0107-344 (SFD)LICENSED CONTRACTOR DECLARATION x
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's Exp. Date
" ' 1
B MAW(
D - P�+„"�95� nature of Contractor��"'
gA t y
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 Co.:ie).
( ) 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.
( ) J"have and will maintain workers' compensation insurance, as required by
SeIctX� 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 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' compensatinprovisions of Section 3700 &the Labor
Code`I sh 11 forthwith comply with those provisions. t
Date: ,L 2 ��A�pplicant �
Warning: Failure to secure Workers' Compensation coveragxis unlawful and
'shall subject an employer to criminal penalties•an6 civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such '
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the, building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property fir inspectlom�urposes.
S- nature (Owner/Agent) �! r1 Date
F
-•--BUILDINIG PERMIT PERMIT#
4.1
DATE VALUATION LOT W07 -.M4 TRACT
JOB SITE /
APN
ADDRESS
p/� y�y ��
2 �,q,�++�� �py ,y �,p VE
1-Wiw S AVENWnom If?.T..��ht'L.�IB AS
pry fl /� o
! /.�••Y4r,,:y-001. 5
773445-001.5
OWNER
CONTRACTOR / DESIGNER / ENGINEER
IT 1.9 +,� .fl��'�FI i I""
1719 3 7101At3.N
OCYANIN [YE CA 9 054
3 0CEO A,IrI'bl=
CA,. 9205
(76opm-006;
CWX 1955
USE OF PERMIT
f.�J�'Pt3hd+�a41!`MMf.•J..A.'�C'�Jn.'�7'
. i
SOD � 1-%F6Z' &7C3tt5 3i �� C;i.13f1i FZL.°�CKf3�11k.).y POIiL C1Tt 13C'
.�1�P1��${ CK MAS; T ER 1;., C+1?� PE N COD.F o :k&,d�—Tu
SC
24 2001
TRACT CK�A�O"fi�.p.)CTION 1,'332.00 SF
fl
PO11.CHJ'PATIO 108.00 SF CITY
F LA QUINTA
(1ARA.OFJC".ARt?ORT 460,00 3F FIN
NCE DEPT.
woou nmr, 200,00 LF
f
I
ESPt'CaWd:ED COW OF C:0TVT.9' ;TC: 10.e'+I
CUNSTRU'C1')ON FER l01-000--4•)8-000
Pk,A14 d�*HFCK EF101-000-439-318 $456.71
WCHAMCAL ME 101-000-421-000 $55,30
EL3i M'JUCALF11,Z' 401-000-420-000 $106.0
i'I..L1'MBIHO PFA 101.1000-119-000 $110.75
>'1.R.OI3O MUTIC+A VER - RESID , 101-000-241-000 $3.w
i?RADING FF'E 1011.000-423.000 ; $200
V.Z Zi.P;PfPR.114PAC;i' FEE $1,9D7.0
PRECISE P1440 101-,000-441.345 �, � 11111f1.dEil
WE, DEPOSIT I C 4 -0001 43 9-•31 {3
1(Ts_1V011.CON T'.1stUCTaCi.g. ANY.) 1111W CE:MCK
$3,380.25
LIVS3 PRE -J -1m) M.5
411250100
RECEIPT
DATE %/ BY
DAT FI
tC0
INSPECTOR
Z�'
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings.
_ ! �.�
S'
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
��� , p
S't
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
'? ..A
:4'r
Compressor
Insulation
V
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall 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 Plbg, Test
Final
I
I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
_ _ _ _
i
51
Heater Final
Water Piping
lA j.¢+—�
Plumbing Final
Plumbing Top Out
`
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection A/o
_ _
/ �T
��
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice
�yA
(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
14
=222
Utility Notice (Perm)
-
I V
Building��
Address
Owner /
P.O. BOX 1504 APPLICATION ONLY
% 78-495 CALLE TAMPICO
✓,1L�f„�L fJ LA QUINTA, CALIFORNIA 92253
Mailing
Address
City Zip ITel. _
Contractor " --IN
Aaaress
City lZip Tel.
BUILDING: TYPE"CONST. OCC. GRP.
A.P. Number /:z
Legal Description
Project
ject Description Z •
State Lic. City
�p
& Classif. %"i [f 7'� 'ate C� Lic. N
Designer
Address Tel.
City (Zip (State I
Lic. q
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to file a signed statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis
for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
1] 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, Butsness and
Professions Code: The Contractor's License Law does not apply to an owner or property who
builds or improves thereon and who does such work himself or through his own employees,
provided that such improvements are not intended or offered for sale. If, however, the building
or improvement is sold within one year or completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose of sale.)
1 11, as owner of the property, am exclusively contracting with licensed contractors to con•
strucI the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner of property who builds or improves thereon, and who contracts for
such projects with a contractors) licensed pursuant to the Contractor's License Law.)
i? 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to sell -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
r7 Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of the workforwhich 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.
Date Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives -of this city to enter the above•
mentioned property for inspection purposes.
Signature of a0plicant Date
Mailing Address
City, State, Zip
New Q:-- Add
No. No. Dw.
Stories Units
Alter ❑ Repair ❑ Demolition ❑
ltimated Valuation
PERMIT AMOUNT
Plan Chk. Dep. J
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
ZONE:
BY:
Minimum Setback
Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback fr
+* I i��—
N� TOR
FINAL DATE
Issued by:
Date i Permit
JUL 31 X01
Validated by:
'y:
Validation:
7
rlilr.Il�t 4E1'(
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
I
CITY OF LA QUINTA
�FboFo`` BUILDING '& SAFETY DEPARTMENT
.777-7012
INSPECTION REQUEST LINE
777-7153
r DAVID R. MILLER
Owner. i .
Contractor
PACIFIC TRADES ;
•
Permit Number 0107-344
POST ON JOB IN CONSPICUOUS PLACE ' \
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 51-535 AVENIDA BERMUDAS
SFD - PERMIT DOES NOT,INCLUDE BLOCK !
WALL, POOL OR DRIVEWAY APPROACH.
MASTER SAN FELIPE 98' CODE.
TYPE OF INSPECTION DATE INSP.
FOUNDATION & SETBACK
FOOTING STEEL -
i
MAIN GROUND SYSTEM
GROUND PLUMBING
PRE-GUNITE i
DO NOT POUR CONCRETE UNTIL ALL AB VE HAS BEEN SIGNED
CONCRETE SLAB / ../ 4
I
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING I
ROUGH GAS & GAS TEST
HEATING & VENT - A/C
-FIREPLACE i
ROOF
BOND BEAM
O.K. TO WRAP U
GROUT ❑ 4' ❑ 8'
FRAMING
INSULATION
PRE -ROOF I
I
COVER NO WORK UNTIL ABOVE HAS BEVN SIGNED ;
DRYWALL INTERIOR
EXTERIOR LATH I
POOL PRE PLASTER
i
SAL, FENCE & GATE
•/ S R SEPTIC TANK �� ��- Ci
FINALS _.
ELECTRICAL
! PLUMBING
FINAL GAS TEST
! HEATING -A/C
HOUSE NUMBERS
JOB COMPLETED
_
TEMP POWER
W ,
Certificatel'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
ollowing.
BUILDING ADDRESS: 51-535 AVENIDA BERMUDAS
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0107-344
Occupancy Group: R-3, U-1 Type of .Construction: VN Land Use Zone: RC
Owner of Building: DAVID R MILLER
Building Official
Address: 1719 SOUTH FREEMONT
City: OCEANSIDE CA 92054
By: KIRK'KIRKLAND
Date: JANUARY -16, 2002
POST IN A CONSPICUOUS PLACE