SFD (0301-104)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
67404 B IRC 7r3 1103
Date ' ", Signature of Contractor ' ~
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).
( ) 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.
<( ) 1 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 113TATE FUND Policy No. 046-7, 38-2Zj?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_I should become
subject to the workers' compensation provisions of :Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.
Date:: % 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.
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 ate
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,ente'r. upon.
the above-mentioned property for inspection purposes. s
Signature (Owner/Agent) Date E,rt ;•,: ,
PERMIT #
BUILDING PERMIT
. 4XV]-104
DATE VALUATION
max; LOT 49 TRACT 292els
`
JOB SITE -F'
ADDRESS %.-e�l.iV.dtU�`/.II�Vd1'.vrJa��,��
APN Qr•2i� �iiT�
OWNER
CONTRACTOR / DESIGNER / EN (NEER
T-10 r
LAQXIINI-A CA 92253
LA,QU11`t'rA C•A 92253
(7faU,7"Pi�1y4 f k 2996
USE OF PERMIT
SING FFA LY DVV=1KG
wP%P- o. LOT 49. P./,..H M3. PERly IT DOES NO;' !XCLUDE'BLOCK
WAI,t,.%P0014 SPA CP. D EWAYA`PPROACFi. 5%RFDUCT'IO14 TO PLANC°IrP.W
!`rW. GU TG MUPZIPLE ISSU.lANCE Ott SAME PLJeW `f'Y"PE
CUSTOM. CONSTRUCTION 4;243.00 SF
PORC.F1 RATIO 522,00 S
0ARAt1UCARF'OWC 710.00 8F
U,•.!?d.►.M,Il.nL+J3) C017f 4.3.', C0JgYG.&i.Ua rJ011S
���N7i36X9•+�'4•
$'1r''R?a I] MIM, i;Cff�"V.c "m
CONSTAUCT1ON :REA 101-000-418.000 $1,521,.5t1
PLAN C:klECr 1110, 101 -NO -439-318 $308.73
B(dRC;I-iANICAL FEE 1 C i-0'xEp 421.000 51300
E,PZCTRICAI,, FEE 10 2 -ONX-41 20-000 $246,71
PLtfM13P1 0 FEE 101-000-41S>-000 $20,40
S RON. O to OT1011 FEE - RESID 101 w000-241.000 $35.14
ca E R .000
1�Ft�101-0004213-000
/ J A�i1;
fylt2Dli�1.140
yT� 1 � 11 q �u pe
3 00
.A.C,'T IN PORLIC FLAC FX - RESTE VO*000—i45.000 5172.47
f• y
:t3:I�-';I•'ti:� I A t�xS�. ITCIIt3:t•1' MM ;'L Aid' C" 1 t`'.K
$3,252.05
<, LESS PRE- PAID FEW
$1(00
1
JAN 2, 2093
CiTy OF L4 Oi. N YA /
FIFi�;�}CE P�EPT VVV
RECEIPT
DATE
B/Y�l�
DATE FINALLEED
INSPECT
INSPECTION! RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
_
_ 3
Ducts
Slab Grade
- - 3
Return Air
Steel
- Q-
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
- o
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final I
Final
- ` `1
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
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines �/�'
'7-
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection-
tj Q - '3,
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas) =J
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 _ l'
Utility Notice (Perm) -
Certificate of Occupancy
IaeTm
C� OF Z1 Building y p & Safety Department
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 Code and the various ordinances of the City regulating building
construction and/or use.
BUILDING ADDRESS: 79-334 MISSION DR. WEST
Use classification: S.F.D. Building Permit No.: 0301-104
Occupancy Group: R-3 Type of Construction: V-N Land Use Zone: R-L
Owner of Building: TD DESERT DEVELOPMEMT Address: PO BOX 1716
City, ST, ZIP: LA QUINTA CA 92253
By: G. SHOWALTER
Date: 05/05/04
Building Officiale
POST IN A CONSPICUOUS PLACE