SFD (0301-105)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
674 1C f �� 1 !I 11iI
Date /_7� ''A 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.
( ) 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:
Cartier STATF FUND Policy No. m6_` e-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 workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.
_
Date: � •''� �� �^� Applicant "~-Y"'`' f
Warning: Failure to secure Workers' Compensation coverage is unla,Afful 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. Al
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 of r%inspection'purposes.
Signature (Owner/Ageht) ' ryi_ ' Date 4/ t
BUILDING PERMIT. PERMIT #03011405
DATE VALUATION LOT TRACT
1 •_ ,__)e1 < f --. $2410,1 17,10 0 50
JOB SITE
ADDRESS 79—W XIM610H D M— W:-S'f
APN
C�5► % fT—�t,�p
OWNER
CONTRACTOR / DESIGNER / EN (NEER
TiD'D1"f,5EWrD'F4r a. E T
SPA RKS CON1MRUC11%0N
PO b'0X1 716
79.295 RAW!°I'O WiU NTA DR.
iA QUMTA • CA 4.922,13.
LA QTTINTA CA 922
USE OF PERMIT
01'OfiIT- 1" mul'Y Dw,
141?.D . i� t .", PL"l F2. PERMIT DOES 3+401- INCLUDE 8LC-.C1:
WALLA P004 SPA. OP. DldJV.Z ii AY'APPROAck
CUSTOM Cblln- RUCTION 2924100 Sip
POPICH#i AYi0 215,00.8f,
OARApEICAPPORIP of
EMMA, ME 11 COST OF C014MU6MOR
240,117.10
PERKVP YrrYWASY
C0.10TBtirtG' ION FEE 101.0a"do.00d s1,1..33.00
PLAN t<1"TEKFMA; '101=000.4394• ?, 19 $918.97
IM CHAVICAL t IR 101-000-4214% 100.50
F1,.WT.-RICAL FEZ 101 -WO -420-000
PLUMB -100 j?�'iEP. 101.«.8300-419^000
S'TF',OWO MOTION Fft > RL^SIO 101 -000 -TA -1-000 $74.01
X3CAWRO FEF 101.000>423.000 $5310
DEVELOPER PER IMPACT FIFE $4405.00
ART IN PUBW PI, CES - RMIC 270-000-44St LGQO $100.29
L' OLWyAL COS -RU'C!10 AND 1hy XP
36.
I, ISS PPYR-PAD :£STEW;
U1,00
JAN 2 2003 'f
q
i
0TY OF LA irAPN sA
R€CEIPT
DATEBY
/-_ ,/-- -
A
:-, j
DATINAL D
INSPEC
L,
I
P%.
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
/j
Steel
_ /p -p3
Combustion Air
Roof Deck
O.K. to Wrap
;_=g _ _
_
Exhaust Fans
F.A.U.
Framing
3
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
i
Final
b
Final
BLOCKWALL APPROVALS
Steel
POOLS - SPAS
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
2 $-
Heater Final
Water Piping
Plumbing Top Out
Plumbing Final
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Notice
I ELECTRICAL APPROVALS
Temp. Power Pole
Underground Condui
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)
COMMENTS: Ggc!•5 49�
Certificate of Occupancy
T-Vf 4- xpagmz
Building & 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.
Use classification: S.F.D.
Occupancy Group: R-3
BUILDING ADDRESS: 79-346 MISSION DR. WEST
Type of Construction: V -N
Owner of Building: TD DESERT DEVELOPMENT
Building Offi ial
POST IN A CONSPICUOUS
Building Permit No.: 0301-105
Land Use Zone: R -L
Address: PO BOX 81716
City, ST, ZIP: LA QUINTA CA 92253
By: G. SHOWALTER
Date: 06/15/04