SFD (9708-025)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
omkq
/Dat -!f '' r� Signature of Contra
OWNER -BUILDER DE ARATION
I hereby affirm under penalty of perjury that 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.
(y) I have and will maintain workers' compensation insurance, as required by
Sec ion 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,, rij"jD Policy No.14up.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, I shallffortrthRwiith comply ho ps ovjs�or 4.0 .r
ate: Aem Applicarr1'� /enaltpies
�Warning: Failure to secure WorKersmsation cove� i�awful and
shall subject an employer to criminal 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 f
construction, and hereby authorize representatives of this City to enter upon gi
the above-mentioned pro��j,ert for inspection purposes. 1.f
lVa-va 1�?�T PvA�dove_ 0
Signature (Owner/Agent) Date
PERMIT # CONTROL #
BUILDING PERMIT
DATE VALUATION LOT TRACT '� X002
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t
SITE
ADDRESS " WAY
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AJOB
"9499 -Ug pA �Ug
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OWNER
CONTRACTOR / DESIGNER / ENGINEER
Si'r' RLIGIfi [(1NkS 1. C
DFANi S1'AR1,10-rr ili tmrs me
P.O. EkA 5140
P.O. 6Uk 144)
N1±W1'O RT BEACH ('.A 92602
NEWPORTMACH CA 92662
t714)75 .1517 CKS
USE OF PERMIT
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"[T13'1'i�T!�a1.s'c1Nq'{'R.iX-110N AND PLAN C1IFCK
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p,UG 15 1997 LE&S PRE PAID FEES
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(RECEIPT
DATE
By
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
J
Underground Ducts
Forms & Footings
Ducts
Slab Grade
7
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O. K. to Wrap
F.A.U.
Framing
Compressor
Insulation
p
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
6 G
Final
Final '
BLOCKWALL APkOVALS
POOLS - SPAS
Sted%
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
aL
Appliances
Final
Final
Utility Notice (Gas) 117 it 1 11
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Law Voftage 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:
Use Classification: SFD
Occupancy Group: R 3
78-865 MERIDIAN WAY
Type of Construction: VN
Owner of Building: STARLIGHT DUNES LLC
Building Official
Bldg. Permit No.: 9708-025
Land Use Zone: RL
Address: P.O. BOX 5140
City: NEWPORT BEACH, CA 92662
By: STEVE TRAXEL
Date: 9-28-98
POST IN A CONSPICUOUS PLACE