SFD (0111-172)_ LICENSED CONTRACTOR DECLARATION
(hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 9 (commencing with Section 7000) of Division 3 of the Busine'ss and
Professionals Code, end my License is in full force and effect.
License # ? Lic. Class Exp. Date
r3 i
Date it ---/6' i Signature of Contractor
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 owners of the property, am exclusively contracting with licensed
contractors to, construct the project .(Sec. 7044, Business & Professionals
Code). f
O 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.
( 1) 1 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:
Cartier Policy No. 046-0007330
(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�plowsions of Secflon'3700 of the Labor
Code, I shall forthwith,comply with those pro'vlslons. ,,-
Date' - (0y l Applicant_�- =•� `�
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to' the conditions and restrictions set forth 'on i his
application.
1. Each person"upon whose behalf this application is made & each person at
whose, request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
Work is not commenced within 180 days from date of issuance of such
i permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby auuthorizq representatives of this City to enter upon
the above-mentioned property for Inspection,pu'rposes.
Signature (Owner/Agent) " "" t"' { • 'Date ar' 0 .
-BUILDING PERMIT PERMIT
DATE VALUATION e LOT. e11i�.°� TRACT
JOB SITE
APN
ADDRESS
r' - b3 AUS R10N 1)f WM EAST
OWNER
CONTRACTOR/ EN
x p-�
d�DESIGNER/ 7INEER
11 SEA 1716
-79,495 R Ai�CHO LA QTM4TAD�
LA QVIMA CA 922.113
LA QLWTA i:"A 92253
1760)771-1941.w- 29%6
USE OF PERMIT
ff W01;1$!a#Lt D1?1C3
$311) - i:,vf"S PIA114 811. P11112'►APT.i3t: 91311`1OT 01C.',Lufv3e? 8 L.=K WALIA
OR DRIVEWAY APPROACH
CU19 OM WNSTRUCiTION Z$35.00 A?:C'
i3a1�i.�.s UC,'AT4,PORT SF
E�e�}l"�':i.69'F6A.9'�v,r) cf,.i61' o2P F.'�.',tli�i�'Lt.lU3„`•'�'dGow,
00
2204151
t1 ���p•y
d`�gL.Y' nS67,4Ydc-V.0.lA..�'�.�1
CONSTRUCTION FEE 101.000.418-000 $1,063.00
PLAN C, R.ECK FEE 101_000439_31;R �a17.9a
MECHANICAL MU 101.000-421-0100 3103100
ru. zmp's-CAL ff:": 1091.000-42.0-000 $162.01
PIANY30.40 FIZZ 101.000-419a000
Sa"kCXlt� 0 MOTIO'1.8 &dUS - atL". D 101-000-241-000) W.09
QR DfN0Fill 2 101--000-423-000 ` �za,
YWVE1110- ER31PACT FEY$1,907.00
1T W 614B.L' ,' dF8,- EyySIap rywNX)-Ypp.^000 WAS
,•.i
13 B' TMAJ C"O1!'STRUCM014 M-11) PT AN CA19C:"F4
$3,728.38
L932 PB WaD EROS
c�'}ip�x. a�Yrfs
.
TMAL ArLd .M.ti.DW, NOW
112
RECEIPT
DATE
BY
D ILVAL
INSPECTOR;:
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms &Footings
_ _
Iz /S ai
Underground Ducts
Ducts
Slab Grade
Return Air
3
_ -�
Steel
Combustion Air
Roof Deck /�` , ,
- !�s- r,2�
Exhaust Fans
O.K. to Wrap
•2- Z -�
F.A.U.
_
Framing
3;.�! _ Z
�ae
Compressor
F
Insulation
3 ,Y' Z
Vents
Fireplace P.L.
Grills
Fireplace T.O.
lv
Fans & Controls
Party Wall Insulation
_
Condensate Lines
Party Wall Firewall
Exterior Lath
C�
Drywall - Int. Lath
(
Final
Final
POOLS -SPAS
BLOCKWALL APPROVALS
steel
Set Backs
Electric Bond
Footings
,.
Main Drain
Bond Beam
Approval to Cover
" zA, v
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
_
Electric Final
Waste Lines
�Z ��/ �'
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
/
Pool Cover
Sewer Connection
_
% Z / U
Encapsulation
Gas Piping
Gas Test
Appliances
'
Final
COMMENTS:
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)
.. Certi
ca to of Occupancy
City of La. Quinta
V
Building and Safety Department ��MOFTti
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 variousordinances
of the City regulating building construction or use. For the following
BUILDING ADDRESS: 79-508 MISSION DRIVE EAST
Use -Classification: S.F.D. Bldg. Permit No.: 0111-172
Occupancy Group: R-3 Type of Construction:' V=N Land Use Zone:.. R -L
Owner of Building: TD DESERT DEVELOPMENT' Address: PO'BOX 1716
City: - LA QUINTA CA. 92253
By: GARY SHOWALTER
Date: 7\2\02
Building Official
POST IN A CONSPICUOUS PLACE ,
INERo
M■ D