0308-216 (SFD)LICENSED CONTRACTOR DECLARATION
,=ad,hereby affirm under penalty of perjury that I am licensed under provisions of
Ir- Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
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W Professionals Code, and my License is in full force and effect.
O J M License # Lic. Class Exp. Date
r- LLJ
oZ r-- Date Y— Signature of Contractor �I 1� !!T; ,!�'�' �;4
� OWNER -BUILDER DECLARATION'
CD
Hd I hereby affirm under penalty of perjury that I am exempt from the Contractor's
U) 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
O)
Q WORKER'S COMPENSATION DECLARATION
C) Cc I hereby affirm under penalty of perjury one of the following declarations:
p () 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
m_ Q performance of the work for which this permit is issued.
Q () ()f I have and will maintain workers' compensation insurance, as required by
b U Q Section 3700 of the Labor Code, for the performance of the work for which this
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permit is issued. My workers' compensation insurance carrier & policy no. are:
? Z Carrier :`i' AIIT' FUND Policy No. OKI-10P,11_11ro
M 5
V
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 with'l5o�e�ovisions:.1 ,.�� �' f
Applicantva.�' 0/.. (
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) �� %� u� . ✓ri � Ar = Date 2, ^ �`
BUILDING PERMIT PERMIT`-��
DATE VALUATION S3.6(}'464.40 LOT, ?Tj TRACT $Usk^
JOB SITE 49-191n BIUAIVI Cr,7'DRr
APN
ADDRESS
OWNER
CONTRACTOR / DESIGNER / ENGINEER
PUM ZtliivAAMA17(w'V U. C'
TRAMS,1,ATST3 ��i�a ±I�i � 114C
i 960 E'1�n IZ17�7' Jam. r,"'1.7"x, �s•'.1':. 107
99013 :I'HY31p°.RT UP MM. 102
0ANT ii3IE<10 GA, 92131
s4.�A1dn\%J3:�"c3.tf^r^•� CA 9TT'21L 31t2
e ,,99
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USE OF PERMIT
M N161:y, FAp> Wl, Y'' 1) Va':i;:i .:iA G
3.R lk • N/! 1 i! .JY:eN
FOOL, SPA, 0R DRIN1 MAY APPROACH, , '7P U-1 stlC'1' O 1 '''d PuV4 G'°eiz °@ ,
FEF DUE 70 MIN.•'IgR8 i. -MILIA Jfv:P., OF I IPI..AN TYPV
P-OtZMPA`f:D :1
L.6&T OF 0..-Ri.C81TMd.-fCCJ 01
160, 4A0
AydLr8TTJ.O.6fS.LA1.P./'-
t1,e 0 -4 -fir, aA tr !to
301-900-4-18-000
PLAN CHKC11'.`9 0N,111
INLR:;M.'A2' ICIAL101.000.42.1.•fif;C)
_VL..rZTR.1C4`L.;ft,2 101-000-420-000 iws2.
PLUMBIM0 PRE 101-10300,41 �e-000 M030
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3UONO 1010TXe 'PO, - YtUID 101-600-24.1-000 16.05
ORAV4140 01419 1.034�`.004ZIdC'00 WIN
S,30-*KiTAL CC' sRXMTTMICK AND P�l�y�tt A
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• ® dAltr:.LjSY�J:.4 �}'A�wM1�fJ DUE NOW
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C17Y OF iA6�Z,11f.'�•h` /
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F19�9AN
RECEIPT
DATE
DATE FINALED
NSPECT
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings _ - zs- 7j
Ducts
Slab Grade /
Return Air
Steel _ .7- 3
Combustion Air
Roof Deck --
Exhaust Fans
O.K. to Wrap /p p
F.A.U.
Framing
Compressor
Insulation ®
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final 1 Al -
Final
BLOCKWALL APPROVALS
POOLS - SPAS
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
OX for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection -
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
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
Final _
Utility Notice (Perm)
COMMENTS:
Certificate of Occupancy
4
—DW-Mox!
C OF'TYBuilding & 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: 49-390 BRIAN COURT
Use classification: S.F.D. Building Permit No.: 0308-216
Occupancy Group: R-3 Type of Construction: V -N Land Use Zone: R -L
Owner of Building: PM RENAISSANCE LLC Address: 9968 HIBERT STREET STE102
"City, ST, ZIP: SAN DIEGO CA 92131
By: G. SHOWALTER
Date: 04/29/04
Building Officeal
POST IN A CONSPICUOUS PLACE 11
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