SFD (0301-009)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
674074 B :FITS' � � V 1103
Dater Signature of Contractor r
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).
( ) 1, 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
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.
( j) I have and will maintain workers' compensation insurance, as required by
S &tion 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'g'fI j,,,.Z FUt4J) Policy No. 046-r.3112MY3
(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.p,rovisions of Section 3700 of the Labor
Code, I shall forthwith comply with those)provisions. }
Date: • /^ y', 'x• 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.
z.
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.. 3''
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 employe
2. Any permit issued as a result of this application becomes null and voi Ijt)
work is not commenced within 180 days from date of issuance of s �I
,permit, or cessation of work for 180 days will subject permit to cancellati
I certify that I have read this application and state that the above informatio '
correct. I agree to comply with all City, and State laws relating to the build ng
construction, and hereby authorize representatives of this City to enter u on
the above-mentionedproperty for inspectilon purposes.
.Signature (Owner/Agent) f Date
BUILDING PERMIT PERMIT/J
DATE VALUATION rt` y. ;?J LOT TRACT
ID
ADDRESS 79-9501111USe�a 90"KIDrIU a�..M JOB SITE
APN
OWNER
CONTRACTOR / DESIGNER / ENGINEER
:i:`D DMERX DEVEL v;Ptt 3:,4
LA QUI WtI CA 92.253
1A 01:i?MA. CA. 92253
(160)711-19ny (MIJI, VM
USE OF PERMIT
SY D • LOT 259 PLAN 3,2M P.AERNAT 008S's O 1`tdC;tLU DE 8Wt" K
ka.'fMDUC.TI.ON F09. MUL' PIX 13SUA RM Of' SAIvQ. PL AH TYPF,
G,XiS!OM C00TRUCPIGYN 402.4,00 Ss?
► rr�e r�� �a'►z z�sg.a sp
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gess, ,i. m COST Or co.wnwic-TION
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t'Crs T7,11 iir'1 RYN M01B i 01.0011.418-000 %J111313400
144, d CHU"K en" 101-000-43.0-31.9
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1?,1 L4 WGAcl. ME, 101''AilJl�.l^�•J•.�0-A� 0 •?����•. b�xi
f'F,ti.NISING FLS. 101-000-419-000 S173. b
..T.r CL"?14401`+ oi,mw -.000.44 1 -00r;
0T;;i'V%0?FJZ IMPACT 1?8E
ART 01J'LIBLIC J'JACP S = #EMI: 217E -000-44zv-000 • �IttA.�
41
8TS3$AiyV�L C:+`�'1�NISTRUC'1111679 AM PLAN aml:;:h'
r 1Y.05
` .09
JUN 2 2'2003
CITY OF L�L QUiN' A ;.
BY `''
DATE FINALED
INSPECTO
41 M y P
. Z4.
INSPECTION RECORD
OPERATION
DATE
I INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
—
Ducts
Slab Grade3
_ 2 y -.3
Return Air
Steel
Combustion Air
Roof Deck
--
Exhaust Fans
O.K. to Wrap
—
F.A.U.
Framing
Compressor
Insulation
� —3
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
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
A
Waste Lines �2 — vy
Gas Test
Electric Final
Heater Final
Water Piping
/
/J
Plumbing Final
Plumbing Top Out
_ _
`�
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
0.1
Pool Cover
Sewer Connection
—
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring J ,
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
r
Final
Utility Notice (Perm)
COMMENTS:
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..This Certificate, is issued pursuant to; therequirements of: Section 109'6f^the,.California, Building .
" :Code, �.cert� m _that, at: the,Ainne �of issuance, :'this structure was in compliance with the
fY 9.
.
I , the Building Code and the.various ordinances of'the City regulating buildingnstruction
Zrovisionsof
and/or use. -
.
BUILDING. ADDRESS: 79-950 MISSION DR..EAST
X
lJse classification:. SINGLE fAMILY.DWELLING � " ;� . I. -Building Permit No.: 0301-009
-
_
Occupancy Group: R=3 �. - - Type-of.Construction: V -N __ = - ' " Land Use Zone: RL
Owner of Building:< TD DESERT DEVELOPMENT..PO BOX 1716. '
City, ST, ZIP: LA QUINTA -CA 92253
By: GARY SHOWALTER '; 4
' - �� ' •. Date: 11 /13/2003 `
, , _ ..
- _..,:.Building Official
POST+INA CONSPICUOUS'P_LACE