SFD (9907-368)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of. perjury that I Arn licensed under provlslons"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: L
License # Lic: Class.: Exp. Date
bate' :� �Signature,of Contractor W
OWNER -BUILDER DECLARATION
t hereby affirm under penalty' of perjurythai' 1, am exempt from the- Contractor's
License Law for the following reason: -
(.) I, as owner of the -prop", .
he.property,. or my• ei» ployees with wages'as their sole
compensation, will do,the work, and the structure.is,not intended or offered'for
sale (Sec.:7044, Business & Prof essionals'Code).:._ -
( ) I, as/owne,r• of: the proPerty, am :exclusively contracting with licensed
contractors ,to construct the' project (Sec: 7044, Business & Professionals
Code):' '
O Lam exempt under•Section B&P.C.'for, this reason
Date ` `;Signature of -'Owner.
WORKER!.S COMPENSATION DECLARATION'
I hereby affirm, under enalty of perjury one. of -the following declarations:
O I, have and will man`tain a certificaWV consent to.self-insure for. workers'
Compensation, as prov6,'d`for by Sec'tiori 3700.of.:the�Labor"Code, for 'the
performance of the work for which this permit'is-issued. • . ;
( a have and will' •maintain•workers' compensation Insurance, as required by's
Section 3700 of the Labor Code; for the performance of the work for which this
permit is issued. My workers':compensation insurance carrier & policy,.rio?are:
Carrier Policy No.
1k .7',t P�tf ,/tv..7. j..•�.. e:�1�' 1 . -e a+.- -i J•,i!iw J.
(This section,need not be completed if the permit valuation is for.$1b0.00 or less).
T, I certify that In the.performance.of the'work for which this permit is issued,
I shall. not employ any:per son Iin any manner so as to become subject to the
workers': compensation lawsbf California;'and agree'that if I should become
Subject to.the'workers' compensation prD�vjsions of'Seetion.3700'of the. Labor
Code, -'I shall forthwith comply with, thos vg's ons.
Date' 4►'^fay Applicant a
Warning Failure to secure Workers. Compensation coverage is unlawfufand
shall subject an employe r, to criminal penalties and civil fines up to.$100,000„in
addition to the cost of compensation; damages as provided for`in Sectioh, 3706
of the Labor Code, interest•and attorney's.fees.
IMPORTANT. Application is hereby made to the Director of•Building,and.Safety
fora permit sub ject:to'the''condltlons'and,restrictions •set forth'on his
application.• ;
1. Each person upon'whose behalf this application is made&'each person.at
whose request arid -for whose benefit.work,is performed under -or pursuant -to
any.p'e'rrnit issued as a result MANS ao.plicaton.agrees,to; &•shalll;.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'arid 'void if
work 'is not, commenced'w'ithin 180 days from date. of lssuance..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,%Jhe building
construction,•and hereby authorize, representatives of this•City:to enter upon
the'aboJe-mentioned property for ing ection purposes-'
0
Signature (Owner/Agent) \Date
BUILDING PERMIT PERM�T�Y'�tcii
C EAI E o 2000 VALUATION , �4 991 .LOT ¢� f 'TRACT
JOB SITE.
ADDRESS ,' 79:-,746.&uuo►..,f33it% iJ51 e d:pB; t k
APN 94N'10 -r020
OWNER.- _ _ __
CONTRACTOR/ D.ESIGNERJ ENGINEER _
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4"CIRY FEW, Od. E NOW
RECEIPT ,.
DATE •'`
`BY s
DATE FINALED
INSPECTOR '
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts.
Forms 8 Footings
Z-7
Ducts
— �p �9
Slab Grade
Return Air
zz -- a—p
Steel
Combustion Air
Roof Deck
Exhaust Fans
0. K. to Wrap6.
Q
: F.A.U.
Framing
Insulation
Compressor
Vents
Fireplace P.L.
Grills
Fireplace T.O.
; Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
/z /6-p/
Drywall - Int. Lath
a
Final
Final
BLOCKWALL APPROVALS
steel
POOLS - SPAS
Set Hacks
Electric Bond
Footings
Main Drain
Bond Beam
Z
t Approval to Cover
Equipment Location
Underground Electric
f Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
I Gas Test
1 Electric Final
Waste Lines
��� %/b-
! Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
f�
v Z7�
j Pool Cover
I Encapsulation
Gas Piping
_ 0 _
I
Gas Test
Appliances
j Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring _Cg/
Low Voltage 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 Quinton
5
in n SafetyDepartmeilt �F, OFBuitd g,a d'
This Certificate issued, pursuant tothe 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: 79-740 MIRAFLORES BLVD `.. k'
Use Classification: SFD Bldg. Permit No.: 9907-368.
Occupancy Group: R-3 ' " Type of Construction:j• V -N, t Land Use Zone: ' CR
Owner of Building: CATELLUS RESIDENTIAL.. Address: STARK PLAZA STE 400
COMMUNITIES
City: IRVINE CA. 92614
y By: GARY SHOWALTER
Date: 03\01 \02
Building Official
PORT IN A MR1001t-1 1" 19
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