SFD (0301-011)LICENSED CONTRACTOR DECLARATION
reby affirm under penalty nalty o f perjury that I am licensed under provisions of
�iipter 9 (comrne6ciAg with Section 7000) of Division 3 of the Business and
6fessibn6lg,Co6e, and my License is in full force and effect.
ense # Lic. Class Exp. Date
72, HJC .7/32 1 /03
ate Signature of Contractor
A
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) 1, 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).
1, -as owner of, the, property, am exclusively. contracting with licensed
contractors to construct the project (Sec. -7044, Business & Professionals
tocle).:
I am exempt under Section'— B&P.C. for this, reason
Date Signature, of Owner
WORKER'SCOMPENSATIONDECLARATION
I hereby -affirm under penalty -of perjury one of the following declarations:
.1 have.and will maintain a certificate of consent to self -insure for woirkers'
compensation,' as provid6d fqr by Section, 3700 of the Labor Code, for the
performance of the*work for which this permit is issued.
1, have and will maintain workers' compensation insurance, rance, as required by
Sciion 3760 of the Labor Code, for the perf6rman'ce of the work for which this
permit is issued. My workers' compensation insurance carrier & policy no. are:.
Cartier„;,'1 FUND _.Policy No. 04"38-20011i
(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.th6
workers' compensation laws of California, and agree that if I should become'
subj6c ' t to - the workers' compensation provisions of Section 3700 of the Labor
Co'de, I shall forthwith comply with thcr§&'Prov isions
Date: AP plicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000; in
addition to the Cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
A.
IMPORTANT Application is hereby made to the Director of Building and Safety
4or' i perr-hit' subject. to , the conditions and restrictions set fortlr'on his
application
1.:E ch person upon Whos; behalf this application is made & each perton at
Whose request and for whose benefit work is performed under or pursuant to”,
any permit issued as a result of this applicaton agrees to, & shall, inde, m-nify-
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
perrNt, or cessation of work for 180 days will subject permit to cancellation.
I certify.that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City tenter upon
the abov6-mentioned p! rope rtyf6r,i nspection pur
I_
�0S,REc
Signature (Owner/Agent) Date
BUILDING PERMIT
DATE I VALUATION s220,952.00 LOT
JOB SITE
ADDRESS KA OT
OWNER
•
POD 'UX 17 16
L& Quo rA CA 92253
USE OF PERMIT
''SWOU FAMLLYMEMN(I
PERMIT#
TRACT
APN
*9
CONTRACTOR/DESIGNER/EN (NEER
SPAIkks C-10HER'RUCTiox,
LA, (Yj4\TrA CA 92153
(760)7714941 MILS 29945
SM - LDT 34 PLAN ZIP- PERMIT DOES NOT INCLUEDE' ZLOGK�;,
WATT. POO 141 VA WI/0 P1 AVO 06!4 r. [,az
FUMUCTION FO'11% MULTYPIAO, ISSLIANCZ OF SAME Pljw TYP2
COST ON CON57RUC7100 Z03,400 uw
GARWEXARPORt MUD 8F
Z
Y.11;M1A*1X0 09ST (Mr WAMMUC11011
'$' .JAN �2 2 2003.-'o
MwAfty
ur LmQu
INANCE DEgTr
Comob"lioFlow Pop.
101 -000-418-000
$11011 co
Ru\14 CHMIX
MEC14AWMAJ, ME
$10100
R.L=TRIC.Al. ?BY, '
1101-000-420-000
$16.1.0,
S'MDNO MOTIOR FRA - MID
'-I ill -OZ -241 -000
GRADING FRE
101-000-423-000
D ZV I ELOPER IMPACT FEE
;?,405. OP
ARTIN PUBLIC PL CM Wiff 2710-000-44.5-000
$ fir, 1.3
C WX
.8m,TCYrAX.0MW.RXT. 70. AMPLAW,
M 'ITS PP "A
E Z,T, 'It', T400
R "N
VO.TALP WIMMYONESIKEING Y*
BY qa
22095.2.913 .1 -
DATE FI ALED INSPECTOR
'$' .JAN �2 2 2003.-'o
ur LmQu
INANCE DEgTr
BY qa
22095.2.913 .1 -
DATE FI ALED INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms 8 Footings
2—Z--3
Ducts
Slab Grade
Return Air
Steel
_
Combustion Air
Roof Deck
_/�
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
G _ 5'. 3
Vents
Fireplace P.L.
Grills
Fireplace T.O.
_
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
6 - —
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
- 2 — 3
Heater Final
Water Piping_���
3
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
/
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
- 3
Pool Cover
Encapsulation
Gas Piping
Gas Test
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) — —
7
o .oCertfficaldf Oc_ upancy oc
G�oF9w . Building Safety Department ...
_.&
f This Certificate is. issued pursuant to the requirements of Section 109 of the California Buildinlg -
Code;• certifying: that, at ahe time, of issuance, this '.structure was in compliance - with. the
provisions -of.-'the Building Code and the various+ ordinances• of the Citv'regulating "building
'~ construction and/or use..
t f •
- _ �' ADDRESS:,579-934:MISSION DR EAST`
_ .BUILDING
Use•classification -SINGLE FAMILY, DWELLING building.Permit No:: _0301=011---'
Occupancy,Group: R3... _ ` .' �� ~Type of'Construction: V -N rLand Use•Zone:' RL
Owner ofBuilding: -TD DESERT DEVELOPMENT '' Ad' '§--'PO BOX 1716;; : ` ' " L • `
�, . _
City, ST, ZIP;,'LA QUINTA "CA 92253 rT
By: GARY- SHOWALTER
Date. '10/29/2003
-Building :Offi al
' POST IN A CONSPICUOUS PLACE ""