SFD (0301-007)5` LICENSED CONTRACTOR DECLARATION
I her 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 D
Professionals Code, and my License is in full force and effect. •
License # Lic. Class Exp. Date
6744 B MC. -� � Bt�IIJ�' J
A
.y
Date f �A PF ? Signature of Contractor, o
OWNER -BUILDER DECLARATION j
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).
( ),; l.am exempt.unde_r Section '. B&P.C: for this reason
Date Signature of Owner +�
WORKER'S COMPENSATION DECLARATION
If 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.
tQ) I have and will maintain workers' compensation insurance, as required by
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 . _BT.AT& vIOND Policy No. 046MA-200.•
(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 `workeis'•compensation provisions of Section 3700 -of the Labor
Code,, I shall forthwith comply with those provisions. r �.
•Date �G Applicant
Warriirig: 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.. '
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 ispot 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 propertji"for inspection purposes. 3 } RE
5..
Signatuie (Owner/Agent)'• ' ! L " Date ;
BUILDING PERMIT
ATE VALUATION 9"011 a 710 LOT
OB SITE
DDR SS 79 3SA.GM DE, EM
WNER
110BOX 1716
Lt. QUTAd'.iA CA 9225:3
PERMIT#
w(A-007 -
f TRACT
APN
CONTRACTOR / DESIGNER / ENNEER
S-Rf
:LA, Qla t lvk C1% 9225:
Cf 60)q71-1941 CR:i:t 7,996
USE OF PERMIT
SOT) +'f~OT r/; PIA ',`r..�R, PERWY 000S 11401' Yfi1CLA109 BVJC :
W. IA T'e701.12PA.OR !�LAW C+IR.CiC, 17L1�1
kK0UCTION FOR 1d3ULTIP1.T: ISSUM4CM 0V ZAM P1,.AN 'TYPK
CUA TOW1 C;OMMUC'I'ION %924,00 [IF!
POT.d4IHIPATIO P
FISIMM TkID CONT OF {:CANSIR,UMON
pmTr ffaMMARY
C014STAXICITION PER
101
PLAN +L`I`1ECK 1?t;tl
101-000-439-118
$232.14
M>~iCMAMQKi, TES
$130;50
101-000-420-000
PLU)"Ma PIS
10.1.000.419.000
31 .7.s
Ca ct�nc�°�ss�lrrel.-t�' t�
ati3»qu a3,Qota
$ .01
�SIi�iI�?ldc3:f?F)4
It�l "3GIS7+'�t2.��t�L1i7
$1�A30
iMl?AcT .PFY,
A.lU D4 PUBLIC PJACC4 - ,RVJK
270a00 -445 -(WO
I�C:'1it31`TMD r -,T -A +i OHCK
'
1 .8.1 '13 MV
-,-:PAW
TIMMIT FEYIN DUE NOW
JAN ,
i2�2° 2003.
PT6fhT". 1.�' : BY �v DATE FINALED T INS
FIPIAN x
9 as /r .3
f
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms& Footings
73—/ —_3
Ducts
Slab Grade
Return Air
Steel
— 3
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
z5-15
F.A.U.
Framing
Compressor
Insulation
— L —
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wail 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
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater.Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
— y — 3
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 • D
Utility Notice (Perm)
S
Corca to of Occu a�nc.f p Y�
r _
T d-7
'T. 4'
w Building ` & ; Safe.ty• D.epartm,ent ,i
OF
This is issued pursuant, to the -requirements• of Section 109Jof the California Building `
-Certificate 4. a i_: _ r
Code, :certifying that, at- the time of _issuance, -'this ,structure y was -in:- co►npliance_ with he
provisions of .the Building Code and the.`- various ordinances. of the' -City, regulating t %building
.:`. Y �.
construction and%r` use..
BUILDING ADDRESS: 7.9-966 MISSION DR. -EAST
4 r
^ Use classification: SINGLE FAMILY DWELLING Building Permit No.: _03011=007
i
* Occupancy Group: R-3 Type of Construction. 'V -N ,� Land Use Zone: RL
Owner of Building. TD.DESERT DEVELOPMENT `Address: -PO BOX 1716.
-
• .: _ , . City, ST, ZIP.. L'TkQUINTA• .CA' 92253.
By:'GARY SHOWALTER -
:, '+ Date: 11/13/2003
Building .Official
'
`_ POST IN A CONSPICUOUS PLACE