0311-103 (SFD)55535 Medallist Dr
0311-103
LICENSED CONTRACTOR DECLARATION
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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
482086 13 1'l3t9l 1:
Date /7- "'p 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.
(/- 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. M workers' compensation insurance carrier & policyno. are:
Carrier SPATS 1 PID Policy No. 00229.679X-01
(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 provisidhs of Section 3700 of the Labor
Code, I shall forthwith comply with tho provisions.
'Date: - / 7-6 Applicant ;r, .Eti.»,
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 L•abor`: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 i D
work is not commenced within 180, days from date of issuance of suc
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 i
correct. I agree to comply with all City, and State laws relating to the buildin
construction, and hereby authorir` representatives of this City to enter upo
the above-mentioned property for'Ins, ection purposes.
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Signature, (Owner/Agent)_ Date
PERMIT #
BUILDING PERMIT
DATE VALUATION ` p LOT Q TRACT r .tri c657 •'
TVALUA
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I// -e-^. F
JOB SITE
ADDRESS o-..a'}.4..,-Cr.a.iS3
APN . '] •: B :J•'Y - ,.
OWNER
CONTRACTOR / DESIGNER / EN INEER
-095 XhiIO NA.S.rDRIVE,
ffiffrfa2 FL. 334,17?s
;C.A ilMITA, CA, 92253
(7&50)7`17p8770 Csvt
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USE OF PERMIT
aid' d - `IAJ 1,:>' C:A tlxg '_,
P00 4 SQA OR DRi-VYWA" APPROWN4. 75% REDUCTION TO PLAN CHECK
r, KE F)UX, TO MUT, i 1PLE ISSUANCE OF SP MY, PL XN 'fYPE
- eft -
•.
U; QMJ COMTRIJUM1014 3.732,00 SF
PORCHlP.d TIO ! 710.00 SP
10A.11.f+EXARPOFt`4' 646,00 SF
• ESTM!1'f`.EE:.✓ \.4aYST ROY CO NSaJGa.id C110t.'i
:03f: w ..
FT'i:1.,3'`a is' WMA'
-11Q
.•.
CONSTRUC TINN FRE 1011!-00,0-418-000 51.3"M50
'
PLAN CHFCK FEE 101w{tL (1-fa 9-aTf3 $2 ,13
NECI3ANIC A.L Fi?.E 101.000.421.000 SiX50
91>LCTR1CXL1 YZE 107-000-420-000 $318.54
i'1.CjM 4tP1'C3 FER 10.1--WO-410-000 $19935
1',I?,0N0 P1tOT1014 FEE, a REBID 101-000-24.1-L1(DrJ :fl.3t
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0111 S IAt 71S L1? 101.000.423-000
? N31,1:,f:DI'ER IMPACT PKE, .405.Ofi
ART IN PUBLIC P.LACE0 1RiiS1r 2-70=000443.000 S2821170
ti3 3- ' ' ..;'.tZ ':'s .ir1C.1:L°13 i` k .4 I 3l: Ls' C" 11rt`1{',
'+ •, ' ' .d •.
TZOD A':ftEAPATI) FEES
$0100
T(Yf AL ME NOW'
DEC •1.7 2003
CITY OF LA QUINTA
17
68Y
J : ^
DATE? ED
7
INSPE iT _
//
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS _
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings -"
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck na
Exhaust Fans
O.K. to Wrap Q
F.A.U.
Framing o
Compressor
_
Insulation S 6
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test ,
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
INSULATION O!I=QTI
I TE
This is to certify that insulation has been installed in conformance with the current energy
regulation, California Administratve Code, Title 24, State Of California, in the building at
1557036 MEDALLI$T, DRIVE LOT 9, L4 QUINTA CA
9LLLNGS
TYPE: BAITS MAUNFACTURER: Cert-ai.9tesd THICKNESS: R-38
_WALLS:
TYPE: BATTS MANUFACTURER: Owens Ccrnino' THICKNESS: R-19
GENERAL CONTRACTOR: ENLINE CO BUILDERS LICENSE
BY:
TITLE,
PARAGON SCHMID BUILDING PRODUCTS A MASCO Company LICENSE # 221517
BY. TITLE: ACCOUNT REPRESENTIVE., DATE:
INSULATIam nwip -ATE
This is to CertiWkat insulation has peen Installed in conformance with the current energy
regulation. Californi dministrative Code, Title 24, State of California, in the Widing located at:
CEILINGS:
TY 'E: BATTS MAUNFAC ER: Ceftinteed
T -38
TYPE: BATTS MAUNF RER: Certainte
THICKNESS: R-19
GENERAL CONT OR. EHLINE CO BUILDERS DENSE##
BY: TITLE:
PARAGOHMID BUILDING PRODUCTS A MASCO:Company LICEN 221517
BY:
TITLE: ACCOUNT RERRESENTiVE D
ATE: