SFD (9708-023)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 # '7U -k* Lic. Class Exp. Date
-�
14,&J4 tk�ar fi-
/te(� Signature of Contract s d
a
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 MPAIC �00t) Policy No. (4(c,4137 —91
(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.
,«.I
Date: �Applicant W STA - d,W atl9!r, e+v
Warning: Failure to secure Wor o er I
ers' pensation cs awful 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 or pursuanAtto
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 upor*IL
the above-mentioneproperty for ins ection purposes.
Signature (Owner/Agent)01 11e,101%Date A e'
PERMIT # CONTROL #
BUILDING PERMIT •
DATE % VALUATION LOT TRACT 4`80
I S l
ADDRESS 7W# Al�le.�mnwu N WAYJOB SITE
APN
OWNER
CONTRACTOR/DESIGNER/ENGINEER
..rAR110i f' DUNES LLC
DE'ANE Sf'ARLI(iffT f7UNES 1NC
P.V. k3OX 314)
P.U. Bux %40
NPWK)RT REACH CA 920i2
NFWtK)RtT i31'.ACH CA 92662
M4)754-1517 C8"
USE OF PERMIT
SFU
LUT i. PLAN 44
TRA(7 CONMUC'T K N 3.3w.W
P(ACUPATIO 80.W W
c}APAk*i CA61 k -W1' 636,W V
WIT"TEID OWT OF C'MMIXTION
197^5.64
PERMt M, SilMM.A V
1`(.)N.8 Rt)t710N FEE 101-0(()-41844 VIV2 50
,,��A ANc�"as�sl 1�?.V -000-41Q-318
ply 7`4
♦wa /t'�; t401
Apl
t7N['J:i�i ifi11�\. AL FW 101 `{/'{7V 4,411-000 x.7', N
IiLhk rRiC AL FEL. 101-000420-000 5179.12
P1A*vI ltMJ FEE 101-00"1+4= S#+' 0 (11111)
T, M(?NO W)TI 4N FEW - RF3117) 101-fi11()-N14jfl(1 119.71
GRAi)"N , FLI 101-01010423400 SIn),00
04WRA.ti't'1 LK 1"th Yhh 225 -(ft -443-342 34,401.9V
ART 1N Pgff31,.1C PLA04- RE9117: 7014M -25i-000 $242.66
SU1l3-fiC71'AL C'ONStRI.1—DON AN.D PLAN CHFC'K
36,4( 6?
P ® USS PARE -PAID FEES
$D.00
TOTAL ffRMIT F11g1M DU F WYW
$6.WA2
AUG -151997
>t
s
'RECE
DATE
BYDATE
FINALED
INSPECTOR
INSPECTION RECORD
r
OPERATION
DATE
INSPECTOR
OPERATION
DATE
I INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Retum Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap 9 7
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wail Insulation
Condensate Lines
Party Wail Firewall
Exterior Lath
D I - Int. Lath
/1
Final
Final �- —
BLOCKWALL APPROVALS
POOLS - SPAS
steer;,
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final I
Gas Piping
PLUMBING AP ROVALS
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
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:
y NO lr�•Q+e�i�
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
78-870 MERIDIAN WAY
Bldg. Permit No.: 9708-023
Type of Construction: VN Land Use Zone: RL
Owner of Building: STARLIGHTDUNES LLC
Building Official
Address: P.O. BOX 5140
City: NEWPORT BEACH, CA 92662
By: STEVE TRAXEL
Date: 9-17-98
POST IN A CONSPICUOUS PLACE