SFD (0111-204)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 ,rte' Exp. Date
4/
674
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 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).
( ) 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:
CarrierPolicy 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 and agree that;if•'�should become'
subject to theiworkers' compensation.o o California_sions of Section 3 00 of the Labor
Code, I shallfforthwith comply with.those provisions.r
�i� Applicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees. .
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each persori"upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as'a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit4o cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to,enter;,upon
the above-mentioned prope rty�forins ection purposes.
Signature (Owner/Agent) t Dat. ¢"^ �d
PERMIT# t Jw.:wC,
` BUILDING PERMIT � `�`.
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DATE VALUATION LOT 3�•�—�TRACT
�qy��Q(� + p ,/.'p [% /( )
t
29457-2
JOB SITE
APN
ADDRESS. `79„5.FalR. >ON.ORNE F.49r
OWNER
CONTRACTOR/DESIGNER/EN (NEER
PO BOX 1716-
7 9 291' RANCa-1.3 LfiA Q�.i.1..�; tEA M,
3.A Q%ii2 rA, CA 92:253
LA Q TA CA 92253
("➢60)771-194,1 C'BLO 2.996
USE OF PERMIT ,
.3 P 1-0T 17 PLAN 112R, YEW, IT DOEST40T 11�10XDE 21=- WAwus,
c��1c•��SpT�Y�M C0.1,10TRUCTION 2,P24.00 we {
Y�Jattw.E 7J1?.l�i.A �4.% /c�3. 4 sy
a3ARAGEW- "ORT 40,10 OF
�ll9�+.4�1a9Lkil. cogir (Y3�'' C OVI RWIC.'.t:�C�K
240e�,.17.10
A 7y�y��•
1%YI!'�Si:$G CARP
(!t e5h 'ftlT � 3 a FIFIR 101-000-418-00D $1,133.00
PLAN CHPXK M. 10;t•000-431-,'318 $23114
MF,cIuP''.NIJaAL,I` E 101.000.4214*0 2E30;50
LlT%21G�;,4 MY L. 101.-.000-420-,144 $.100121
y1A'?
S-lJVMB910 L'.IE 101-000:419-000
"l RONO VfaTION FEE - RESID 101-•000-241.000
GRADING KEE' 101-000-423-000 SAW
:LI;f VL;LOPE..Y.a.1Zb9PA'C T NKA
AW 114 PUBLIC PUACF0 - :HESd.i 270-.000-445.000 $100129
MMAX) AL C01,W1RIX— €ON AND R..Ag E'M
$3,892.03
LEBO 3''3CR-P AID FLral5
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DUF1'Now
RECEIPT
DATE
BY
DATE FINALED
INSPECT
— //-eD
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
j7 , 7.2
Underground Ducts
Forms &Footings
Slab Grade
2, 2
Ducts
Retum Air
Steel
3� ��
Combustion Air
-
Roof Deck
_
Exhaust Fans
O.K. to Wrap
F.A.U.
_
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
_
Fireplace T.O.
Party Wall Insulation
q/i
�/'t
Fans & Controls
Condensate Lines
_
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final=�G�
--0
POOLS - SPAS
BLOCKWALL
APPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING APPROVALS
Waste Lines
Gas Test
Electric Final
Heater Final
Water Piping
Plumbing Top Out
_
Plumbing Final
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
2— — L - Z
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
--
Final
Utility Notice (Gas)Lie
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels yr 1AP_
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
Final
��
Utility Notice (Perm)
Certificate of occupancy -
City
..
of La Quinta
.
� CSM
Building.and Safety Department Of
1
This Certificate issued ursuant to the requirements of Section 109 of the Uniform Building Code,
P ��-
certifying that, at the time of issuance, ffiis structure was in compliance with the various ordinances
✓
of the City regulating building construction or use. For the following: y
BUILDING ADDRESS: 79-588 MISSION DRIVE EAST
-Use Classification: SINGLE FAMILY DWELLING' .
. - Bldg. Permit No.: 0111=204
Occupancy Group: R/3 Type of Construction: VIN Land Use Zone: R/L
Owner of Building: TD DESERT DEVELOPMENT Address: PO BOX 1716
City: LA QUINTA CA92253.
By- GARY SHOWALTER
Date: 09/16/02
Building Official
POST IN A CONSPICUOUS PLACE