SFD (0301-008)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that"I am licensed under provisions of
Chapter'b4z5omrriencing 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
67c)'7t' - x''3'31#iI
f Date / ! Signature of Contractor
J
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 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.
Se( 1) 1 have and will maintain workers' compensation insurance, as required -by
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 aT 11 :1'ily+l Policy No. 046_i'3NO-20 3
(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-= should become
subject to the workers' compensation proGisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provis ons.
Date: ... Applicant w
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. f s
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 property for Inspectionipurposes. r
Si nature (Owner/A ent) 4 Date"
BUILDING PERMIT PERMIT#
DATE VALUATION LOT TRACT
2907"S
JOB SITE'
ADDRESS sg iJ� c n I ��R
APN . 64940043.6
OWNER
CONTRACTOR/ DESIGNER/ EN (NEER
SPAM COXTU.CRUCM0111
PO k3CIJA 1,716
7S>> ! S' RANi..IE0 Lh.d� i'.C1�iT.!t. M.
LA (.111'fMIA Qk 9225?
:4:.y& (,)�'.i1p1.��'�"�, : -Ch 25:Sn,
q l �y9y C'
USE OF PERMIT
:ad�t�> 1..0`i' F'f�/L3'6 x$12, f'*�'dRk➢S' 17G?i�S�NS.,'1'•lka#;:i,.tfiri3?:.ti�.t::yt;!!� '
WAMS. POOL, $aPA eft DR.1YF*A,YA,'prt(?m;"._ -*A,%
REDUCTION VOR ML0.,TJVLZ 1S.3V i=- OF SAME 111-kl; '&Px-
Ct1'SiOM CONSTRUCTION M35.00 9F
CONSTPLUC'T)ON fe-VA 101.O.W4V=Ot1U U.106110
PLAN (NECK R,& 9-31.a $MN
MKI A ICIALF0 1,01•000-421-()0.0 $105.00
F,LIX°i RJCAJ., ML
1011
?LIMLl(-WO-439-00
.ttK
STH -0140 FJTtUMPpR T RED 101-000-24$'000
nzw,E--oPr,,R INAACT RE
.RT iia MAX PLACLI -R WE 210-000-445-000 13
f�('�, �j p. ,•�E �j j�''(q y�} j� p �(ya.�a�1 �.�q•��
6. UTI NVB�'AI, COb�1.C:}.1.5'.W'•.i.IION ii9.W }.i d_.L/AN IA.t.Y:+W�._^�
•pl�(� j ]y
{ .�s Me -PAID 14-163 3
$0.00
JS4✓3161L�.!..�1�`4��X. Fn:L>.Ce6'Y.1}�.G 3�7,5d 7'�
'�+"Y6A'E%'•.6 se
"JAN � !►
2 2 2003 a
RECEIPT '
C L4 ul 7 . [
BY
DATE FINALED
INSPECTOR
FIi110N ..`A')
_ '..� ..1`'•i_ fid}, _ ..
INSPECTION RECORD
.; OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
met Backs
Underground Ducts
- , rms & Footings °-
Ducts
`Slab Grade — 3
Return Air
Veil' -3 —
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap 6 ,.
F.A.U.
_ _
Framing 6 - j _
Compressor
Insulation / y_ 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 -ts
BLOCKWALL APPROVALS
POOLS - SPAS
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 Z — _-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 �2 a —
Encapsulation
Gas Piping
Gas'Test
Appliances _
Final
Final
Utility Notice (Gas)_!
,ELECTRICAL APPROVALS
-Temp. Power Pole
-Underground Conduit
.Rough Wiring &/Z
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
tfCeriicates-.of-Occupancyo
�
IjJCO11POM7FD
OF_'L'9 : ` Building_ &:1Safety=Department n ;
This Certificate 'is issued "pursuant to ,the. requirements of Section' -109 'of the :California 'Building
yCode, certifying` that,, -at: the time of 'issuance, this. -structure, was: -in .compliance with the
provisions of.ahe 'Building Code„ and `the various ,ordinanc6ss, of; the City .regulating building
' Cohstruction and/or use. - y
°BUILDING_ADDRESS:'79-958 MISSION DR EAST
Use classification: SINGLE-FAMILY DWELLING = _ -Building Permit No.: -.0301`-008
•,Occupancy Group: R-3 t . , Type of"Construction ,V=N' � ' :�`'' � ` Land Use Zone: RL
Owner of'Building: TD DESERT DEVELOPMENT S Address: PO BOX 1716
- City,_ST, ZIP: LA QUINTA ' CA 92253
_ By: GARY SHOWALTER _
Date: 10/29/2003 J
Building Official,
POST IN A CONSPICUOUS PLACE