SFD (0301-006)`LICENSED CONTRACTOR DECLARATION ,
.1,%Iereby-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
6741774,,-' ` 77 n, 103
Date- `' ` Signature of Contractor J. J
OWNER -BUILDER DECLARATION t
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).
as owner of the property, am exclusively contracting with licensed
contractors to construct, the project (Sec. 7044,1 Business & Professionals
Code).
() I.am exempt under Se ctiori 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 fo'r which this permit is issued.
(),t) 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. Sf�tT� 1Pld)� Policy No. 046.7,333-200
(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 !,should become
subject to the workers' compensation provisions of Section 3700)the Labor
Code, I shall forthwith comply with those provisions`„.,
Date: d r 3 f ", Applicant—
Warning:
pplicant 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.
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:riot 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 !,have read this application and state that the above information !s
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+inspection''purposes. r
S' t OwnedA -M + ! a Date L'
PERMIT# ..
BUILDING PERMIT,
DATE VALUATION LOT TRACT
5
JOB SITE ADDRESS 7%.9 'Eii AMNSICIAN,YM�pt�k'Sl
APN
OWNER
CONTRACTOR/DESIGNER/EN (NEER
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7 16
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.1.,/�i. QLLi.'�l'A A CA 92M,
f� {.��i,+�I^}3
1A. Q�/w�.' 0t. � CA 91CD2S3
(MY171-1942 CaUt 2996
USE OF PERMIT
SSD • LACY' �:t5,,>�1Pd P FI'P. P.01141't' 00,1b.>!'f�t�i'i' INCL4MP, �td.,t;.0
WAUA
i?fiLCH1I�.� f ) 267A 51?
Cif3:PAC��t'.Xi"„ARP- lx°T b,Cd 131
.T ti-Id.tC.ltTiI ld D COO 01F CWASsl*.4.J1'6v'MIO
.220M-G:.4XI
rMiTar�"�Sr' ' 4YU'd�1!�.�ilLAiY
C0)4ST1',1, tL1TJO)w FE9 101.000.4.19 -NO 51,063,00
latxo93di Cii3w AL1± ).4iaf3(�q�8a_,1' $k'l1.61
�Y;�)9�ki)i*-.�.1. �£;� 1 �T �tJ*J���fi•� 1 «•C)®� � i 05�G0
ZLW,'r7t1V.A.t11 til i;t 3,t1kU 4 [a -t3 i� $t6 'rra
P1.,UM13M0TeR? 111.«�St�D ).<41i1U 1? n
STRO110 M01710td Mit v REM I7 101 -OW -241.000
i!: PINDfP O FIFE
J.R,i' D.4 PUBLIC' PLAW - HERM 2,f)§G1it-4� 5.000 MA, 13
LEI' Pi R-PAT. r, M TWO
°
$0.00
D
a rAL 1,13 n1W.V XW18 DUR NOW
JAN 2 2 2003
ae
7 �` _CITY OF L•A Qi/iN'iA '�?:,r.
FINANCE REPT . �4v
RECEIPT DATE BY •+"y DAT INALE INSPECTOR
INSPECTION RECORD
• v OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
— – 5
_ _
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
j
F.A.U.
Framing
_
j
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
7
Drywall - Int. Lath
Final
Final
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
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Water Piping
Plumbing Top Out
_ !1_ j �,s
_22
�_�� c�
Heater Final
Plumbing Final
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
_
3 ¢ _ 5
Encapsulation
Gas Piping
Gas Test
Appliances
Final
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) d '34
COMMENTS:
' - t. w + � ` ^ : y.,�• -', ' - ,yam � .
�s--lam _ Cortificate of Occu clr:
- p,
ti �R ti
Buildn &S,
Safet -'D.e0a.trientOFgY.3
' This -Certificate is -issued pursuant to the requirements . of Section 109_ of the California Building -
Code; certifying" that; at ° the , time -of issuance, this structure -was.. in compliance with 'the
` provisions .of `the Building -`Coale: and the various. ordinances of the City --regulating building
construction -'and/or use:-
.DR.EAST'-
., .79-974 MISSION
BUILDING ADDRESS: ;
�.
o : 0301-006
'. Use;cla_ ssification: SINGLE.FAMILY DWELLING _ _ ;_ :,Building Permit No.,:, -
'Land
' Type of.Construction: VN r Land Use Zone: -R -L
Occupancy Group: 'R-3*,,,,' yp -
r
-Owner of Building: TD bESERT DEVELOPMENTS �'. Address:. PO BOX 1716 ,
' s City, ST,rZIP: LA QUINTA CA 92253 a
By: GARTSHOWALTER ..�'-
��� ., n Date: 11 /03/03.
2 r Building Offici r r r '
r POST IN A CONSPICUOUS PLACE