SFD (0111-209)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
DateSignature of Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty;6fierjury 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).
O 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:
Carrierz TPolicy No.
"k. Er Mie t t6 t►i30 s'i
(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 California—,and agree that if I should become
subject to the workers' compensation provisions of Section 3700'of3the Labor
Code -I shallorthwith comply with those provisions.
Date',41' 16' f f° "Applicant ,
Warning: Failure to secure Workers' Compensation coverage is unlawfulland
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 is
correct. I agree to comply with, all, City, and State laws relating to the building
construction, and hereby aut�Iorize re�f,Tentativ of this. City toenter upon
the above-mentioned property for inspectio, rposCes
w fir"
Signature (Owner/Ageht),=---•-� Date N'
BUILDING PERMIT PERMIT#
DATE VALUATION LOT W11 _2W TRACT
42 29457-2'
JOB SITE APN
ADDRESS W AINsaSIOND1R'I % A 6491-100-M
OWNER CONTRACTOR/DESIGNER/EN INEER
rb J�f ,FI:ZTM-NET-OphCE i %"ri�l '1':�3 f4p2 rz' ZI )3
P0 1107, 1 116 79-295 RN4010 LA Q•(7I fA DR,
LJk QUDFrA CA, 92251 LA QT.e'WA CA • 9223::
f= "Ut 29946
USE OF PERMIT
,,FD L T 42 K,AN Y:AP_ .i 3P, r DUES NOT I'MC1,101TERLOCK WAJ,L%
P004 SPA. 0111 PPIVIM&Y APPROACH
CUSTOM C,°OYa mI-LvCTiON 4121.E SP
Pi,3AQWATYO 267.00 SE'
0t:R&OPJC;ARPORT 639,00 SF
Frev: ti�+���+�..F..F�"q�(yspye�JJt� �• S: y 101 -OW -419-000
rte} 1 y 9 00„ pq ttt p00
ALAN CH.= FEE 101»f#(f0_439-3118 ;117.98
E, 101-000-421.000 sic►..S,0®
RX 101•-000-4.2•,0-000 $1".01
P'LUMNO PEF. 101-000-419-000 ct'79,.7.5
Af T W PUBLIC .MAC 9 •• RESIC.27'tJmQMW-000 ist 0 3
IMUB-"E't3`.i'.P,L C0141Mi1:TCMON WD Pl<&K M -W:
3 PR7-PAU) FBF y $0.00
QFC � 6- -- ��• •
RECEIP CipY J'[q),)1 ;yam r w' BY DATE FINALED INSPECT
T
oIi
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Z
Underground Ducts
Forms & Footingsaj
—�—Z _
Ducts
Slab Grade
Return Air
Steel
—Z
Combustion Air
Roof Deck
— 2
Exhaust Fans
O.K. to Wrap_
_ h�
F.A.U.
Framing
Compressor
®1
Insulation
Vents
lo_
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
_
Party Wall Insulation
_
Condensate Lines
Party Wali Firewall
Exterior Lath--�—oZ
Drywall - Int. Lath
( - ®z
Final
9-�7_
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
— 19-,V.)—
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
J
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)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
_ o .2--
ZLow
LowVoltage Wiring
Fixtures
Main Service
Sub Panels
(ice
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
—6 —�-
Utility Notice (Perm)
Certificate of0ccupa0cy..',T
City of- La Quints
Building.SafetyDepattment.and f
This Certificate issued pursuant to the requirements of Section 109 of the Uniform Bui/ding Code,
5 `
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: 79-608 MISSION DRIVE EAST,
Use Classification: SINGEL FAMILY DWELLING Bldg. Permit No.: 0111-209
Occupancy Group: R/3 Type of Construction: V/N Land Use Zone: R/L
Owner of Building: TD DESERT DEVELOPMENT Address: . PO BOX 1716
C•t I AQUINTA CA 92253
J
Building Official
� y.
By: GARY SHOWALTER
Date: 09/26/02
POST IN A CONSPICUOUS PLACE
a;A
Certificate of0ccupa0cy..',T
City of- La Quints
Building.SafetyDepattment.and f
This Certificate issued pursuant to the requirements of Section 109 of the Uniform Bui/ding Code,
5 `
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: 79-608 MISSION DRIVE EAST,
Use Classification: SINGEL FAMILY DWELLING Bldg. Permit No.: 0111-209
Occupancy Group: R/3 Type of Construction: V/N Land Use Zone: R/L
Owner of Building: TD DESERT DEVELOPMENT Address: . PO BOX 1716
C•t I AQUINTA CA 92253
J
Building Official
� y.
By: GARY SHOWALTER
Date: 09/26/02
POST IN A CONSPICUOUS PLACE