Uniform ,dui/din Code
certifying that, at the time of issuance, g '
this structure was in pomp/lance ,with the various ordinances
of the City regulating building construction or use. For the fo/%wing;
BUILDING ADDRESS: _ 78-483 MAGENTA DRIVE
Use Classification: SFA
Occupancy Group: .133 Type of Construction:. VN
Address: 16 CADIZ CIRCLE
,Bldg. Permit No.: 9906-230
Land Use Zone: RM
Owner of Building:. BAY CITY ESTATES(ARIMMAulur_
I
Building Official
City: . RANCHO MIRAGE,CA 92270
By: GARY HARTMAN
Date: '7-28-00 '
e
POST IN A CONSPICUOUS PLACI