SFD (0111-182)LICENSED CONTRACTOR DECLARATION
| hereby affirm under penalty ofperjury that | mm licensed under of
Chapter (commencing with Section 7000) of Division 8o/the Business and
PmfeooionaisCmUe.and myUuonooiuin�n�meand effect.
License � � ' uv.muax Exp. Date '
Signature of Contracto ii r
-OWNER-BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
1, 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 owne'r of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
. u". °"°".v. ".d°. Section —_-----.-.B"P.^. for this '""""''---�----_
Date Signature m'Dwno,
,.~WORKER'S COMPENSATION DECLARATION
' | »anouy affirm under penalty m perjury one o/ mo following declarations: | have and will mointain-pcertificate u/consent mself-insure for workers'
compensation,. as provided for by Section 3700 of the Labor Codefor the
performance of the work4or which this permit is issued.
I'have and will, maintain workers'. compensation insurance, as required by
S"""o'"'"""' the� Labor ^""". for "=p"' -o,=~°"' the work for which this
permit is issued, My'workers' insurance carrier & policy no. are:
Camo � ` ' poo�'wu
— �%�TZ�uW�.
.^ '
(This section need not,be completed if the permit valuation isfor �0.0.o less).
I ( ) 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' comppirisapon laws of Califo a, -and agree thati"Ll should become
Warning:� Failure to secure Workers' Compensation covera e is u
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
�f the Labor Code, interest and attorney's fees.
IMPORTANT Application ishereby made mthe Director mBuilding and Safety
for u permit subject to the conditions and mmnmiono set forth on 'his
application.
1. Eoohpo upon whose behalf this application ismode&each person vn
whose request and for whose benefit work ioperformed under orpumuant10
any permit issued aoaresult odthis app|ioauonagrees to, &vhaU.indomnify
& hold harmless the City ofLoOuintu. its officers, agents and employees.
o.Any permit issued aoo mou|(nfthis application becomes nun and void if
*nm is not commenced within 180 days from doxo of issuance of such,permit, or cessation of work for 180 days '
i|| � i | i
agreeI certify that I'have read this application and state that the above informlaito'n Is,- - ;
correct. I
construction, and hereby authorize representatives of this Qty
Dote
Signature
'
PERMIT #
BUILDING PERMIT
DATE VALUATION LOT TRACT
*24%117.10 11 7.5457-2
JOB SITE
APN
ADDRESS
794"S DITS-0,10110E)KA(Z RM."I'
649-210-W2
OWNER
CONTRACTOR DESIGNER ENGINEER
LA QT)WXA CA. 92253
'4A QUIM CA, 92253
USE OF PERMIT
i�VSTQM CONSTRUCTION 2;Q4,W 3F
(MRAWCARPORT 470,00 8F
XISTWAM COST OF CONMUCITON
240,11740
CONSTRUCTION "M 30)-000-419-000 S),13no
PLJ,tw CIHECK FEE 101-000-419-3118 $232,24
MEM-L&NICA.VVER 101-000-421-000 100.50
PLUMBINO FIRE 101-000-419-000 31115.75
92.03
RECEIPT,,
DATE
BY
DATEfINALEP
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backsn�i�^
Underground Ducts
Forms &Footings
Slab Grade
/
v
Ducts
Return Air
`
Steel
3
Combustion Air
Roof Deck
O.K. to Wrap
_ �� 2
_
Exhaust Fans
F.A.U.
Framing
O_Z
S�
Compressor
�
r/L=
Insulation
6f a
Vents
Fireplace P.L.
Grills
_
Fireplace T.O.
�/
Fans & Controls
Party Wall Insulation
L
Condensate Lines
Party Wall Firewall
Exterior Lath
- L
Drywall - Int. Lath
-,
Final
Z ^ �6/C
��
Final-/�
�2
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
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
Final
Water Piping
_��Heater
�+
��
Plumbing Final
Plumbing Top Out
_
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping-
71V
_
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice
(Gas)
ELECTRICAL APPROVALS
Temp. Power. Pole
Underground Conduit
At
Rough Wiring
/ G�
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
_
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
t).
Building and Safety-.Department tiv
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=548 MISSION. DRIVE EAST
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0111-182
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
Building Official -
POST IN A CONSPICUOUS PLACE