SFD (0111-188)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
i�,v*!yy ///��� /// �3 ✓ft V' F `9XJ(Y /f.)� A,...:
f11/"M 112
. (J y.
Date •�.
a�
Signature of Contracto,
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) I, 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. 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 providedrfor 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:
Cartier Policy No.
NUNf�6b ' 33
(This section need not be completed if the permit valuation is for $100.00 or less).
( j. I certify that in the performance of the work for which this permit is issued,
I shallnot employ any person in any manner so as to become subject to the
workers'•.compan sation laws of California, and agree that if L.s�ould become
subject to the.rworkefs' compensation,provisi4ns of Section' 3700 of the Labor
Code, I shall-forthWith comply with`i ose provisions.... •. ;�
Date:r�T f" f Applicat Qy
Warning: Failure to secure Workers' Compensation coverage•^is unlawful'anlq
shall subject an employer to criminal penalties and civil fines up to $100,000, In
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT' Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
;t
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of. this application becomes null and void if
Work is not commenced within 180 days from date of issuance.cf such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby aut..o�izt=•representatives of this City to enter upon
the above mentioned property for1inspection•pbrposes.
Signature (Owner/Agen Date- arYY �,r•
`BUILDING PERMIT PERMIT#
DATE VALUATION LOTS TRACT
'..7.,_.o. 294.57A2 .
JOB SITE
ADDRESS
79-5 72 All 3S..O.NT Mn RA'.�.
APN
OWNER
CONTRACTOR/DESIGNER/ENGINEER
WARMS CONKRUC-MON'
P011=1716
79-29 5 Rm'l:,° ao J_ -A pwm nxt,
LA Q$aWA. CA 92253
]LA Qi#1 TA. 'CA. 92253
it771� �FZ -1 4 2996
USE OF PERMIT
411011 # !.AY `dd'V1AN*' .K2. �X€.I><R'i.f' Doms NOT .OXk:R• OM 81,0C'F$liALA
DRAW FWA.5t"APPROACH
MO SQA% K:CaTdS'!`R1:1CV011 2,.924,00 OF
Pokc, PA.. d6p w.15,80 sp
GAMOTUVARPORT 4X00 9F
PFAINOT FREE SUMMARY
COPBSTRUC`1'.KiN RE 101e,000-418.0300 $1,133.00
&%1. AW C H U, C K ;i M 101-04YO-430-31.8 $232.m
MECHAMCAl~= '101.000.421.000 $130.59
ELTeX11rk1?,C L PEE, 101-000-420-000
PUiMBT.HoFFIF 101 -000 -119 -Mo
S'I'3 000 ''1&YsY'AC7 T } . RESID 10). -000-241-006 UAW
04RAD010 FEE 101-0 00-423-000 $20,00
?WEs,OPEP, IMPAr.I .VEYs $1,9rn. 00
ART IN PUBLIC KAtw' , - €L Fr:270-000445.000 5150.231
'H
MD ;I ILAN CHEM
$:3,992.03
'. A.0',q.!39.lS,Lkl.'LtW3r.E.Q.FZ;uItLCf.'P-+ME.\'SO
S%.IW2A*
DEC u b 2i
Cn"YOFLAQUIJITA
BY
DAT INALED
INSP
w _a .....:�:
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
`
;� ,, o
�� �. ��
Underground Ducts
Ducts
Slab Grade W
Retum Air
C9
Steel
(= /= S
Combustion Air
Roof Deck
3 — �_� _
Exhaust Fans
O.K. to Wrap
i'�$z
F.A.U.-/17
Framing
�� z _ Z
Compressor
J�
Insulation
Vents
_
Fireplace P.L.
Grills
Fireplace T.O.
/C
Fans & Controls
_
Party Wall Insulation
s
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
_
Electric Final
Waste Lines
D� -
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
p _
Pool Cover
Encapsulation
Gas Piping
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
_
Exterior Receptacles
G. F.I.
1
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
t
Certificate -of Occupancy.
City of La Quin ta
Buildinand-SafetyDepartment G� o.F A
g
r
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: 79-572 MISSION DRIVE EAST..
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0111-188
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