0111-224 (SFD)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
67474
Date;e) r /, /•` Signature of Co tractor
f
V 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:
Policy No.
.Carrier 91•�?x3'1s FUND Policy
(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 Calif�qr.niarand agree that if I should become
subject to the workers' compensation provisions of Section •3700)of the Labor
Code, I shall forthW)th comply with those provisions.
Date: , F: Applicant 1':v f ttr
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 applicator 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 voidIf i
work is not commenced .within 180 days from date of issuance f, such f.
�VI
permit, or cessation of work for 180 days will subject permit to cane,ell tion.
I certify that I have read this application and state that the above infor n isn�
correct. I agree to comply with all City, and State laws relating to the b II ing
construction, and hereby authorize�jepresentativgs of, this City to en er 1 01
the above-mentioned property for inspection.pdrrposes.
Signature (Owner/Agent) Date4
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 0111 �-2`•4 TRACT
57
JOB SITE `
ADDRESS 4;9" 1140 �c;i.P'.NMO �.'U.1114714'
APN
"L `�.� �.• SJ ih '
OWNER
CONTRACTOR / DESIGNER / EN (NEER
I:.1 R:1'DRVELOIA'ME;Irf
1311.FiRX6CC3N''`i7tG'CAO,113
kC BOX 1'716
79-295 RAFTCHID LA C.�UIN TA ISR
LAQ'11�!TA; CA 92253
LA(,�131wrA CA 92253
(?6fJ)771A19,11 =Aft 2996
USE OF PERMIT
SIDE) - J, T !r, Pl.." M3. F')�ItiIllf )T i1OF.S 3100 INCLUDE I1I.Orr, l�a':f•~,LLS,
POOL, 91PA, OR DIUVEWAYAJIPROACH
k�OSl4Ciil�'�iTIO 522.00 Sr
OA€ A(WJC ",POR,T 7W.01v GF
EEO WA .^7ED >-'0 .1:' OF CO.Nt�1�i1: cnoi'�
3511398.2U)
XERA ^�` FEE �v0� ly
;
C'0�1;�`�lY'tfCTION aT� 101.000-�i1t3yiOW r1,$2;j,30
F�f.A14 CHWK l 41, 101-000-43,9-318 3C4fI.' r
1� EC;I�INICALFEE 141-000.4421-00x0 3S13(tr30
ELI C T)WI C:�.i.:i 9 101-0�t4-42(i-000
�uMB111c,9 nim - 101.4 00-4,19-000
S RONO MOT 013 17jM . ��.WID 101-00004,41-000 1:35, I4
0R,�`Dal(f'FLEE 101-000-4,23-000 $20.00
k_f?:t� KL,0PZPkPi� IMPACT FEE $J,4CIx.tsil
AR's 64 PIJI LKr , P' A,C1M iCiir:.M 270.000,445 -%fit? 5 :47
A
r it
81L)1's-7�OTA1•. C0N11'1RX CT1('t13:4XHD PLAN C1:1 1C
S4,759,05
.uEs.1 ,P'.rN1;�� a� ��� S
$0100
TUTAL POWTIM-8 DUE- NOW
$4,7555%05
q 1 ,
gmwo
BREGEIP�T��" '
DATE 7
By
DATE FINALED
INSPECT •
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
y —Z l—Z
-Underground Ducts
Forms & Footings I
Ducts
Slab Grade
Return Air
Steel i !
y —mac/ �Z S
Combustion Air
Roof Deck
_
��
Exhaust Fans
O.K. to Wrap I I
! _
--/ —
F.A.U.
Framing
Compressor
Insulation ; }=�
rsj —�2
Vents
Fireplace P.L.
_
Grills
Fireplace T.O. ! s
Fans & Controls
Party Wall Insulation;
Condensate Lines
Party Wall Firewall I i
Exterior Lath !
__
Drywall - Int. Lath IJ
r
ii
Final—
Final
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
Set Backs }'
Electric Bond
Footings ; ,
Main Drain
Bond Beam
Approval to Cover
1
Equipment Location
Underground Electric
} .
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Waste Lines �'�
�3- Z _
Electric Final
Heater Final
Water Piping}
l f_ /
��- /4
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans I'
O.K. for Finish Plaster
Sewer Lateral i +.
Sewer Connection
�--��
Pool Cover
Encapsulation
Gas Piping ;;
Gas Test
Appliances i
i
Final
COMMENTS:
t -
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)
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: 49-150 RANCHO POINTE
Use Classification: SINGEL FAMILY DWELLING Bldg. Permit No.: 0111-224
Occupancy Group: R/3 Type of Construction: V/N Land Use Zone: R/L
Owner of Building: TD DESERT DEVELOPMENT
_/49
Building Official
Address: . PO BOX 1716
City: LAQUINTA CA 92253
By: GARY SHOWALTER
Date: 09/26/02
POST IN A CONSPICUOUS PLACE