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SFD (0111-187), . LICENSED CONTRACTOR DECLARATION | hereby affirm unuo,penuK ovperjury that |amlicensed under Chapter 9. (commencing with Section 7VOo)ofDivision 3o«the Business and ,Professionals Code, and myLicense ioinfull force and effect. ^ uommo#. , '. . �, uc.class Exp. Date OW.NiR-BUILDER DECLARATION I hereby affirm un�ler 0enalty'of perjury that I am exerinpt 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). i, as owner),' of the,,property, am exclusively contracting with licensed contractors to cons6u�t the project (Sec. 7044, Business & Professionals WORKER'S COMPENSATION. DECLARATION' "I hereby affirm' under p . e , nalty, of perjury, one of the following declara tions: I have andMill maintain a certificate. of consent to self -insure for workers' comp6nsation,. as,.p . rov . ided�for,by section' 3700 Of the Labor Code, for the performance of th-e..work f81r"which this permit is issued. 1 -have . and . will maintain workers' compensation insurance, as required by 'Section 3700 ' of t ' he Labor. Code, for the performance of the work for which thid, -�Ormit_ is'issued. 'My worke.rs', compensation insurance carrier & policy . no. are: Carrier Policy No� '(This s�don 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, A shall not employ any person in any maper so as to become subject to the worke.rs' compensation, laws of Califorr6; a , M agree that if I should become Da Appli t' Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fin�s up to $100,000, in' addition to the cost of compensation', damages as provided.for in Section 370 1 6 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 1 n upon whose behalf this application is mad eac _�'D� whose request and for whose benef it work is performed under or. pQrsuar� .any permit issued as a result of this applicaton agrees'to, & shall, ind6minify. I & hold harmless the City of La Quinta, -its,.off icers, agents and employees. 2. Any permit issued as a result of this application becomes hull and.vdid if work is not commenced -within 180 days f rom, date of issuance of such permit,. or cessation of work for. 180 day s will subject permit t Af cancellation. I c6rtify that I have read this,application and state that the abovd -information is correct. Fagree to comply with all City, and State laws relating to . the building construction, and hereby -authi—orTz.`b�represen, tatives of t his City to enter: U, n the above-mentione pro 5rty for inspection purpose SPERMIT # BUILDING PERMIT DATE VAL'ATION U LOT TRACT 29457-2 JOB SITE APN ADDRESS -ZTWNER CONTRACTOR/ DESIGNER/ EN INEER LAQUTNTIA CA 92253 1A QTTMA CA 92253 USE OF PERMIT 'CV;5T6M CONSTRUCT ION 4635-00 OF UAVALIMC&PTORT 04,0 BY ESI DWA'MD COW OF CONM 1ON 220.U52.00 Ry CONSTRWIMON ITY, .101 8-000 $1,043.00 hPIECKMI ACA1.1 FEE 101-000-421,000 $1.05,411 DIVIV9110PIZ111 IMPACT FEE TAL PUMMITMPN AIM $317=38 DEC 0 6 2001 A� ignature `__.=—` --- INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING Set Backs APPROVALS / -_ = © � MECHANICAL APPROVALS Underground Ducts Forms & Footings Slab Grade Steel — j/ -dam ox Ducts Return Air Combustion Air Roof Deck oZ _ Exhaust Fans F.A.U. Compressor , Vents O.K. to Wrap Framinga_z-A Insulationy �2b _ Fireplace P.L. Grills Fireplace T.O. _ �� Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath _ - Z Drywall - Int. Lath G - 7 - Final Final !Jj�=pZ BLOCKWALL APPROVALS POOLS -SPAS 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 Waste Lines� Water Piping Q Gas Test Electric Final Heater Final Plumbing Final Plumbing Top Out Shower Paas Equipment Enclosure O.K. for Finish Plaster Pool Cover Encapsulation Sewer Lateral / Sewer Connection/�� ��/ Gas Piping Gas Test Appliances Final COMMENTS: i Final -�- - Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. i Smoke Detectors _ Temp. Use of Power Final Utility Notice (Perm) Z to of OccupancCert�f ca- - � - • C ty of La. QuinM Building and -Safety Pepartment 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 fol%wing: BUILDING ADDRESS:- 79-568 MISSION DRIVE EAST. . Use Classification: SINGLE FAMILY DWELLING Bldg-. Permit No.: 0111-187 Occupancy Group: R/3 Type of Construction: V/N Land Use Zone: R/L Owner of Building: TD DESERT DEVELOPMENT. Address: PO BOX 1716 City: LA QUINTA CA 92253 By: GARY SHOWALTER ' Date: 08/15/02 Building Official. POST IN A CONSPICUOUS PLACE