SFD (0205-033)50120 Malaga Ct
0205-033
LICENSED CONTRACTOR DECLARATION
` 1 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
Date Signature of Coritractor- f J
fj 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). 00
:( ) 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.
*y ,LI 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 NATS I UND Policy No. • 07152
a
(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^Lshall forthwith comoly with thd..se Drovisions: i,•'"tae r7
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000,4in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees. r
IMPORTANT Application is hereby made to the Director of Building and Safety ,
for a permit subject to the conditions and,,restrictions set forth on his
application. y
1. Each person upon whose behalf this application•is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify,
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180- days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is: :
correct. I agree to comply with all City, and; State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspectt'lon`purposes
Signature (OwnedArgent) Dat'q) f
,. . .. .. .. ... .... "".yrs .. _. .. ,... .,r
BUILDING PERMIT PERM T#
DATE VALUATION,
S1 y .2{•) LOT TRACT
JOB SITE
ADDRESS L0%)-1, a ,P I 7,41G4A (:'01YRT
APN
OWNER
CONTRACTOR / DESIGNER / ENGINEER
77 fa> 'C 'vf'.S ',}C C:I:, 3.#%:1 7E . ]:4
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i J ir :C G"ll 9121211
PKU -1 DIMM, T CA 927.60
(76U)7:1Z-82?,,4 MIR I P
USE OF PERMIT
fit`NGIA PAMIL,Y D'i} i [90_
aIFID • I.A)T 39 PLAN IP. PEWIT DOES ADO!• t7.d'M Z 9LOCY WMAA
i't >°}Y. Sp, , OR. t S .dW'is" ' .i`'.A► 'PItfJ ti;t•I. 7,' i &,old ,".EII . i £'w
11MliMION MI TO .MU>x.•`TIPI.E ISS1,YAAi P OF SAM14001AN TYPM
2,236.PORCH/p00 SP
CUSTOM/C.
rya`11Ti ySTRUCTION
Me
EfInT iA 'off OF d:`O:ry3SW$TMON
1861W49.120
CONSTRUC:TIONFi'a lo!-906A-Imoo 00
PLAN CHVIC M0,
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MECHANICAL PIE rC13pJi1n l2i=t)a $9S,110
FNXCMCtu ME
l l.Ug'i f 11 G3 TME. $162,50
S7'i7:C1'd+ic ®'7'TQ%f . ''7is3T. R ' iO 4 t ,1-J1C)C?••2 i'4 d" fl0 t .fi^+
ORADINO PER,
iMMOPIEP. IMFF f. QT 1?8Z $ o9tt7,fE
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C1 OF LAQUINTA Q i
FINANCEDE
RECEIPT:
DATE
12 - 2
BY"
l ( 71—
DATE FINALED
. 3
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms 8 Footings
Q- - Z
Ducts
Slab Grade
Return Air
Steel
—692.Combustion
Air
Roof Deck
Q ,
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
Compressor
_
Insulation
3- Z
Vents
_
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final -
Final
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
Water Piping
��!�C/
Heater Final
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) / e-
COMMENTS:
ifi to ot-Occupancy,pert ca-
o o
City of La Quinta
_Bui,lding and Safety- Department OF
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
ol%wing:BUILDING ADDRESS: 50-120 MALAGA COURT
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0205-033
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL
Owner of Building: SEDONA HOMES, INC Address: 77-564 COUNTRY CLUB DR. #137
City: PALM DESERT, CA 92211
By: GARY SHOWALTER
Date: 1-30-2003
Building Official
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