SFD (0101-068)': `(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 an
K-
Professionals. Code, and my License is in full force and effect.,
License #' .. Lic. Class Exp. Date
47t -R689 � � B
Date Signature of Contractor y
s _
'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 isnot 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
i
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury' one of the following declarations:
O 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.
,A./) 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:
Cartier Policy No.
. " ink ;�+�i1.1.7.� 3+1Y#fi�d: �4'd�►,9��1
(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 those>provlslons H •�„
' Date b,4 f „ Applicant--
Warning:
pplicant Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000;iin
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, 1
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 uor...inspection purposes. -0
Signature (Owner/Agent)tDate,��
r�
BUILDING PERMIT PERMIT#
+ ,.
DATE VALUATION LOT. >F�T`� TRACTlo
1 Yw .8 di a 'brl LW1.-s s 7
JOB SITE '_
ADDRESS
re��k'Yd43
APN .
OWNER
CONTRACTOR / DESIGNER / EN INEER '
501
4.
YL, 33477
L.OTNTA ; .- C.A,. 97253
;)3 4-.5612 L C f 5487
USE OF PERMIT
WYD w J OT 3 MAN iRli C*',P, VXERMIT D011,'3 •1 ()T 7=1111D ,BLOCK
..- .
NA OR APPROACH DR,VEWAY,
4.°13�"iOM CK3MMUC: ION 4464,04111F
PORCHYi?,ATIO MI. 00 S:Y
-
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��f' 'n V'�,RKD 4,io✓X 0 Wr�)1'i}xrA•IY..VCA�X.4JN .''w,
a' y. rySF��-:
•.q 303,445'.39),:z,
� ••t C nY03,445' ?9J,.z,i
CONi°1RUC`JOVPEE 1113-W0418-000
PLAN CHECK
A t:'•k1 R�1G 5iF,{ GTY 103.000'421••000 $130,
T1 C o t
,EC.7, TICAL YHE 101-O I0-420-000
PLUMBING FEE 101-O00-419.000 S1,997S "'
�� �-► s
t,n,'A0N t MOTION FEE - R6.31D 101 -GOO -211-000
GR.r'►,1:?Y110 FEE 101,-,000-423-0r.*
f)WRI.i PH-I•.ii'. IMPA.C'9' 1�ib'-3:
.ART 1.14 FtF131, C PLACES - RVENE 701.000.25.1-000 ��fi8.0t
SUB -1.10T41- CONEVERWffox AWYPLAX CHEM
T , •;•1<3 �R�?�3''�14'31+;E�.1��
� �;il,(2C3
. ' `A`{.1"L'k'(t`� L'�1f•',.1. ' �"�i 3t'�?-�tl�i �'�: �+�BTt�'
����63' '
RECEIPT .
DttATLBY
l_
94
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BU WING APPROVALS
MECHANICAL APPROVALS
Set Backs_
Underground Ducts
ootings
Forms & F(�
Ducts
Slab Grade 2/
Return Air
Steen
Combustion Air
Roof Deck/ �L
Exhaust Fans
O.K. to Wrap
F.A.U.
s
Framing � _
Insulation 5/llj
Compressor
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wail insulation
Condensate Lines
Party Wail Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping • ,
PLUMBING APPROVALS
Gas Test
Electfic Final
Waste Lines D/
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral_
Pool Cover
Sewer Connection /Z Q
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
TEDCBT ��/
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. : K
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm) �`
-
Certificate of Occupancy k�,
City'of La Quinta
Building and Safety Depattment,�°EoFn
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=195 NATIONAL -DRIVE'
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0101-068
Occupancy Group: R-3 Type of Construction: VN Land UseZone: RL
Owner of Building: NORMAN ESTATES II LLC Address: 501 N. AIA
City: JUPITER, FL., 33477
:. By: DANIEL P. CRAWFORD JR.
Date: 6/20/02
Building Official
POST IN A CONSPICUOUS PLACE
o0■