SFD (0301-107)LICENSED CONTRACTOR DECLARATION
I fereby affirm under penalty of perjury that I am licensed under provisions of
ham—:- 'Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
c4 W , Professionals Code, and my License is in full force and effect.
O Q. � License # Lic. Class Exp. Date
oti
r- Z Date Signature of Contractors
J I.— OWNER -BUILDER DECLARATION
W UU I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
Z_ ( ) 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).
C0 () I am exempt under Section B&P.C. for this reason
U
N Date Signature of Owner
pN
0)
U Q 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:
Carrier �M.D Policy No. 044-1333-203,
(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 thoseprovisions.
Date: f 1 -% 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 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 inspectlon�purposes i I ' . r✓
Signature (Owner/Agent) = Date 1 -'
9'
BUILDING• PERMIT PERMIT J/
w olo't-107
DATE VALUATION��vv.yy��.t�gg+,� gqq,,ttyy LOT gryry TRACT
•'� r� e&etfV�Fd�'�•CvM:7d V,:4• .6,.VRa,?
,�• l r..-
JOB SITE t _ a�'MMI-WE
ADDRESS i yl. �',� a LO Dr �
APN 1
OWNER
CONTRACTOR/DESIGNER/EN INFER
T%3DE:3EX,'C3 FIV,.?YUI�i�1`
151A$3KSC"el"1<iM: CIU_01
PO B(TIZ 17 16
7 9- 293 RANICUTO LA QUINT -AMR,
ukQTwp, CA -92252.
1AQuwm CA 92253
(60'r771,,1341 CMIA 2996
,
USE OF PERMIT
SWOLE
3FD 4 'LOT 32� .PL.AN Ma, AMER rt.IT DOMS $di3T 1,1NMAi,'CYE B14CK `t AL1A
M04 SPA OR IiR1VP'33fiAY.APPR01WH. *80* REDUCTION TO ?I,A9 LUCK
!1731'L: Dtil TO A/ TULTIViA'MSU.I1;KCZ.OF 1*1m , PLEB TYPE
CUSTOM COMSTRUC ION W4,00 S'F
1hOkC;ii1F.FL'1 O a145.00I •
0AEACf.G ICARPOU 47€ Ak 5
C:l
i,
WFA[AMI,CUNT OFIMaYMO
240,117.10
PERMn FEF. OEMAlbliiar&
CO><3f TRt1t'=` ION M, ` o
PLAN C'13EC,.K, Mil WIZ24
M1L+t:I•i.+ WCALAsh S13030
ELECTRICAL LYZ1r $1,69.24:
Pt,lJMI33 O T' FF '101-000419-000
5.°1'3tGb:+lCt tWiC+i7C]4 i�> - k lD 1.01-000-2441-000
GRADING FGR 101 F00.6 4X.3-000 WIN
DNV"f.:l,YOPER, IMPACT Pict
AV 3'I+t !'1.aB3,1.0 PLACKS-WK-270-000-443-000 '$'litOr29
.;i
C 'URUC11014 AND PLIMN (MMCK,
x,4; -RE aa.��
P JAN 2 •g
2003 `
�p y
A.
. V ' �+�yq���p.� �'�y NOW
88JtdSoh,'6d'.Y.¢J;A1f'.i'�+a1��'�.4a dpi e?Tit
i6i�]ha�a�w
F CITY OF LA'
k
FIN, NCE 0rPT.�A
RECEIPT
DATE„
/
BY `
I
hat
DATE FINALED
INSPECT
f
a•2g r
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
• BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings m3
Ducts
Slab Grade p3
Return Air
3 91
Steel
Combustion Air
_
Roof Deck �—�— .y
Exhaust Fans
O.K. to Wrap — 3—
F.A.U.
Framing
Compressor
Insulation --t/
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath ~
Drywall - Int. Lath
Final
BLOCKWALL APPROVALS
Final
Steel
POOLS - /SPAS
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
Heater Final
Water Piping Q✓
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
_
Gas Test _
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring sf.
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles /
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm) /
COMMENTS:
1.
Certificate of Occupancy
T4ht 4 4 Qumt
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: 79-370 MISSION DR. WEST
Type of Construction: V -N
Owner of Building: TD DESERT DEVELOPMENT
Building Official
A CONSPICUOUS
Building Permit No 0301-107.:
Land Use Zone: R -L
Address: PO BOX 1716
City, ST, LA QUINTA CA 92253
By: G. SHOWALTER
Date: 06/18/04