SFD (0111-180)LI CENSEOCONTRACTOR DECLARATION a w•
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 1
Date a, ,,��•� % !' Signature of Coritracto� < ""
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).
( ) 1, 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 STA1'1+' 1tON Policy No. 04640ft=
'(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' compensatjon laws of California arid` gree that if I should become
subject to the workers' compensation provisionsof Section 3700 f the Labor
Code, I sha)(forth4th comply with`those provisions.
Date Jf 4r I'', Applicant^"q
Warning. Failure to secure Workers '"Compensation coverage is unlawfultand
shall subject an employer to criminal penalties and civil fines up to $100,080, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT 'Application is hereby made to the Director of Building and Safety;
for a permit subject to the conditions and restrictions set forth on his'.
application.
.1. Each person upon whose behalf this application is made & each person at
whose request and f,)r whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La 06inta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I hay a read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to 'the building
construction, and hereby authofi a representatives of this City to enter upon
the above-mentioned proper y for inspection pu�rpo'ses
Signature (Owner/Agent) Dat-'.. lx ;
r 'BUILDING PERMIT PERM T# ..
DATE VALUATION LOT TRACT
9,21401 117110 13 29457-2
JOB SITE
APN
ADDRESS
?VS -10 V1'R9:atia-.�011 ..IHR VE EAU
M94,1,1 a.062
OWNER
CONTRACTOR / DESIGNER / EN 1NEER
O 1: 7EWRT DFVLWT1hfl'�.Tr
SPAM, CC?Wff;r'R C .'rf XT
PO 'BOY" 111;.15
756295 RA1`d'OSO L&QUTITfA:i X
LA CJ1'.7:rN A CA :92253.
1AQU a",A CA 92M3
(760)771-1941 M-1.411 2996
USE PERMIT
�OF1
i,7�AV�a7-L.if.7r XroXMtVJ�1�:YJ'Vb.Lay.�.a.Ed�i 5.7,
.
P005.4 S#'.A, OR DR1V1!WAYAPPROACH
t,WTOM COWai't'1$ill:°I'F.f I 2,,924,00 as
PC11%K,'kffpATIG 235.00 S19'
C4.4iR"MCAit.CORT °J6.E3 SH
1!e&7MXXrD C01Y3' OF CQiVS''1 t'7MOfit
240,917.1.0
VINN TAUCT'1C* RE 101-000-418.0nn - sl.moo
���&1yvE�>>99'Ryy',,f��'sY;� v+Q1-Oi`lA;i�l.�fl<n11fp�� ,$iN�,.�m�dq,
A41C:1Fwr.i.1C,A�'Zil AI, ,}'.EY 101• W-4121"Viae/ � :Y: 0.50
PRIAfCTRICAL FILZ 101-000-420.000 $1169.761
PLLIMk3D40 VEE 101-000-419-000 SSi'5.
S't'kt+C N0 �7 Tla,4 FEE o .RLISID 101.000-241-000 P .CJI
` ORA0WO i 3? 2 (f Y. •:r 0� i"i•-; 00 7 t) flu
f?L� Jt�1'Irk4;MIFACT FE'E'
ART Do PUBLIC LIC PL AC ES - REWE 270,000.445 -WO $100.29
b ,t.
,W•1
.L��.i1
yUB- Ljy�AL;
pV ryG4X
JMiSy 5D PL
(p �dq f1Z
118.30 PRE -PAW NEWS
$0.00
? MAL ]EsIM9'1i. J':fP' ES DDR NOW
RECEIPT
DATE
1
BY
DATE F ALED
7
INSPECTOR
" � • .fes:- - R�1 i'
1,1 j.i
(�
COPY_.T fr�l�..7/(O
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
_
Underground Ducts
Forms & Footings
Slab Grade
�J��v�
Ducts
Return Air
_ _
-d 2
Steel
G��
Combustion Air
Roof Deck
j— p
Exhaust Fans
O.K. to Wrap
F.A.U.
i
Framing
�_ 2 2 — L _
Compressor
U
Insulation
)0—' —,2 1
Vents
_
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wail Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
_
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
` Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
lz�/j�
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
-2 _ L
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
r
Encapsulation
Gas Piping •
Gas Test
_
Appliances
Final
COMMENTS:
Final
, Z-��� G
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
—G — y
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
_
Smoke Detectors
Temp.. Use of Power _
_
Final
,
Utility Notice (Perm)
Li
Certificate of -Occupancy
. • . _ .+ .' .. a� _' mo`'`o
h
city.of La Qu-inta
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: 79-540 MISSION DRIVE EAST
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0111-180
Occupancy Group: R-3 Type of Construction: V -N Land Use Zone: RL
Owner of Building: TD.DESERT DEVELOPMENT Address: PO BOX 1716
City: LA QUINTA CA. 92253
By: GARY-SHOWALTER.
�- Date: 07-16-02
ing Official
POST IN A CONSPICUOUS PLACE
f