SFD (0101-070)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
f
47 ttq`3.5�
Date Signature of Contractor t
• 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.
(f�.. 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 Policy No.
t`.101..,ORN NWT S•3`7fl1401.
(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, l shall forthwith comply with,thos provisions.
Date' (� ` t? Applicant n., div
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages•as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application. `
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent)~,...a* S Date `r•�s." ��'
BUILDING PERMIT PERMIT#
DATE VALUATION LOT ,.1•f'�( �s,'.. TRACT
OIX"XX V73.713.'X) 29657
_49
JOB SITE
APN
ADDRESS _
eTa NW-.
OWNER
CONT// DESIIGaNgE�R / ENGINEER ;
a,�n o y AM to
LLC
4iRACTOrR
YL 13477
LA QUNTA CA 9221:3
(760)564.5612 Mit 54tr1
USE OF PERMIT
3w,G11.IOkd�"�a Y MIMUNG
SM - LOT 4A PIAN ,SSB" I'Et:.tt IT NOT, INi;LU1.3E .4i3 OCK'
W AisidE" C7OWPA Of3..fAb kOAC11.[36F.i:1T. .AY, 7$% t LAX. <k r1 M97 FEZ
}1.3n:)LIC'11014 l T)R M1J1,T1PU:, ISSC N14CE OF SAWK £'1, K11 TYPE
CUSTOM CON."J" T LY-OT1Otr1 141%48100 QSF
POI CHIPATIO I,11.7.00 Sir
4,i4A'f1A,COCAR'fJRT (.3) .17,032.40
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.�:��3N*�6"d:��A €��ro'�I` 4�:1.�° 4�'4�.1�'�".�,":5a':�7€,�C`.$A�
:�t"r���•�p•�.�'�}
(110133S' UCT1O341E1`i 1 ONX10-41 (3.000 51,994.50
.r.1C�-� r`
PLA14 C�41I.1I E 101-AY00-439-d1£� $:d1t>.56
�.� � s � t::n
MFICHAII1.0.+9.1I ME 101-000-421,.000 $104,30
nw. l'123r.�,7►d..I�£!.F'. 1. 0 1 -01010 -42W- 000 $V3.46
PLIUMOTHO".9 - S%5.2�
SYROY10 MOTION ION FE- • RKS10 MI. 37
OR A .'sYNO FEE 101.000.423.0,00 U0100
r)rvT, PER imFAL"T m. $1,907.00
ART IN PUBLIC PLACES »RUME 701-000-255-000 901,20
�1•f� ��•
03 M—PAID 117-29
$0, 00
M AG ,F- xU.MT E FELES DVE NOW
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Yin R:
RECEIPT
DATE �-
BY • �l
DAT �IVA�
I P OCTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings„�
Slab Grade
Q�Zp ��
Underground Ducts
Ducts
Return Air
Steel
Roof Deck2(pld/
Combustion Air _
Exhaust Fans
O.K. to Wrap
Framing
_
_
�/O/ j..CompressorInsulation
F.A.U. l
2��GjL
Vents i�
Fireplace P.L.
_
Grills A
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lathi-
D ll - Int. Lath
s Final
Final Q
_
POOLS - SPAS
BLOCKWALL APPROVALS
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
Waste Lines
/��i�i� /��/
Electric Final
Heater Final
Water Piping
r
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
_
/�f�ji�0�
Pool Cover
Encapsulation
Gas Piping
Gas Test
aria/
Appliances
Final
COMMENTS:
Final
Util4 Notice (Gas)
'
/
.�
ELECTRICAL APPROVALS
��Nd �til�
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
/ G7
Exterior Receptacles
G.F.I.
j
Smoke Detectors
Temp. Use of Power
_
I-
Final
--
{
Utility Notice (Perm)
_
Certificate of Occu'p, a'
City_ of LaQuinta
,r.
BYRding. and Safety Department OF
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: 81-180 NATIONAL DRIVE
Use Classification: SINGLE FAMILY DWELLING Bldg: Permit No.: 0101-070
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL
Owner of Building: NORMAN ESTATES II, LLC Address: 501 N. AIA
City: JUPITER, FL., 33477
By:- BILL GORDON
Date: MAY 24, 2002
Building .Official
POST IN A CONSPICUOUS PLACE