0111-206 (SFD)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
6741104
Date % rr,^ O Signature of Contractor ) a
OWNER -BUILDER DECLARATION A
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 ti
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:
Carver I`� Policy No.
wx&f13 1�1 C3; -
(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,
•1 shall not employ any person in any manner so as to become subject to the
workers' compensation laws of California, and agree thatg I should become
subject to the workeJJs. compensalon provisions of Section 700 of the Labor
Code, I shall forthwlKicomply with thoseprovisions:O�
Date lr /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 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
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 propeqy-for'llispectio'46rposet. %
Signature (Owner/Agent) _' - Date7_�- F irj
r
BUILDING PERMIT PERMIT #
DATE VALUATION LOT ol11 10r) TRACT
VA0,117.J.0 39 25457»2
JOB SITE
APN
ADDRESS ^wiC2i�J ±�1'i eyT?M �'A,�'.�
�t�r°� 1f�1�1• ���
OWNER
CONTRACTOR / DESIGNER / ENGINEER
.11
Po : lQ)1r 171 6
mto LA. g(gy 9;J).� Lilt,
1,s?, QUIT+ M CA 92253
LA C;i�'.[ TA.,- C,t'k, 9223.31
USE OF PERMIT
lZA8LV 47d.ZYMNLal DY7MJVJle6z G
1plZY:i+ T .00ES NOT
CU .'Tom i'ONSTR1 CIT101+Y Z -924.w 3F
SY
l+efryn"M COST OF d°ONSC7t:fCTroyl
240,11140
�r.�:���r�r��'a�a,ta r�a<: 301�4'trJ�1�1�b•^®�r, a1,Fs3.itt!
PLAN Fuji 101-000-4igg :318
MECYaANItL'-t L n1i, 101-00i)421 •-000. SI3Ca %
A:9Z5 'Fft:1>W,+U. FRE 1101-00"20-000 $119.24
PLUMBING PER ]M -00m- 19-000 3173.11S
STWONO MOT'IMI (ET, - REIN',i0 1111-000-241.,000 $24.01
G 101-000-42-3-00. $20.00
.O,tADMO
R)XFJl7F;1iFAArqFp, $1,927.10
ART'IN PUBLIC PLnCM - 4E.M1 270-00'044S-000 $10129
i:Xl1'!?t `_ C? pMM? O1v M-1TytY'yy��. yNt�� yiy � lk� ��� g
$3;5��p'7 .(3:1
.00
wy®r
'RECEIPT
DATE y';BY
DATE FINAL D
INSPEC
r3 ,•, r
e:/�, l
Off_
ne>I
t,. -
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
- G -
Ducts
_ q
%w
Slab Grade
��
Return Air
Steel
_
_ G - Z
Combustion Air
Roof Deck
-Z
Exhaust Fans
O.K. to Wrap
-// 4 _
F.A.U.
Framing
$'- j -_z-
Compressor
/17
Insulation
Vents
Fireplace P.L._
Grills
_
Fireplace T.O.
Fans & Controls
_
Party Wall Insulation
_
Condensate Lines
Party Wall Firewall
04
Exterior Lath
Drywall - Int. Lath
Final
Final
4 `oZ
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 .
�i7 _ pa
Heater Final
Water Piping
hh�
`�L
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
_
-� , p Z_
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
cl_zl
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.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
�— -
ifi .te of Occupancy,Cert ca
Cit of La Quinta-
Buildipg.arid
_
y _
Safety, Department
This Certificate issued pursuant to the, requirements of Section 109 of4he Uniform Buildiiig 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: 79-596 MISSION DRIVE.EAST
'Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 01-11-206
Occupancy Group: R/3. Type of'Construction: V/N Land Use Zone: R/L
Owner of Building: TD DESERT DEVELOPMENT Address: PO BOX 1716
s Cit LA QUINTA CA92253
. y:
By: GARY SHOWALTER
Date: 09/16/02 ,
Building Official -
POST IN A CONSPICUOUS PLACE