SFD (9708-022)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 # —1 ace Lic. Class a Exp. Da
1S�rAt�lJ1t tit
J i
ate Signature of Contractor 1
OWNER -BUILDER DECL RATION
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.
" fi I have and will maintain workers' compensation insurance, as required by
Sec on 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 ,*��'f;'i-4 FV MD Policy No. 464P-73-7 11
(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 fo ith comply wL!' pro si
Dater Applicant
-
Warning:
i �vtlf, �Nc
Warning: Failure to secure Wor r�'oampensation coverage is unlawful and
shall subjectan employer to cri'nes 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 t0J
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
ty a above-mentiong� r�prtfror��,ept,rt yl pt�rpSignature (Owner/Aggnf Date +r
Ina oe-A
PERMIT # CONTROL #
BUILDING PERMIT 970118-822 5679
qK'1417
DATE LUATION S211,612" LOT n TRACTJOB
SITE
DDRESS 7 Y-S+MEiR OUN WAYAPN
-�
OWNER
CONTRACTOR/ DESIGNER/ ENGINEER
91'ARLIGIrr Df INES LLC
DEANS TrARLIGIr1' D(WFS INC
P.U. BOX 51140
P.U. DOX 5140
NFWP(__)kT REACH CA 92tx)7
NHWPORT 13F;At'H CA WNS2
x71.1?i'ia-1 SIS t"1t1,�
USE OF PERMIT
PLAN .iii
TRACT C'UN:,"17RU(71i N 3.v5 .tK13
0AKAQfA'ARo,* F O7S+ UU SF
EMIMATRD CONT OF CONSTRUCTION
21116ILSO
t 'I 7NSTkV,'r1t IN "At 101 -O(X)-41 )(4)00 Y t ,O { 110
1n AN 04FCX Fn-- 10140f 10-11K "4A 17
NU -4 1ANICAL IUF 101-000--121-000 585.
hLECtIU AL F I% 101-000,410-" S l tiv.5xt
PIXT411 OMi F1_1 1014*419-M 419-M S160t3l)
*1'1'it "I MOTWIN FT0: - WRIT) 101-L100-341-000 Rai 16
` KAi M40 F't3[i 101-000-421-W $20.W
iN}��kA.9'1'It1.1(.1 t►121: k!~.F ,f.1J-iillli'�_i- X14 ads x61.1,'
ART IN NL71i1 IC W.ACV3 - ll 70(4i(i(7-25S-0(X) S27904
°;1 Iii -11 -TY i 1, V0NtZM!. (""T' ON ANT) P1, A N C•11171 -K_
t47 394 71
4 A a../ LESS PRETAID F UES
O
SODO
TMAL PFRMIT PFM Bite' N(>°W
37,3�%.73
AUG 15 1997
C I T BY 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
p
F.A.U.
Framing
/
Compressor
Insulation
/ -f
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 Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
7
Heater Final
Water Piping
7.
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) nd
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Vottage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm) lo-rl 7-1
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:
Use Classification: SFD
Occupancy Group: R 3 Type of Construction: VN
78-860 MERIDIAN WAY
Owner of Building: STARLIGHT DUNES LLC
Building Official.
Bldg. Permit No.: 9108-022
Land Use Zone: RL
Address: P.O. BOX 5140
City: NEWPORT BEACH, CA 92662
By: STEVE TRAXEL
Date: 8-20-98
POST IN A CONSPICUOUS PLACE