SFD (0301-113)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
331310 7/3110
Date '� f7 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:
( ) 1, 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).
( ) 11 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
"Sebtion 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:
Carver STATE MOD Policy No. 046-73JI8-21303
(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 whicb 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: ' r ''' 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•inspection ptirposes.
-Signature (Owner/Agent), , Date'! ' "IX -1
BUILDING PERMIT PERM T#
03U1••I.>l3
DATE VALUATION LOT 54 TRACT
- !,2 292,
JOB SITE ADDRESS ` ..70r to . WNSIQ P'�L.#•'0`A9 )AM $A.•
APN 649-210-06-71
OWNER
CONTRACTOR/ DESIGNER/ EN
b)* gTYrEDLO7AEN7
rbt3101 Ir-10145d,ZRpN
LA QT.g13 tk CA 92253
u. QiJwnk CA a°'tw`"2'33
C160)111.19 1 0W.Al 2996
USE OF PERMIT
SIROLEFAIL, Y'7`Cd. •s .��tFI.Y'
SF 7) - LOT 54 X1•,414 83; H M`MI T DOTS NOT 611=1C
WA.LW, P001,; SPA OR DRMEWAY,AI'F'ROA<.H, %,A MM93C' ION TO PLAIZ
CHECK FF -E 413F, TO MULTIPLE It"'U ? NC E tats SAME PLAN TYPE
PORCH&ATIO 1010 SF
C-APANK,'ARfi ORT 470.00 sp
r
, ' 4 C,;:CIb��' 1? :0?`1' r.: 1.kCngiO,��
240.117.10
qg�;,,%%�� �fikr�}} 77,� ����yy,, p ,y p►",
.(CWJ:�Y'.MAs dJM,Aw71a fi��.9.L7/1.9i►:i�,Z
CONOTRUCa ION ne 101.000.418 000 U13100
P. A14 CHECKAM 0311
101-0110-421.000 11130„50
<.
PLUMD114011M, 101-000-419-000 $173.75
S T'FzfJ1VC9 MOTION RT A RLESI r,' 101-000-241-000 $21.01
G.ir' A.DNO .M 101 -0 00-423-00-0 J `1y $.00
DIEVE1,0PM IMPACT :FEE $4,40_00
. 17.'1' Px1 PUBLIC PL&C',EZ -MIC IC 2/0-070-446.000 $rIA4�.2Q
LESSFEM-PAID "M
MOO
f 1%
RECEIPT
DATE V.
%..
BY 7
DATE FINALED
L �l
IN
d off
— _
1
`4NSPECTION RECORD
OPERATION DATE INSPECTOR
BUILDING APPROVALS
Set Backs
Forms & Footings /
Slab Grade
Steel l p
Roof Deck _ y
0. K. to Wrap _ 4
Framing . r3U - y
Inculatinn Is se_ lv
ace P.L.
ace T.O.
Wall Insulation
Wall Firewall
or Lath
ill - Int. Lath
OPERATION DATE INSPECTOR
MECHANICAL APPROVALS=
Underground Ducts
Ducts
Return Air
Combustion Air
Exhaust Fans
F.A.U.
Fans & Controls
Condensate Lines
Final
ELECTRICAL APPROVALS
Temp. Power Pole
Underaround Conduit
Low Voltage Wiring '
Fixtures
Main Service _
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility
COMMENTS:
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
2 - — s
Heater Final
Water Piping
_
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Fnranculatinn
Final
ELECTRICAL APPROVALS
Temp. Power Pole
Underaround Conduit
Low Voltage Wiring '
Fixtures
Main Service _
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility
COMMENTS:
Certificate of -Occupancy
Tvf 4 XP 12amm ,
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.
BUILDING ADDRESS: 79-442 MISSION DR. WEST
Use classification: S.F.D.
Occupancy Group: R-3 Type of Construction: V -N
Owner of Building: TD DESERT DEVELOP MENT
Building fficial
s
Building Permit No.: 0301-113
Land Use Zone: R -L
Address: PO BOX 1716
City, ST, ZIP: LA QUINTA CA 92253
By: G. SHOWALTER
Date: 07/_