SFD (0111-185)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 # Lic. Class Exp. Date
.O zjxc
Date/?� Signature of Contractor__ •�' t
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contract's
License Law for the following reason:
( ) I, as owner of the property, oi� 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 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:
Carver10TATE FUND
Policy No.
(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�rworkers' compensation �provisions of.Secti .n 3700 of the Labor
Code, I shall/forthwith'comply with thb-0 provisions.
Date:,i ±r te =;A' Applicant-
Warning:
pplicant Warning: Failure to secure Workers`Compensation coverage is,unla� ul 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 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 is
correct. I agree to comply With all City, and State laws relating to the building a
construction, and hereby authorize representatives of his City to enter upon,
the above-mentioned propeprty4or,inspection purpose' s.
Signature (Owner/Agent)
BUILDING PERMIT PERMIT#
DATE VALUATION LOT TRACT
$yqaay,� gq[r�a�+pp yyyy�
JOB SITE
APN
ADDRESS ,�5f�.�e5n1wuratn►a�s9~—T�,r�
OWNER
CONTRACTOR / DESIGNER / EN (NEER
TO l.`:Te'`k't���°(� {'J�3'�
�eR1C13 e�tSxvxlIc7C3A�'
PO ROX 177 6
79.295 RANCHO LA QmY1'ADR.
I Quwu C".le,. 92255
LAQT.;dI.YrA C".,�5. 92253
(760)771-7.941 CBIR 2996
USE OF PERMIT
�3 Cfi9 ? t l # Y lyd FI ING
Sir) WT IS Y11.AX trt. P..REf;Kc IT i3t; N S NOT II%=,0Dr4.8LOCK WA,f..E.;.
1`004 0 -PA OPWRIVIAVAY APPROACH
CUSTOM 0fJ'A STRUCTION 2,635.00 OF
E'^f3RCWP.+ TIO 267.00 SP
GARA.f1'W A"!<i7 ORT 614.00 .St
ry& �[M�e �//ryy��,,,p �o7t p��¢q y ('� �'pf� �/y�'p�7[�a+p�ra'�`(�`Wj yj�M
dwdF.Lfi.LYdE76.+1°.Y-Y.Td i. os 0 bSY-NS .�+' QL10,14
q+,p �(.�
s 201S52.0.R
,1'��
prnmff E WAO"Ry
wd'C�P317`ilLtl"2'6�`JAit+ 1U1�00t? Bl9.000 Ee,(Ifj1,00
PLAN CHECK FRIK $2111.90
101 -000-421 -000 $165.00
k3„'fi FX','Pa§UQt _ YEF 101-000-420-000 I62:ff3.
PIA)3i BINE F.K.R. 10.1.000-419-000 $130,25
IT 11040 MOTION iUE n REBID 101-000-241-000
ONAV '.40 F13.G 101-000-4234 30 3;20,00
1. FVWL0O'MRIMP13C T PEI: $1,9SJ3.w
A1t.y ),td PUBLIC PLACES - &ti;M.E VilwWO 445aWID WA
is
i d (B— O$AL CION C/,LNIX7.,A` M ,d?lVD I,1-.R'16Y P?A,164Aw
IMS PRZ—'PAM ;FFT0
$0,00
RECEIPT
DATE
BY
D E FINALED
INSPE TOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
_ c9
Underground Ducts
Forms & Footings
_ �9�
Ducts
Slab Grade
�r `. y _
Return Air
Steel
Roof Deck
L �/ - DZ ,
l7 - �yZ �% /
Combustion Air
Exhaust Fans
O.K. to Wrap
-�L v`
F.A.U.
Framing
1�-��. Z 5
Compressor
Insulation
Vents
Fireplace P.L.
_
Q
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
-Z s
Drywall - Int. Lath
- Z ¢ Z_ fj
Final3-!��'-��
Final
4S f 3� l9�
_ _
°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
I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
_
�o
Heater Final
Water Piping _
_�- O� GG
Plumbing Final
Plumbing Top Out
_ _ _ ,f_
Equipment Enclosure
Shower Pans
-✓ {�
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
/
/ y
Pool Cover
Gas Piping
Encapsulation
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
r
Exterior Receptacles
_
G.F.I.
_
Smoke Detectors
Temp. Use of Power
Final
S - -U.
Utility Notice (Perm)
7 _ - p -
Certificate of, Occu,pancy
..City OfLa Quinta
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: 79-560 MISSION DRIVE EAST
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0111-185
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'
Date: 08/13/02
Building Official
POST IN A CONSPICUOUS PLACE
•11