SFD (9712-043)57101 Medinah
9712-043
r+LICENSED CONTRACTOR DECLARATION
I hereby affi m 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 #14509yybc. Class Exp, Date
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e € t 7 Signature of Contractor r1
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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).
O I am exempt under Section r ' B&P.C: for this; reason
Date Signaturre 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.
Se( ) I have and will maintain workers' compensation insurance, as required byi
ion'•3700 of the Labor Code, for the performance of the work for -which this r
permit 'is issued. My workers' compensation insurance carrier & policy. no. are: s••.
Carrier Policy No.,
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11A I L.+t:i ,r!' - t- c.rjnnifl, ,o.r
(This Sectiori,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 _l. should become
subject to the workers' compensation provisions of Section 3700 of -the Labor
Code, I shall forthwith comply with those provisions.
,f Date t_ Applicant -
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•3708
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.
A. 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
1' permit,._or cessation"of work for 180 days will subject -permit to caricellation.
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
thefabove mentioned'property for inspection purposes.
(Signature (Owner/Agent) -- -- Date '.1
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C'ONSTRUCTION FEF, 101-000-418-00
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INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms 8 Footings teDucts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap —Z. 15,
F.A.U.
Framing
Compressor
Insulation fy
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 Pibg. Test
Final
Gas Piping
PLUMBING APPROVALS
de
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 311
Encapsulation
Gas Piping
Gas Test -
Appliances
Final
COMMENTS:
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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 40 cz
Utility Notice (Perm) 1110
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City of La. Quinta
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Buildingand -Safety Department MOF.
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:. 57-101 MEDINAH
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 97127043.
Occupancy Group: R-3 Type of Construction: VN Land Use -Zone: RL
Owner of Building: MCCOMIC - SEOKTOP LLC Address: 750 B STREET STE 3140
City: SAN DIEGO, CA.; -9210.1
By: DANIEL P. CRAWFORD•JR. -
y i G%c ` Date: 12/22/99 '
Building Official
liQ POST IN A CONSPICUOUS PLACE