SFD (0004-074)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
77€8214 B 05ra31 PC
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. •
( W&e and will maintain workers' compensation insurance, as required by
Stiction 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 EXEMPT Policy No.
(T is section need not be completed if the permit valuation is for $100.00 or less).
"( certify that in the performance of the work for which this permit is issued,
'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 prQvisions of Section 3700 of the Labor
Code, I.sha forthwit comply with thoepr
Date: Applicant ((1�"=`."'"
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'raspection purposes. r z
6 Z
Signature (Owner/Agent) Date
BUILDING PERMIT PERMIT"
DATE -1 � /" VALUATION LOT 4 0 y TRACT
�! 1!//A $417,120" 2 ' 29657
JOBS17E I �S`S�
ADDRESS }�v,�•= ar
[•� .ASW lV
APN
7614AW038
�+•�
OWNER
CONTRACTOR / DESIGNER / EN &NEER
'
1"A1M QO%.-151 VMOPMF.A1'1'
2 C. HOBB19 c imP"T.We
.5oI -_t TOm A1A
14301~ CEMP 1.A1+1 A'V ;:
:LWITER FL. 33477
ORANGE : CA 92866
(714)633.7260 CBTJ. 5487
USE OF PERMIT
fOi,�.:FA1VrMY 1aW3?�..J7 &
SKID-P1N ' ,3' DOE NOT 1Nt.IXID9 41LOCICWA.IA S OR POOL
,,I &r 2/ 16W
CUSTOM, CONSTRUCTION 4,921,00 8F
PORCH/PATIO 1,222.00 S
G.1 RA,.C#MARPORT (SP) 1?,522,40
t
a FISIMI&VIKV COST (Yrl CON-Mlyarx0v .
417.120"
i'.MW FEE SIThT 1�.'V'
CONSTRUCTION PUE 101.000.418-000 V052.50
PLAN CHECK FEE 101-000-439-318 $1,410.1,16
MECHANICAL FEE 101.000.42)*•000 51 S6, 00
P3,ECTR1C.,AL 1 : 101-000-420.000 $?A2:b3
PLtlMBINO FXF 101.000.419.000 $232.25
STAGY O MUrION YEE a RESID 101-000-M.000 $41.11
GRADING i+,ER 101-000-4216000 $20.iio
DLVELOPER. IMPACT PIM $1,907.00
Air iN PueLIC PLACE - 119311 701-000-255=000 2542,80
FEE DEPOSIT 101-000.439-•31 I 41,000.00
µ �}
SUB-70AL COX A19D PLA..9 C.I>1
$6.,:305.64
LESS PRE -PAID F=1
41,000,00
e 1"CnAL Y`Qt 33+IF-117, S D1)X . N0W
• ... •A �.) oY
-64 I
AU` G 012 2000
RECEIPT
DATE jX
113YDATE
FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings jj
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck IXK� Q L'Q
Exhaust Fans
O.K to Wrap _
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
/n J
-
Final
Final I
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
Heater Final
Water Piping I
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
Pool Cover
Encapsulation
Gas Piping
Gas Test
A pliances
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
Utility Notice (Perm)
COMMENTS:
Certificate of Ocd.upancy-
City
of La Quinta,
Building and Safety Department � o.,,r°`
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
ollowing;BUILDING ADDRESS: 81-155 NATIONAL
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0004-074
Occupancy Group:, R-3 Type of. Construction: VN Land Use Zone: RL
Owner of Building: NORMAN ESTATES II, LLC Address: 501 N AIA
Building Official
City: JUPITER, FL., 33477
By: RICHARD K. KIRKLAND
Date: 3/29/01
POST IN A CONSPICUOUS PLACE