0305-269 (SFD)LICENSED CONTRACTOR DECLARATION
f'. C/).I hereby affirm under penalty of perjury that I am licensed under provisions of
I— Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
04
W Professionals Code, and my License is in full force and effect.
p = M License At Lic. Class Exp. Date
o Z r` Date -„' CA Signature of Coriti•a.. ,
(O
_J w OWNER -BUILDER DECLARAT ON
W a I hereby affirm under penalty of perjury that I am exempt from the Contractor's
U) License Law for the following reason: J
Z_ ( ) 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).
( ) 1, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
M () I am exempt under Section
D7 B&P.C. for this reason
N Date Signature of Owner
ON
0)
a z WORKER'S COMPENSATION DECLARATION
C) 2 Z I hereby affirm under penalty of perjury one of the following declarations:
LO O () 1 have and will maintain a certificate of consent to self -insure for workers'
X W compensation, as provided for by Section 3700 of the Labor Code, for the
m0 J Q performance of the work for which this permit is issued.
Q C) (+�)' I have and will maintain workers' compensation insurance, as required by
O U Q Section 3700 of the Labor Code, for the performance of the work for which this
LO
H permit is issued. My workers' compensation insurance carrier &' olicy no. are:
? Z Carrier STAJE Pt ND2 Policy No. G(111-si��4 Iii;! -fit
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J (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'
shall forthwith comply with ttiose.provisions.
Date: f ;� �•. Applicant _ _• f- __ .�,
Warning: Failure to secure Workers' Compehsation/coyerage is unlawful and
shall subject an employer to criminal penalties and,6vil 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 a,
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""s made & each person at
whose request and for whose benefit work is perfcWmed 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
�% '4 construction, and heieby authorize representatives of this City to enter upon
the above-mentioned -propbr y for inspection purpos. s._ ,
Signature (Owner/Agent) .� "<` " C Date L_,�:;`
BUILDING PERMIT PERMIT”
DATE VALUATION LOT ZS TRACT 2-9053-1
JOB SITE
ADDRESS fl �Ji �1♦lavZe�) ,.R� ±�
APN f;.!4' - G30-020
OWNER
CONTRACTOR/DESIGNER/EN INFER
201411.. ••1 DDIGO C12 9,2131
SAY10V[1u'r1"J CA 92 13 1
USE OF PERMIT
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$7,405.60
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4750,00
JUN 0 2 2003
CITY OF -LA QUINTA
FINANCE DEPT. "
RECEIPT
DATE
fir"- • c'.r'�
BY 3
1�!� A-(
DATE FINALED'
� '� �O
INSPECT
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
-/7- j
Ducts
Slab Grade
aQ- cp A
Return Air
Steel
Combustion Air
Roof Deck
-7— —
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
Final
Final
BLOCKWALL APPROVALS
steel
POOLS - SPAS
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
6. - ,3 ..
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Z4Equipment
Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
:5.
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring - p 4_3
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm) —/� -
COMMENTS:
t
Certificate of Occupancy
V = II,,II
• ��N��
OFTBuildin & Safet Department
9► Y p
This Certificate is issued pursuant to the requirements of Section 109 of the California Building
Code, certifying that, at the time of issuance, this structure was in compliance with the
- provisions of the Building Code and the various ordinances of the City regulating building
construction and/or use.
BUILDING ADDRESS: 49-585 BRIAN COURT
Use classification: S.F.D. Building Permit No.: 0305-269
Occupancy Group: R-3 Type of Construction: V -N Land Use Zone: R -L
Owner.of Building: PM RENAISANCE, LLC Address: 9968 HIBERT STREET STE 102
City, ST, ZIP: SAN DIEGO CA 92131
By: G. SHOWALTER
�! Date: 01/13/04
Building Official/
__ POST IN A CONSPICUOUS PLACE