SFD (0204-076)51640 Avenida Martinez
0204-076
,4 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.
License # Lic.' Class Exp. Date
r,' '
Date 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 & P?ofgssionals Code)
( ) I, as owner• of the prdp"el y.., am exclusiv tcontracting with licensed
contractors to construct therr6,l4ct (Sec. 704 usiness & Professionals
Code). n
() I am exempt under Section_/ _19, B&P. this reason
Date Signiilid of Owner n
WORKER'S COMPENSATION E • LARATION
I hereby affirm under penalty perjury one the following declarations:
() I have and will maintain c1,tificate of con t o self -insure for workers'
compensation, as provided by Section 3700 j the Labor Code, for the
Performance of the work for which this permit is issudd.
f) 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 fF'.4'A'fi Policy No..
(This section need not be completed if the permit valuation is for $100.00 or less).
( ;) .1 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
Geode, I shall"forthw5comply with those provisions.•
Date: ' Applicant—
Warning:
pplicant Warning: Failure to secure Workers' Compensation coverage is 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 Citylo enter upon
the above-mentioned property for inspection purpoes. r
Signature (Owner/Agent)R,• t Date,F r
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BUILDING -PERMIT,,
DATE +tea VALUATION LOT TRACT
JOB SITE.
APN
ADDRESS .f04: a ? A NAKUN 4Z
.} T Q 1
OWNER
CONTRACTOR/DESIGNER/EN (NEER '
PACIk'10 TIAA3:J3+'S CON'.9`ME'Ja`. HON
1 AOFIC: 'I'.FiADRS CONSiTRUC' (OX
1719 9 TREMONT
1719 9 ':I ALES MONT r
9';??MMME CAL 92054
0 tst;'1 ,t" MIM CA 91051
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USE OF PERMIT
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CFfY OF LAQUINTA •
FINANCEDEPT.
RECEIPT
DATE
BY
DAT- FINALEDa
INSP T,Oji
4
a
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings .p?/
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck 2 02
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation — /
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 - - O
POOLS - SPAS
BLOCKWALL APPROVALS
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 -7 f�
Heater Final
Water Piping ' 1 "`
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 Z ,
Utility Notice (Perm) ��/�
Certificate of.0ccupancy
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 ADDRESS:
Use Classification: SINGLE FAMILY DWELLING
Occupancy Group: R-3 Type of Construction:
51-640 AVENIDA MARTINEZ
Owner of Building: PACIFIC TRADES CONSTRUCTION
Building Official
vni
Bldg. Permit No.: 0204-076
Land Use Zone: RC
Address: 1719 S. TREMONT
City: S. OCEANSIDE, CA 92054
By: KIRK KIRKLAND
Date: NOVEMBER 6, 2002
R
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