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LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
.,hapter 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
333118 13 10131/97
/Dal*�_Signature of Contri actor r �+
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.
�() I have and will maintain workers' compensation insurance, as required by
Sion 3700 of the Labor Code, for the performance of the work for which this
permit is'iSsEetj_�My?AJrkers' compensation insurance cJr1i'P'V fio`)iby no. are:
Carrier Policy No.
(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' comp sa� n provisions of Section 3700 of the Labor
C dle shall forthwith compl. with , se provis"
�����✓ Applicant
WfingFa: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and herebautoo e representatives of this City to enter upon
z
bove-mentioned property o inspection ppurposes.^� /ature (Owner/Aaentl A4 AA I t�I Date��iS, A
BUILDINGPERMIT
PERMIT#
CONTROL#
4(ri1(a-1;�7
3622
DATE (�%� {� VALUATION S6JJ$,N.53. 0 LOT
TRACT
— 2_ 9 44
JOB SITE
7fi:12(i t.• %i!.0 BA`►'
APN 643-20-0-0
ADDRESS .
OWNER
CONTRACTOR / DESIGNER / ENGINEER
IIAROU):'1N1J.1•%ARRIE":'f1A,RRIS
C11AS1LFS L. MARTIN
32-904 PARKS.IM DRIVE
73733 FIIC"1.HWAY lil
SAN k31i NA1)1N�) t:A w +1
PALMPALMUk:/s�F�i/�lti
C'fl9226f)
((w)p46--V)0 )0
CUit 4231
pp
USE OF PERMIT '
COMM13- kCfA1_.
i ,',MVV f)OH 3 NC, f 1NCLIYO LE f3LQCK WALL OR Pool -
(I ARA06 A1tI'0WI.' 682.0
.i�,'��"t'9.1t�€r1:t'ED CI)ST Q, V C:(.�T.Y:i'�'tt.11L'.1.10I1Y
y ry, �{A
�• �j �( Q ¢ {�{., NA
If 117 K St'INI b3AR
iERNIIJI'
i'LIN14 CHECK toffE l,t�l.-4N)�k +i3�►-31st
fM,fr71.6�
I"tt*c1r�.7"lOt�t 1 Cs1: 1 t}1l •(�/1/t)i-�I..1 R-/t�1�00
kQ.3 3�f.Syy�b
1411•,f BANICAL FUR 1F)1-(I()()-4al-(lilU
S S`T8•{ri!
1-f.f7CTRICA1, PT -C- l.tii•t}iiU-a!(i-Cl()0
$vt(it)AS
1'LUXfill NG.-'f:1ti
i:1"it�"1�fCI iC�('et3tr I li-+viaAiA1 100-000-2,11.00
$125,2.7
OR kI .! -101-I(M-4734M
$29.(as
1NFRAS'!'I4K71l'tIRVFFT' 2250044',0 42
53,760.00
. A!t'(' tl`: 1'L�f31.t�.�" 1'1..;1C'I:; • +_'`+'?1tt?t 701-.QQ(3-655.1}1)0
�..,9�.t>5
SCJ13-'t`C AL CONS'i12lUC'1'ION AND PLAN C11133CK.
$111,911-18
LESS PRE-1'AW l EES
41,1it113.00
TOTAL ,PERIlffFE[+SDIM, NOW
513.111.28
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
r=
INSPECTION RECORD
OPERATION I DATE I INSPECTOR
BUILDING APPROVALS
OPERATION I DATE I INSPECTOR
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck ,uy y�iugZ
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wali Insulation
Condensate Lines
Party Wail Firewall
Exterior Lath
Drywall - Int. Lath
Set Backs
BLOCKWALL APPROV,
PLUMBING APPROVALS
Waste Lines
Water Piping
Plumbing Top Out
Shower Pans
Sewer Lateral
Sewer onnection
s Piping
Gas Test
Appliances
4&n tid
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole 6
Underaround Conduit ,t
Low Voltage V
Fixtures
Main Service
Sub Panels
Exterior Recel
G.F.I.
Smoke Detecl
TemD. Use of
POOLS - SPAS
Steel
Electric Bond
Main Drain
Approval to Cover [
Equipment Location
Underground Electric
Underground Pibg. Test
Gas Piping �Q
Gas Test S
Electric Final
Heater Final
Plumbing Final
Equipment Enclosure
O.K. for Finish Plaster
Pool Cover I Tiri
COMMENTS: A -dWAI &%a;/V74f
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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: 78-120 CALEO BAY
Use Classification: COMMERCIAL Bldg. Permit No.: 9606-157
Occupancy Group: R-1 Type of Construction: VN Land Use Zone: COMMERCIAL
Owner of Building: HAROLD AND HARRIET HARRIS Address: 78-120 CALEO BAY
g Official
City:
LA QUINTA, CA., 92253
By:
DANIEL P. CRAWFORD JR.
Date:
11/17/97 30 DAY TEMPORARY
POST IN A CONSPICUOUS PLACE