SFD (0301-013)' LICENSED'CONTRACTOR DECLARATION
1/hereby affirm under perialty.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
674614 B 111310
Date ,fes 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). ,
O 1 am exempfunder 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'
W compensation, as provided for by Section 3700 of the Labor Code, for the
Qperformance of the work for which this permit is issued.
Q U (iQ), I have and will maintain workers' compensation insurance, as required by
U' Q 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:.
Carrier ,�I:�t"',I'CIt+9 Policy No. 04-3�#II9
J (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
3 subject to .the workers' compensation provisions,of Section 3700 of the Labor
Code, f shall forthwith,comply with those provisions.
Date: - Applicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation; damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions' set forth'on his
application. '. Y
1. Each person upon whose behalf this application is made & each person,at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I,agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon,
the above-mentioned propertyfor inspection purposes. ;
Signature (Owner/Agent) t..• - `r ` ' Date�', x ��
BUILDING PERMIT PERMIT#
DATE VALUATIONLOT. 33
TRACTJOB
SITE
ADDRESS Y°:iA' �i� �Sj4b".� � �.. _;f
APN ...•64s UK) 211:f r
OWNER
CONTRACTOR / DESIGNER / ENGINEER
Tit? :i? OX 1116
7:AQRTfMA CA 92253
I.A. 011IN7"A CA 92253
(76(Y 7 7 1-1943 CM4 299.6
USE OF PERMIT
W, 0i Z? FAMLY DWEL)ING
SFD . LOT 33, K.AN RMAR. PFR,l+ IT DOES NOT Y'I+ICI,.iy DE 13LOCK
WALLA P40,I4 fsf.P.A. si:R. DRINrM k'YAPPi3ti3.r GIN. 75% PLAN 01,M C K ,I ).01,
I��L7i�GTI�7�1 l"'i:�112 R?171G1'iP�.i 35+$�D.�Td�Y.'O)� f5A�t7� �F.fikY 11?�R
I
P01i'sCIVOATIO 267.00 8F
C72'Y.L'M'1.t.RIC.KtOM 614.0 3.1`
?rabawrFEZ FW14MARV
0WOTRUC:9ION ; Vit; 101-000-418-000 $1,063.100
V t.e 1`d CHECK T+rIF, 101-000-439- v 1 a $11,.913
1SC IA ,I'Cs'1x, FER, 101-000-4,21.0001 510,00
ELErTPUICALY+ ', 101-OM420-000 SI6L.Oi
kL4I1b9t3ft f I Rte 101-000-4 19i.00 ? SOMS
stfK)All i P:R'f `x� If e` Ik` f; Y� 6i a 1111 fi�Cif3�'�41- i� 11• U9
MRADN O iii%E S -00
''Ll�d'tz�3.�'a`!•��:�:II��#y,�iu�° P`l?,�' S'A.4��.4iC�
ART N PUBLIC PI EIS WIT 270"000-40-000 $57.13
tai`i'jt?..IVY,hLCONL.1'tl<IY=MONAN'X)MAF4M�'C.C"• .
U,221_38
.L`rylwu FER:371.IT ri RES 4f IT. ! ,K`w'','Y
t$"s1.4,21;A �38
JAN 2 2 1003 6
CITY OF LA t6JiF!'iA
1
DATE �
BY f q.
DATE FINALED
INSPECTO
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
I�A= BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs. Af
Underground Ducts
I Fotms &Footings7 -
Ducts
Slab Grade, 3
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap /j
F.A.U.
Framing -
Compressor
,Insulation „c j
Vents
Fireplace P.L.
Grills
LZ
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath g
Drywall - Int. Lath
Final
D
Final
BLOCKWALL APPROVALS
Steel
POOLS - SPAS
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 2,- Z —
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
-Underground Conduit
g,Rough Wiring
t Long Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final r
Utility Notice (Perm)
COMMENTS:
•. Y _ _ .• _ .- ... _. ._. ._ ... .-, __ - .....
u..
Cerlifica to of Occu ancy
0 _
de
lggz
G'pF`9 ` B.u�ld�ng &Safety Department'�:.
This Certificate is issued pursuant to 'the requirements of. Section 109 of ihe'California Building
-.,_Code,,certifying that, at the time of issuance,. this structure. was 'in -compliance with `thee.
provision -of • the- Building Coale and y the various ordinances , of the City. regulating building
' construction and/or use."' `'
- }BUILDING ADDRESS: •79-918 MISSION DR. EAST • `�
Use classifcatioh -SINGLETAMILY DWELLING`-:' :- - r 'Building�Permit No.: 0301-013.
Occupancy Group: 'R 3 Type of Construction V -N` '+ - ' ' f Land Use Zone: RL'`
. r
Owner of Building: VTD`DESERT DEVELOPMENT '-.Address: `PO'BOX 1716 -
•
City, ST, ZIP: LA QUINTA CA` 92253
By: GARY SHOWALTER ,
_�*Date: 10/28/2003
T.
- _ Building Offic' I z. _ . _` • r. r , . r
POST IN A CONSPICUOUS PLACE.
IM
._
y