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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. gClass Exp. Date/.�
Date Signature of Contractors ..
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.
Se(, /) I have and will maintain workers' compensation insurance, as required by
don 3700 of the Labor Code, for the performance of the work for which this
permit is issued. My workers' compensation insurance carrier & olic�y no. are:
Carrier lisa`c'� a ^)U Policy No. i10u-11:±?3-�a
(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,.Rrovisions of Section 37.00 of the Labor
Code, slhall forthwith comply with-tho a provisions:-?
Date: ..r A4 '5APplicant%.'n'r'1✓»
V
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){�`'���=�dr7.. Date
BUILDING -PERMIT PERMITN
DATE VALUATION LOT 2c: TRACT
:5 11 -7 4 ",-
JOB SITE 49,525 YIPJAsILI y d'OYT�1'
APN (549 •i,.tft 1-017
ADDRESS
OWNER
CONTRACTOR/DESIGNER/EN (NEER
PM F�`i7t+1At:�SA�3C'ii",;a.,�.�-
°i"t:�a;i":3 VV4Z1,M:(yV81.tW E.AT. C
S�ti€3 MrWi S'11:,i rrl �!'i�, i 02
;3:1' 1711E. i 02
Uaid MEG0 fad, 92131
r 1A111 D'2100 CA 92131
Si,S)653«5003 _ CI -MA 4972
�'1{•/Y.v 1 .1 p9 Al Ai
USE OF PERMIT
fA1•.11 �.Mnit'Yww h tl
WALLS, P00;.t t'A,OE" DR1VI.''•+`'�,4Y AV'FIt0.AaoK $i'o=.I:I:i't3'C'.T1014 TO vLAN
CHECK FEE DUt TO r.,AWT1PLZ ISSUANCE OF amu` PLAN' TYPV
f ,
TRACT C'1.?A,`L?'AUCT10'A 2,m%ow op
PoR.C.Nmv,16 335,00 311P
ERM10144.L? f-10ST girl' (114','tNSTRUC-111Y N
3.6114111345.0
CONSTRUCTIOPFEJJr 101 -000-418-000 �9•itr:3D
PLAN CHECK k'eUM' IE7.44
MECHANICAL FIX 101.000-4.21-000 UAW
'
EL,IYiC ;'RIC.`AL FEE 10t-000-420-= 1111M.85
.
i°I.UMBINO ME 101 -00113-43 �'-000 S1t�ii,�a
Sfat(��€fr9.MlCY'PfCa" ire!L •:7 ^ 1 101_000-2A)-004 ttitii5
ORADIN0 P71E :101.0,00-423000 513.0
1D.l;VI?Z6}.PrA IMPACT FEE �7,s}it3.aL1
• � �:�w3:t�'.�.�i.�:�'��,T"tJ,'�,'.£i4Tf,"'�,'�?�"a�.1�3�i'1:.,r�AY'.���:�`:C
X4,1;°;�'.�'��i
:!:?b t'htraPiE "EEO
a;'C'E NOW
jJ I
AUG 2 7 203
CITY OF LA QW ITA /
FINANCE DEPT.
RECEIPT
DATE
BY
DATE FINALED
INSPECTO
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
w
Ducts
Slab Grade
Return Air
Steel
— 3
Combustion Air
Roof Deck
o
Exhaust Fans
O.K. to Wrap
;t•i y
F.A.U.
FramingL
Compressor
Insulation
- 9 --
Vents
Fireplace P.L.
z
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 Pibg. Test
Final
I
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
Gas Test
Appliances
Final
COMMENTS:
-
Final 141
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.
Smoke Detectors
Temp. Use of Power
4
Final
Utility Notice (Perm) G
1
Certificate of Occupancy
- f
4
Icneoin7m�� .
0 9w� Building Y p & Safety Department
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: 49-525 BRIAN CT.
i
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Use classification: S.F.D. Building Permit No.: 0308
Occupancy Group: R-3 Type of Construction: V -N Land Use Zone: R -L
' I
Owner of Building: PM RENAISSANCE LLC Address: 9968 HIBERT STREET STE 102
City, ST, ZIP: SAN. DIEGO CA 92131
By: G SHOWALTER
Date: 05/14/04 +
Building Official
POST IN A CONSPICUOUS PLACE