0308-218 (SFD)LICENSED CONTRACTOR DECLARATION
U) I hereby affirm under penalty of perjury that I am licensed under provisions of
1— 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 =) ch , License # Lic. Class Exp. Date
a L i010.39 t r� 1r a�Gs
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Z r-- Date 7" ;'� Signature of Contractor's%°
tog 0 f,• ���— fir` i
J
�p OWNER -BUILDER DECLARATION
LU W r- I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ License Law for the following reason:
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).
( ) 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
N Date Signature of Owner
ON
rn
Q WORKER'S COMPENSATION DECLARATION
CL
C:) 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 Y= compensation, as provided for by Section 3700 of the Labor Code, for the
m� Q performance of the work for which this permit is issued.
Q 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
tl M permit is issued. My workers' compensation insurance carrier & policy no. are:
? Z Carrier ZfTiV.11, $'i;ND Policy No. M-16.14 IiM2
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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, I shall forthwith comply withprovisions'.1',
Date: rxf''— Applicant ` w ..X/29' rr // r ✓.� ly
Warning: Failure to secure WorkersComp�risation 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 applicator agrees to, & shall, indemnity
& 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.
r r _
Signature (Owner/Agent)41 Date 1,i.C--�P
BUILDING PERMIT PERMIT
DATE VALUATION . i l.jtL4.,40 LOT 70 TRACT 29 1
JOB SITE 49-4f:S 1IRT&N C.'OU T
APN fj vii (d y
ADDRESS
OWNER
CONTRACTOR/DESIGNER/EN (NEER
PM REVAISS-MM LLC
IMA Ns wFlY 110UMIN "A W, C
99681I17awr 111 tdtiF T, um. 102
!M8 ,><WEIRT ST IT.U!" 10
SAN DIED30 CA �!213)
Sf 14IEG-0 e:A, 92131
(858)6 3-30W, C 1.4 497Y.
USE OF PERMIT
3114(31-1Z, 1t'A.tvt LY 1WTkLUX0
flM - L-15,1 AM PLAN 20. .'cuG•./:N R id CIP-15 MeT 4R`G ♦.rR. MRJ.�r .tlr a.4r�' Y ..R+f. wy
P00),,OP,A.7SIA.REDUCIIONTOPX,.ANCl SCY,
ME F.9i„rT, To MTX ti:PL&,,13313,A14CE OF 3A0411r, PLAN TYPE
TRAL'"Y' ��Cy?i'�Tf'�ll::'1'iCll� �8�3,�►t! SP
PORCHWATIC x49.00 SXR
QA.XWARIC.ARPORT MAI OF
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P1,AN, CHECK 110', lift-tii'C 4;,'9--31 S' s�3t�.13
MECHA'YlXt AL 1SE W1-000-421 -000
ZLECTR GALM 1;"k-(;,11Z�2
kit. )MBANO YEE: 101-QUQ,4`1 -000 S12c4 D
STR.O"1+io M17110141+ER - NE.,117 161- f3t3•'241-0VO pd.05
ORADWO FRE 11510
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RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air -
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
z
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wail Firewall
Exterior Lath
-
Drywall - Int. Lath
/
Final *7- Y
Final
� — -"J
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
Electric Final
Waste Lines 7IV
9-15
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
z
Equipment Enclosure
Shower Pans
OX for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
—
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
-
Final
Utility Notice (Gas) `
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring _ g�
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm) JJI-i
,- Certificate of Occupancy,
4
INcaronTm �'Cy
F'i 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: 49-405 BRIAN CT.
Use classification: S.F.D. Building Permit No.: 0308-218
Occupancy Group: R-3 Type of Construction: V -N Land Use Zone: R -L
Owner of Building: PM RENAISSANCE, LLC. Address: 9968 HIBERT STREET STE 102
City, ST, ZIP: SAN DIEGO CA 92131
By: G.SHOWALTER
Date: 04/27/04
Building Officiaf
W-6
POST IN A CONSPICUOUS PLACE