SFD (0111-183)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 # Llc. Class Exp. Date ;
Y _ • • - r yE'r� F' F '
Date <-,{/ f^"' Signature of Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for tWfollowing.'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 &y Professionals Code).
( ) 1, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec' 7044, Business & Professionals
Code).
O 1 am exempt under Section B&P.C. for this reason
Date Signature of Owner -
',WORKER'$ 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`376b of the Labor Code, for the performance of the work for which this
permit is issued`My workers' compensation insurance carrier & policy no. are:
Caller Policy No:-
FUN
STATS D
(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 .60't employ any person in any manner so as to become subject to the
workers' compensation laws of California, and agree that if, l should become
subject to'
o the workers' compensation provisions of Section'37Q0 of the Labor
Code, I shall forthwith comply,with those provisions.," _
Applicant`
Warning: Failure -to secure Workers'µ Compensation coverage is unla I and
shall subject an employer to criminal penalties and civil fines up to $100000, 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 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
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 iso
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 upon'
the above-mentioned prolerty for�inspection pu poses.
Signature. (Owner/Age ). -} `'� '�"� " Date't'
rpm
BUILDING PERMIT ' ` 'PERMIT#
DATE VALUATION LOT " TRACT
JOB SITE /
APN
ADDRESS ���* o✓ ,5�e.��.�iVI,,2�F.D�?��.�la
OWNER „
CONTRACTOR/DE GENINFER
D D JSR .DrIVLJR110:
~
SIP M0 EONTIrM'4tdowPC)
BOX 1716
?94,95RAVCHOLAQUJITYADR;.
Q0:QT A CA 92253
L& CA 92253
O'Bul ....995 ,
i
USE OF PERMIT
#� ✓`
S7.jttl Ay2;af: •��.f']JiPA3.LJ. J.9'i�° piL�altS�r.'.Y.`S'e•�
SFD ,� IDT Ski PLAN M; -'ER NIfT T.9OES 140T 31 1".I,1«Yf E BLOCK %VALLil, .
pc*l, �P.h OR ):.:.j:MOM Y A)'Ph:.OAC H
XMTRUCTION
CUSTOM CC. 4 ap
r.�irtr+ttar�� ��f.d S'
r .
0ARAOLU Ai PORT/ 014,00 9Y
'
�'�Lv;��.�{�.���y1�1gJ�.`�i'q; ���y
• ,
�y�j�y��. •� /�/•�/r p y ,•��} Qq /ryp ,qtl
Lik.%A�Vil l'X447�>''l�dV A'lL.Air ��.�'L'•lIV&��"L '7.�"TJV� d/Jp5�4u�,VN
� r '
P1! AW CHECK FEE V0 1—?,000-4 "9-31 8
5 ;�§l ftw°,P��e �O1pQt�fl�92�'y(1Q0 $905.o6
/
�%Il��;rlSCi�r�� •, t'�E'Ea4�At�o.'dA9•.iJ�D'� $I'74.29
'.
S T R(JN3 Mf3TRON FEE . RPSID 101-000-2,41-000 $22.09
101-000.423 t�fi0 920.00
st3,iW�.lAY,l>y3"�^i�Ot�)�.�T��ptt��p
yyyy � �
-D.61+_V �>AiGJr YfVR J.IC/,8"CdC CRE- f .7 $1,,907,00
IMPACT
♦'
" � • r
ART -04 MIRK! PLACES- RESlf- 27iPoU0 4- 45.000 13
,
!t2 ry�44y�Lt.�SJiyDI[ULy p.D PLAN
AN ��dCv
$3,728.38 y71p.J8 '
7XV9 PRE-PAWiFT0
$0.00 r_
TO ' �M, 3' 4'Ii ';L' ' la: �iliW
s.. , Qk .
RECEIPTDATE
BY , ,
D FINAy�D
INSPECTOR
t
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
_ C'
-- /tea `�
Underground Ducts
Forms & Footings
Ducts
/l7
Slab Grade
Return Air
Steel
z
Combustion Air
Roof Deck
$"_�� —L
Exhaust Fans
O.K. to Wrap
'? — _tel /�
F.A.U.
Framing
Insulation
_-2—
���
Compressor
Vents
Fireplace P.L.
_
Grills
Fireplace T.O.
Fans & Controls
Party Wall 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 Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Waste Lines
Water Piping
_Z - /_ oty
b
Electric Final
Heater Final
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
%
/-
40
Pool Cover
Sewer Connection
U 6/
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice
(Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
- 2,
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
—_
Utility Notice (Perm)
- c3
Certificate- of Odcupanpy CT .
Clhy'of La Quinto
Building .and Safety Department oF
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: 79-552 MISSION -DRIVE EAST
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0111-183
Occupancy Group: R3 'Type of Construction: VN Land Use Zone: RL
Owner of Building: TD DESERT DEVELOPMENT Address: P.O. BOX 1716
City: LA QUINTA
By: GARY SHOWALTER
mob' Date: 08/13/02
Building Official
POST IN A CONSPICUOUS PLACE