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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 anc
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date.
5� C' J ;�° Al i10:1
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Date' X 'r r" ¢ Signature of Contractor—
OWNER-BUILDER
ontractor OWNER -BUILDER DECLARATION
,4R •
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 fol
sale'(Sec..7044, Business & Professionals Code).
( ) I, as owner of the property, am exclusively contracting with licensec
contractors to construct the project (Sec. 7044, Business & Professional:
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.
�(t) I have and will maintain workers' compensation insurance, as required by
S ction 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:
Carrier a"% r'>?�ID `. Policy No. ,� 43.00'3
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 man ner,so as to become subject to the
workers' compensation laws of California;rand agree thatlif I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.
Date: '- 'y„ Applicant -°"7
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 Directo ;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 employ
2. Any permit issued as a result of this application becomes null and vf
work isnot commenced within 180 days from date of issuance of
permit, or cessation of work for 180 days will subject permit to cancellat .
I certify that I have read this application and state that the above informatio is
correct. I agree to comply with all City, and State laws relating to the buil ing
construction, and hereby authorize representatives of this City to enter u on
the•above-mentioned property fo inspectioh purposes..... .
Date'�
Signature (Owner/Agent), r s, 5-
BUILDING PERMIT PERMIT /i
DATE �y VALUATIONLOT. - TRACT
VG4yVryry,00 -50 29k5y -3
_
JbB SITE
ADDRESS 79 ' .50.V�.SS'u'; 011 1J. ,V.�r.���1�3.
APN
OWNER
CONTRACTOR/DESIGNER/EN (NEER
SZARRS IClNS[MIiJN
_P0 r, OX 11 16
79 295 RYf001AQyI pR1R ,
LA.MA. rTA CA 92253
LA.,QUTRTA SIA 922513
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760) ►4"1941 SII: %
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USE OF PERMIT
SKI . Lo"? 50, PLAN T41. ft"11,11f 002 OT 19MUDE, )8L0..C.X WAJAL , .
POOL' SPA OR L"►RVir1G°i AYtNl�Pktt7At ?€, '�°i° PTAN �fi�Cl Rpm ,a
PLED'UC;'1014 100P, ittlf✓14x'Ydyf.,9 MOY3. rce OF SAmf PL&'N' °I,YPE
0313'I'W CONSTRUCTION ION %635,018k'
t�r�i��a�41t:��,.f'►'1€PM1ti'�E' tS4+k,�Fj s3'�
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,S.AYl^.:WAd.,T 3 COhl' W 7�.."OM.Ii�'���,..;LO.
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CC.kMT31,iit;',1014PEZ 101.000418--000 $1,063.uo
PI'Am CHISVICK FEE 1014000-439-318 $21171901,
Y+kEMA IC,AIa FEE 101.0001'-421.-000 slft t a
101-000-420-000 paol
PL71Mx3Fd40 FLI& 101-000-119-000
S,a°;rz€ W0, M0- TIM VEF,. PEWD 101-000-7AIdati0 .
MADDIG WRQ
DZ k1WPER, I1tN; rcT F rr ,°�tiS.t30
-W �W 901,K! P C'I - RESSL VO.000.445.0100
L2JAN'2 C D ,
C11W PF LA t UIN. TA
P° DREJ,
-RECEIPTDATE
BY
DAT ALD
INSPECT
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
I
Underground Ducts
Forms & Footings
_ 3
Ducts
Slab Grade
Return Air
Steel
7 — A2 — 3
Combustion Air
Roof Deck
'�j7 W _3
Exhaust Fans
O.K. to Wrap
19 --/—
F.A.U.
Framing
04— y^ 3
_
Compressor
Insulation
% —
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wali 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
I I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
3
Heater Final
Water Piping_
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
3
Encapsulation
Gas Piping
�
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
c, '
ELECTRICAL APPROVALS
Temp. Power Pole
Temp.
Underground Conduit
Rough Wiring
9 �3
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final-
Utility Notice (Perm)
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,�, ..... _Certificate of ,Occupancy..
o
oF�9w Building & Safety Department
This Certificate is issued pursuant to -the requirements of Section 109 of'the California Building
Code,. certifying that, at the. time of issuance, ,this structure was in compliance with the
provisions of the Building 'Code and - the various ordinances of the .;City regulating building
construction and/or use.
BUILDING ADDRESS: 79-750 MISSION DR. EAST :.
Use classification: S.F.D. . Building Permit No.: 0301-030
Occupancy Group: R3 ^Type
of Construction: V -N • Land Use Zone: RL •
Owner of Building: TD DDESERT DEVELOPMENT Address:_ P.O. BOX 1716
- City, ST, ZIP: LA QUINTA CA 92253
' By: G. SHOWALTER '
Date: 8/13/03 /
• Building.Offici= _
f POST IN A CONSPICUOUS PLACE '