BLDG (0206-060)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
336142' .D-1 09/ify2c
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 & 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 I3T.r TE FUND Policy No. 1661119.,02
(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./
bate: 4 ir:, l: L Applicant
I t�
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 oi� 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.
Signature (Owner/Agent) !, t` 3'f �� J Date
r i
BUILDING PERMIT
PERMIT#
WIWOW
DATE 06f10r0cVALUATION S4,2".70 LOT
I TRACT U1.1K 20f�
JOB SITE ADDRESS-0A..3.i�.�i NWA1VJct►i 6�A(.� EZ
APN
OWNER
CONTRACTOR/DESIGNER/EN (NEER
WEV MILLMDU DEV. CORR
WILLIAM L. SHLEMS
45.675 GUd?:tEYDRNE.
45671 GURLp'Y DRIVE
1ND;Ctt,�T WELLS CIA.
MAW Warms U
CA. 922; 4
(160)'.,69-2020
CIBL14 3907
USE OF PERMIT
GEIERAL
198 LF i' 'St.CSt:K WA1.ILXITY ST.ANI.ARD.
x FT. 'WALL
LR
xA� CONT sir c OMMY70170IN
4,2M-7 3
. $ j�gy��yy r•{E
Fre
CONSTRUCTION FEY, 101-000-418-000 S'i2.0Et
eA
SMI -TOTAL Mlg3 l-��'7]%r,I�,t+yT[��'�;'l�h".fp"�K�
$72.�f3q(0
_CONSIRUCI-TON
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FE Ir. S DUN 140W
V/2.00
WYOFLAQUINTA
FINANCEDEff
RECEIPT
DATE
BY "y�� y
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
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
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs _17m
Electric Bond
Footings _offer
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
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Server 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)
COMMENTS:
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 ADDRESS:
53-025 AVENIDA MARTINEZ
Use Classification: SINGLE FAMILY DWELLING
Occupancy Group: R-3 Type of Construction
Owner of Building: NEW MILLENIUM DEVELOPMENT
CORPORATION
Building Official
Bldg. Permit No.: 0206-060
VN Land Use Zone: RC
Address: 45-675 GURLEY DRIVE
City: INDIAN WELLS, .CA 92213
By: KIRK KIRKLAND
Date: JULY 25, 2002