0111-225 (SFD);471 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
6174064 Jam imt
Date✓� Signature of Contractor
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
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 SUTZ FUND Policy No. 046- M. 39
(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 works s' compensatiorrpr6Visions of Section'3700 of the Labor
Code, I shall forthwith comply with,fhose provisions.
Date: K Zig Applicant
Warning: Failure to secure Workers' Compensation cove rage�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 4706
of the Labor Code, interest and attorney's fees. )
IMPORTANT Application is hereby made to the Director of Building and Saf&
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, 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 re
esentatives of this City to enter upon -
the above-mentioned property-f�r inspection purposes.
Signature (Owner/Agent)
l� �',,.. �� � .r-.r°r� Datil
y � r
4
I II BUILDING PERMIT PERMIT#
DATE J i VALUATION LOT $ TRACT
JOB SITE APN
ADDRESS •.'�. railt�i� 1� �}Y}«S
IOWNER
CONTRACTOR/ DESIGNER/ ENGINEER
M D&`MlT'D,R�%� WPNE `�*t' r SPAM Gc`�113St�JL•i ON,
TQC 1'�+C13:1716 79.295 MANCHO LA Cts, NTA DR,
L1X'QVJ. TA CA 92253 ].it QUNTA CA 92253
Q60)77-1-1941 MIJ-4 2996
I USE OF PERMIT
I J..OT S PIAIf MIR. PEPUMIT tJ0Wi Nit°r INCLIUDE B1.G.XWALIA
P001, SPA OR I1RTI EWAY APPROACH
CUSTOM C0143TRVOITION 'paw SP
PORCM)AT110. $80.00 SKS
G&RAGWARP43II:T 693,00 8P
ESJUI�.�.�. C09r Off' CO.I`1�� UC911CS� N
;2 n,106.00
+�. •�,�yr y y� ;:y�� r,t
Y
1915O'�.i'N.B.I'r.L,�.df.�ME 90AU4 MRVY
C01110TI:is01C'M AYES
101.000.4114- l.)O
SI,m'op
F'Z1�e2�f C'`sii�i" Ni:
�'pl-d100-439-:318
"m2€+4.33
M- EC1•IA'It9ICAL II<'i P.
1014-M-121 -000
$149,50
kwI
101-000-420-000 •.
$211104
i"9IUMI:SINO1r E,
101.0004419.000
�x t #2.ON0 MOTI.014 FEE . RF -51D
101-0.00-241--000
ORADING FRR
103.000.423.000
On, r11t)1lu IMPI t;;`4 Irp"S
�2, R"d.tffi
AU R1 PUI1LXO PLACM, - REHE 270-000-445-000)
:a
�t
1��11 n%F
.T7.49t� i'1i dk'Ai 1t; }
$0.00
RECEIPT
RM
� .now I .
DEC u 6 2001
BY I DATE FINALED
$4,b71 W
INSPECTION RECORD
OPERATION
11
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set BacksI[
—Z�'j—Z
Underground Ducts
Forms & Footings 11
Lf — y
Ducts
Slab Grade I
Return Air
-
Steel
Combustion Air
Roof Deck 1 I
- 3 —z
Exhaust Fans
O.K. to Wrap I1
F.A.U.
Framing
Compressor
Insulation
Vents
_
Fireplace P.L. • i i
Grills
_
Fireplace T.O. 11
_
Fans & Controls
_
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath ] I
Drywall - Int. Lath I I
Ii
_
Final—
Final I:
%-2 �o� _
POOLS - SPAS
BCOCKWALL APPROVALS
steel
Set Backs j'
Electric Bond
Footings I
Main Drain
Bond Beam I'
Approval to Cover
f
Equipment Location
I ;
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping I
/
Plumbing Final
Plumbing Top Out ] [
Equipment Enclosure
Shower Pans ;; _
O.K. for Finish Plaster
Sewer Lateral I "
Pool Cover
Sewer Connection
_
Encapsulation
Gas Piping I?.
Gas Test '
Appliances
] [
Final
11
COMMENTS:
li
Final
Utility Notice (Gas) I i
ELECTRICAL APPROVALS
Temp. Power Pole I
Underground Conduit
Rough Wiring I
Low Voltage Wiring 1:
Fixtures ;
Main Service
Sub Panels
Exterior Receptacles i
G.F.I. I }
Smoke Detectors ] [
Temp. Use of Power, ;
]I
FinalK—ld
Utility Notice (Perm) i i
(2—
i
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:
49-170 RANCHO POINTE
Use Classification:
SINGEL FAMILY DWELLING
Bldg. Permit No.:
0111-225
Occupancy Group:
R/3 Type of Construction:
V/N Land Use Zone:
R/L
Owner of Building: TD DESERT DEVELOPMENT
Building Official
Address: PO BOX 1716
City: LAQUINTA CA 92253
By: GARY SHOWALTER
Date: 09/26/02
POST IN A CONSPICUOUS PLACE