9706-128 (SFD)U)
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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. Class Exp. Date
674074 B 781 i9 7
/ate , ��`� � '/Signature of Contractor,,
/t 01
OWNER -BUILDERS ECLARA ION
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.
() I have and will maintain workers' compensation insurance, as required by
Section 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.
S TA`1"E Ft`tl'N'D 0710!696
(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 those provisions.
VDate: + * ; ^ •r Applicant
Warning: Failure to secure Workers' CompePsation coverag�Js unlawful and
shall subject an employer to criminal penaltie's 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 AO
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employee§.
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
th`e above-mentioned property for inspection purposes.
,/Signature (Owner/Agent) f .' f r,!' / F.
BUILDING PERMIT PERMIT# CONTROL#
+97416-1.28 5402
DATEI
VALUATION S1',LOT TRACTJOB
SITE 1� r1'1, 3�'r
ADDRESS 78-616 �;l�.ib:l1MLO d�'A �
APN z t�q=1 of
6464G0.0
OWNER
CONTRACTOR/DESIGNER/ENGINEER
T1)1)FSFTr 1)8VEL 0FMi,!I<t' .A.)
Siat3RKS CONS' RUC.31014
PO 13OX 1.71.65
79295 RANCHO LA QlJ.iNITA DR.
!,A• (,Tt„IIA1'Tt\ C11 92.253
LA. ()U!N''f..A CA. 92.253
(760)7714941.. CRL# 3
USE OF PERMIT
SV1
S�i� - i;%,'d :31.i `!'.f�ttltil�.�1.I3.I>lC�r 1. iyf.A.►�f t'•13"r,C'1:. F�i..C�I::I<iLfCi"st.J tai' '7!w,e
t UISI'F'014ECONS'tfi,laC11110H d.2:3.►.m Sf�
A IEE�f3ilaA`C,tr`9 %:O.U(f SP
GrARAMC:tliR13ORT 486.00W
ESTIMATED COST of E;CDmivucrt.oN
(1110411• MCI :SIRUMARY
pi. AN CIMCK PrIt $714.54
V.014M.'R,!K.-rT0'N FEE S94030
14iEt;,'2;3AN1.0 AL t•11i 1tf l.-fi0p-1� �-000 Sl+F3,�®
ii liclf`l2lcw, t. "88 .10-000420-000 $167A1
f>t OF&1't3fW; FFX 01. -OW -419.000 !142.04)
14T0140 M.iRON 1TV-1-R1 SID 10141IO-24.1 ^000 S M516
GRADING F FI: .101-000-423-000 TZO.00
1nft�kA.�`t'ittit,'I�t��� ct„li �1�-C/t7l-d�3-3d'2 �t,l:A.7t
ART W 1'1011'.!x' PLA+'T S - $213.15
PT AN C1'I.ECK FM' 4580.91
(ANT, C'ON 9fItUC"f ION ANO PLAN C1 ECS
y� ± LESS i RE-PA:ICI FEES
$6,5(N) 57
4580.91
�L 1.41991 TOTAL, Pr;RM1i-ir:wEES 103F. NOW
r” L-
l-}o�° f�.,..
RECEIPT
DATE
BY v
DATEPUALE
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs - G
Underground Ducts
Forms & Footings —
Ducts
Slab Grade /,/�
Return Air
Steel
Combustion Air
Roof Deck 1p- -
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
Compressor
Insulation (. -¢j
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
J.
Final -
BLOCKWALL APPROVALS
steel
POOLS - SPAS
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground PI . 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
O.K. 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:
76 i
HVAC Permit Checklist
Comfort Consultant (RSP): V EF-7
Service Order #:
Owner's Name:
Jobsite Address: T 4 616 aN-BT,?-J LLD
D L04C./
LA- Wi Nam- o.o25-_,-3
Permit Application Declaration Page:
❑ Commercial residential
,4ingle family residence ❑ Multi -family residence
❑ Condominium ❑ Other:
Name of Community:
Location of new unit on/in structure:
Plot plan required?:
Line of sight — screened / parapet / distance from lot line:
Components to be: ❑ installed Xreplaced: "like for like" or upgrade? (circle one)
}� X Condenser Size (tonnage):
I FAU / Air Handler SEER: 1�0
�l �xEvaporative Coil XE, ER: 13
❑ Package unit - PGE or HP
❑ Other:
CF-IR-A Form:
Project valuation:
Date Permit Needed at Jobsite:
Other Information:
Certificate 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 ADDRESS:
Use Classification: SFD
Occupancy Group: R3
78-616 CABRILLO
Bldg. Permit No.: 9706-128
Type of Construction: VN Land Use Zone: RL
Owner of Building: TD DESERT DEVELOPMENT
Building Official
Address:
P.O. BOX 1716
City:
LA QUINTA CA 92253
By:
KIRK KIRKLAND
Date:
1-20-98
POST IN A CONSPICUOUS PLACE
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