SFD (0111-186)`
LICENSED, CONTRACTOR DECLARATION
I hereby affirm under penalty of'p`�,,jurylhatll am hcens�id 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.
uvmmo# ucc�» Exp. Date
.
674r 4- Date Signature of Contractor 22
OWNER -BUILDER DECLARATION
-
| o,perjury that |emexempt from the Contractor's
uoonsaLawfor 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 isnot intended moffered for
sale (Soo.ro44.Business uPmmuoiono|vCouo).
(�) |.aoownoroxthe property, 'am exclusively contracting with licensed
contractorsthe nU (Sec. 7044 Business & Professionals,
()/amexempt under Section .aapc'foxthis reason
______�_ '
Dote Signature of Owner
WORKER'S COMPENSATION DECLARATION*
I hereby affirmtunder penalty of perjury one of the following dedlarations:
I have and will maintain a certificate of cons'ent to self -insure for workers'
compensation, as provide . d for by Section 3700 of the Labor Code, for the
performance of the.w.dirk for which this permit is issued.
J 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:
Cartier Policy No.
(Thissection need hot be completed if the pi�rmit valuation is for $100.00 o . r. less).
I certify that,in t he performance of the w ork for which this permit is i ssued,
1shall not omp�ya�pmo�mm�ma�o aoaamb�omeo��u to the
workers' California,and agree that if I should become
subject to the.workers' compensation.provisions of §ectiDh 8700 of the Labor
Wa,nm8: nm/vmmsecure. Workers' Compensation oove�age'oun/owxu/and
shall subject onemployer mcriminal penalties and civil fines upto$1on.000.in
addition tothe cost uvcompensation, Uamogoaaopmvidodho,inGoction37O8
*of the Labor Code, interest a9dattorney's fees.
.
|MPOn7ANT Application is hereby made to the Director cvBuilding and Safety
for a permit subject to the conditions and restrictions set forth on his. i
1. Each person upon whose behalf this application is made & each' Pe"rion-Sat
whose, request,and for whose,benefit work is performed under or pursu - ant to
any'permit issued as a result of this applicaton agrees to, & shall, in.dqmnify
& hold harmless the City of La Quinta, its officers, agents and employe * es.
2. Any permit issued as a result of this application beComes null'and vbid;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 cand'ellation.
| certifyh I have readmi n i d state thathabove information
correct. I agree to comply with all City, and State laws relating to the uil
construction, and hereby authorize representatives of this Cit to ent
the above insppction purposes)
-mentioned property fon,
Signature (Owner/Agent)) b
UILDING PERMIT
DATE VALUATION LOT TRACT
JOB SITE
ADDRESS
APN,:
OWNER
CONTRACTOR DESIGNER �N61NEEFI
11.
(760)VI-1941 C.Blit 2996
USE OF PERMIT
11,061, SPA OR DR IVPWAY iW- PROAC14
CUSTOM, C014107RUCT1.014! 2,02"1. Ott I -F
FREM-TAITID COST Off CONRRU M71014
240A 17,10
CONSTRUCTION RZ 101-000-418-000 si,)33,00
PLIAN CHECK FEE W _00014-39-3 18 $23.124
hH.CHAVAC'u'' FFIR 101 _000-4211 - 000 $130151)
24
.1 IONOVIOTIUN FICK 11 R.12131JI.) 101 -.000- 1-000 $24.01
10 1 -000-423 -000 0910
DEVELOPER IMPACT F22 slpftno
IX -3-5 M-FAID FERZ
$0.00
DEC lb?nfll
WYOFLAQUIWA
RECEIPT
DATE
BY
DATE11t4ALED
INSPECTOR Z�--
�
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
7—:51
Ducts
Forms & Footings
Slab Grade
`GUnderground
_ J_� 02—
—
Ducts
Return Air
Steel
_� j o,�
Combustion Air
Roof Deck
., �i�_ _ _�
Exhaust Fans
O.K. to Wrap
� `�Z _
F.A.U.
Framing
Compressor
Insulation
41 —25 —Z 6s
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
_
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
_ - Z
Final
1 �Z
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
Electric Final
Waste Lines,
'
Heater Final
Water Piping
y 0`/�'
/
Plumbing Final
Plumbing To p Out
_
�Z , _%'S
/ t
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
_ � �/
/ -� /
Pool Cover
Sewer Connection
Encapsulation
Gas Piping_'_
Gas Test_
Appliances
Final
COMMENTS:
Final
_)
Utility Notice (Gas)
_
/APPROVALS
ELECTRICAL
Temp. Power Pole
_
Underground Conduit
—
Rough Wiring
Low Voltage Wiring
Fixtures
Main ServiceSub
Panels
It-
Exterior Receptacles
G.F.I.Smoke
Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
r �fi ate PfOccdpancyT
01
Ce t c
City of LQuinta
Building'and, Safely Department MOF
This Certificate issued pursuant to the requirements of Section 109 of the- Uniform Bui/ding Code, , -
certifying that, at the time of issuance, this structure was in compliance with the various ordinances `
of the City regu/ating'bui/ding construction or use. For. the fo/%wing:
BUILDING ADDRESS: - 79-564 MISSION DRIVE EAST.
Use Classification: SINGLE FAMILY DWELLING* -Bldg. Permit No.:. 0111-186
Occupancy Group: R/3 Type of Construction: j •V/N -.Land Use Zone: R/L
Owner of Building: TD DESERT DEVELOPMENT. Address: PO BOX 1716
Y- City: LA QUINTA CA. 92253
By: GARY SHOWALTER
Date: 08/15/02 -
Building Official
POST IN A CONSPICUOUS PLACE