0001-181 (SFD)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
743967
Vbate �'�-� § ' o '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). r -
O 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 'provid-ed 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:
CarrierPolicy No.
S x'.Arl'1.'.' t."C fi r, . '
(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 iri 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^r-
Oate: /. a Applicant .. \ r Z •-
Warning: Failure to secure. Workers' Compensation coverage is unlawful and
shall subject an employer to crimihal 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. •ti,
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 Quihta, 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 purposes. -
VSignature (Owrer/Agent) "" �" Date
BUILDING PERMIT ' PERMIT Ji
wlo-2K:v
DATE � � % VALUATION x$126.241.90 LOT 2.2L TRACT 24%91•'
JOBSITE*9627l�'�ORNI1'�C+'�.'t3�:9.R 4.;O�.R
APN
ADDRESS
;
OWNER
CONTRACTOR/DESIGNER/ENGINEER
'F�t3 i r,tAl':': t r
?. .lsi, �fv l -r ,f•. .R -y
X1rr�uT f") DST;t•FrtT r )-kipy-1` 'CNIC
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4-333;R` Y,11b i�'MA0.3•
74.3334aniY UI S'I'B. i.Pr„4
1-'AJ,..WU SF'2'�, CA 922660
1?1i.1,M GEShl-Cf' GA. 92260
USE OF PERMIT
i'Ii�t1[.E 17AliItl,Sr DWEf 3.iir+i
s:FD-LOT :22.PLAty TB - PERMIT ,tDO S N0 uTLL5D.r, isu3A.Tr wai.S GIt
k'O(JIL, 75"1o13LAN CHEZC!{,VEU aZUNK;l ION N INIUL'.1°W.iXI i.3317ANCI: OF
WME PLAN VY P F. S.
sx ACT CON SITIM C-410iv n O? .t'h1.Sr
C1iU.2.AU�ili.:H.RCIO T 684.60 SF
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r, -N, iA:�°xD Cosi or f`���'�,�Ru'mor-
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,8',1� Ni 1 � , Si"1-iO�iZ'0ARY
CONS't'k.CJt."1"f��:Ai "r.'I E 101 -ON -418 -OW $734,i�fj
PTI- AN C`H.1'CK FEF, ! 01-f00t 439-718 $ t ^. e7
h er-•pp`h'r w 1rr/'.:gr •r••r.w 't r75 hrt1�` dh erg rrI
Skr1'1;!'AHl4A6s !r LV.AZ 4lJ.!^'VV "ML+.i•` . J41.JV
4,91
EUX- t tMiCAL F"ET, 101-000-420,000 W4,91
P1..11€ BINTO:FFE, 101-000-11,9-M $142.00
ST O'Rf(xP?t Sirri��i'ION rE-15 _ REISTD3 M -000-241-M.1, 2,
l6?
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C�iZe1LD.1--iAll(rY.r:.i -. ,lV�`V1iE�i�E^'� �,4ft,W�l
0-2—VE1:OPER 1IMPAC!' F.EE 51.907,00
^
AW)" INPUBLIC PLA(;;1a•3 - RFbU: 70:14M-255.000
St_t?3-'1 t 1.. CC'�N� `l"!i+ 1s ".i'Ot J 1 "f i�X .!�N %Fi1 I•'
$ 3, '15 :�
F.� 4 t. r •-► k ESS #''IZE-•E 21JT,1?F rc
�0.00
APdff ! 1y'lsf,. DUENOW
qq1..E�``itj3,
RECEIPT DATE BY (/ DATE FINALED INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
,�
Return Air
Steel
Combustion Air
Roof Deck
a-7- -dO
Exhaust Fans
O.K. to Wrap
3 - I6 -0a
F.A.U.
Framing
- 11 - MO
Compressor
Insulation
3 -Zt _ 00
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall insulation
Condensate Lines
Party Wail Firewall
Exterior Lath
Drywall - Int. Lath
7-1-00
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
I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
-�p_tit0
Pool Cover
Sewer Connection
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 . 1 t, - do
Utility Notice (Perm) > (V.1415
COMMENTS:
rCertificate.of Occupancy
City of La Quinta
Building and Safety'Department.
This Certificate issued pursuant' -to the requirements of Section 109 of the Uniform Building Code,
certifying that, at the time of issuance, this structure was in compliance with the various ordinances _
of the City regulating building construction or use. For the following:
BUILDING ADDRESS:-' - 7926.27 MORNING GLORY.000RT
Use Classification: SFD Bldg. Permit No.: 0001-181
Occupancy Group: R-3. Type'of Construction: VN Land Use Zone: RL.
Owner of Building: JIM DAN D LLC Address: 74-333 HWY 111, STE 103
City: PALM DESERT, CA. 92260
By: KEVIN M. HIGGINS
Date: 6-1-00
Building Official
POST IN A CONSPICUOUS PLACE