9903-303 (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
ate 't ��'^ T� Signature of Contractor _ r ms`µ 1. + _ 00
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.
(•) 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.
(This�secton need.not Wcomiple�ted if the permit valuation is for 100'00 or less).
f ) 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
Cocley(shall .forthwith comply with those provisions.
Date: / /'i�(f�rl ` 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 V
Whose request and for whose benefit work is performed under or pursuant to .1
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 ab ve mentioned property for;inspection purposes. # F
f
Ignature (Owner/Agent) :� Daterr
BUILDING PERMIT PERMIT#
DATE � � VALUATION - LOT 9903-30,1 TRACT
$321.251.90 17 2.48904;
JOB SITE
APN
ADDRESS
1945-4LI A
769.6W4117
OWNER CONTRACTOR/DESIGNER/ENGINEER
DESEIRY HOUS NIG L.LC; CXM LLIUS RESTDwrim C-:c7romUh'1'ftES,
5 PARK PLAZA. STE 40,. 5 PARK •PL.AZA, SLT1TE 400
IRVINE CA 9M4 IRVINE Cal. 92514
(940251-6100 C:ltLY 5072
USE OF PERMIT
zyn
8f D, LOW 17, PLAN 3AE 02 . PLAN CIMCX Fi~.3 RMUCi.17 75% FOR
MRR.'f WLF•.19SUANCF OF SAW, LAN'I"YPEL VERI&T IVES NOS' I•M111ou.
.
nr f'S ti '1''i it rini
CUSTOM 0C310111R.t C`1'(Ow 13,879.0 SF
POkCIOATIO 3:10.00 S
GAR.A.GEICARPORT 763.00 SF
C83111'(LA.'1'E:D COSI s<3F Ct"JI SMU CTION
321,251."
` ERNI c= rP:a 901NIAk
CONS111RU IM01+i FPX 101-000-418.000 $.1.AJ&50
'M.ANC` "UK FEE $2,39.97
+WHAN1'CAL 'FIM 01-000-42.1•-000 :1,),11.00
ELECTRICAL Ff'1? 101-000-420400 $235.03
PLUNWING FEE 101-000-419-00.0
STRO140 Nt(3TlO'NM - ES.1D 101-000-241-000 $32.13
GRADING FEE 101-000-423- S20.00
TNPRASW1JM0FM, `?25-OOf1"=i4,3442 lu.ow,00
ART :tN PU.SIAC PL.ACRS ,. RVIS i3 70;11.000-255-t10{1 $553.13
. O AL CONSP RUC'J'ION AND PLAN CHECK
PA1i'
$8,9000
LESS PRE-NUD ETES
50,00
MAY 14 1999
TOTAL PEtiilW VE:GS DUE NOW
S9,9114).01
� �1 3e.
'I® 07 � QU1'1�9TA .
-FIT
RECEIPT
DATE
BY /
DATE FINALED
INSPECTOR
NIC
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
— -
Underground Ducts
Forms & Footings
_ l -
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deckrj�
(�
Exhaust Fans
O.K. to Wrap
Framing
_
- /Q - _
, -j ?/--
F.A.U.
Compressor
y�
Insulation
(. _ �/—
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
_^t
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 Plbg. Test
Final
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
Pool Cover,
Sewer Connection
��(
�"(
Encapsulation
Gas Piping
31
Gas Testa
-At 05
Appliances
Final
COMMENTS:
C2_e C 1 (v— ,�j/-1 � f
O
Final U- Cj
Utility Notice (Gas) - Lt!
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 C1
Utility Notice (Perm)
4eplo,
j AMY OF LA QUINTA
J.BUILDING & SAFETY DEPARTMENT
MAY 14'1999 777-7012
INSPECTION REQUEST LINE
}rte 777-7153
Yp t P 4 �' n SPT.
ner DESERT HOUSING LLC
Contractor CATFi T TT4 RFS CY)N�TR , T1VC
Permit Number 9903-303
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 79-454 LIGA
SFD - LOT 17, PLAN 3AR-G2 - PERAUT DOES
NOT INCLUDE BLOCK WALLS OR POOL
TYPE OF INSPECTION DATE INSP.
FOUNDATION & SETBACK
FOOTING STEEL G
MAIN GROUND SYSTEM
GROUND PLUMBING
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN S GNED
CONCRETE SLAB
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST 0 ,
HEATING & VENT - A/C
FIREPLACE
ROOF � c
BOND BEAM
O.K. TO WRAP
GROUT 0 4' 0 g'
FRAMING
INSULATION
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR _
EXTERIOR LATH
POOL PRE PLASTER
POOL FENCE & GATE
SEWER SEPTIC TANK
FINALS
ELECTRICAL PLUMBINGFINAL GAS TES::fn H EATING - A/CHOUSE NUMBJOB COMPLET
TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING