0111-212 (SFD)LICENSED CONTRACTOR DECLARATION
I herebylaffirm 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
6740,P, n MQ--', 01M 1 /W
Date -�+ �� d/r Signature of Cont�acto�
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).
( ) 1, 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 8T,ATip 1S'$IND Policy No. 0406.00if7338
(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 plovisions of Section 3700,of he Labor
Code, I shall,forthwith comply with those proviel'otls. ,.'
Date: Applicant
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 employeesk.A
2. Any permit issued as a result of this application becomes null and void if 'll
work is not commenced within 180 days from date of issuance of sucli
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 1'Apectiorn,pu1rposes:'?
Signature (Owner/Agent);" v Date
BUILDING PERMIT PERMIT#
613, 1-3112
DATE VALUATION LOT TRACT
.tbl] 45 29457-2
-? f.. r / ixa
JOB SITE
APN
izmm O.+c .i S�1,�.va� .
ADDRESS 49-i �A
649 -IOD-00I
OWNER
CONTRACTOR/DESIGNER/EN (NEER
PO 7K11);K 11716
79-295 FANC;1:10 LA c:U&ITA MR.
LA t, UIW TA CA 92253
LA QIUMIA CA 92253
(760)771.N1941 Mui 2996
USE OF PERMIT
ALMA TaALY x?I ,13Ct
'
S11D . LOT45 PIAN f42.' PI{:i IT VOFS NOT 'INCL=9 BLOCK WALI.A
C00TOM OC.§NSTRUCTIO14 :%343.00 SF
FORCHIPATIO 3E0.00 SP
iTA.1�nOk+.tia',A:#t,POP.`F . la3,0t� sS�
.9S'1 d1 YRD COST OF t:,'OT+TiSEf UC'MON
28.211 6.00
Pkk'N!` T Ti'R.
CJt: NU l'll,.i3c':' ION FF—Et 101.000.418.000 3050.00
PL.AN CHECK FE'S 101-00"39-31€3 $26.4.23
MECHA1414"AL FE E 101-000421-000 $10A
i!i*.L ECTRICAJ "Qf, 101-000-1210-000
P111101491140 re"Iry, 101.000.419-0130
3TRGN0 MOT1011)I=mo . R01D 101-000-24) -000
0fdAD040 YES 101 d000b413-NO $20,00
DEVELOPER 3MRACT ",21, $1,497.00
ART D1 PUBLIC PLACES - RU311270.000-445.000 520547
$4,271.50
C OTM, 1?y"J7'ZPFEES DUE, NOW
94,27L50
nuc o 6 2001
Qu INTA
cffyof
FIL �Y""P11
RECEIPT
DATE - ? tr
BY"
DATE FINAALED
/
INSPECT
I
INSPECTION RECORD
OPERAT ON
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
a 7--Z
Underground Ducts
Forms & Footings
-
Ducts
Slab Grade
L� _ 1- OZ _ _
Return Air
e
Steel
3 -a2
Combustion Air
Roof Deck
2�9
Exhaust Fans
O.K. to Wrap
_ _
F.A.U.
Framing
- /7 _ Z
Compressor
-
Insulation
_
=�Z-
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Party Wall Insulatior
A
=
Fans & Controls
Condensate Lines
Party Wall Firewall
/
MQ
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 Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines Cj�
� _� L
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
_r
Final
COMMENTS:
Final.
-
Utility Notice (Gas)
_
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduct
Rough Wiring
Low Voltage Wiring
-
Fixtures
Main Service
Sub Panels
Alf—
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Z
Utility Notice (Perm)%3v
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: SINGLE FAMILY DWELLING
Occupancy Group: R/3 Type of Construction:
49-195 RANCHO POINTE
Owner of Building: TD DESERT DEVELOPMENT
Building Official
v MAI
Bldg. Permit No.: 0111-212
Land Use Zone: R/L
Address: PO BOX 1716
City: LA QUINTA CA. 92253
By: GARY SHOWALTER
Date: 09/06/02
POST IN A CONSPICUOUS PLACE