0111-215 (SFD)LICENSED CONTRACTOR DECLARATION
I tieret'y 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
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 V .RpUNI) Policy No.
040 M8
(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 the4orers' compensation.•11-rovdons of Section 3,700 of the Labor
Code, I shall''forthwith comply with triose provisions. »^'�
Date/ 1.:4`4 4/ 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 employees.
2. Any permit issued as a result of this application becomes null and void if ', 9
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. '
1'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 prop erfy for inspection, purposes Ig
�`) �a' r' p
Signature (Owner/Agent) Date`s ��% / ! J
BUILDING PERMIT PERMIT #
DATE VALUATION LOT ��— TRACT
U82,106.00 48
JOB SITE
APN
ADDRESS 4_13,., R
649-1W007
OWNER
CONTRACTOR / DESIGNER / EN (NEER
1A. (!%l3: fA. CA, 92253
X.FaQMTA C,& 92.233
(760)771-1941 CBU 2996
USE OF PERMIT
it l) . L0T 49 P AN I. PERMIT lXIES NOT rf4C1.fJL" F ] L0CK NYALA.S,
P004 SPA ars I3fUVEWAY APPROACH
CUSTOM (,VNSTRUCTION : X349,00 SF
PORCHIPATIO $90.60 SF
0A1iMNYCAIti'ORT MOO $ '
.Co3I8A1LTd�tO, ED 6�!/a'�`Y'--04, OY WM?1�A}�.4.CC.WA.+9.Ab4�'H
epifAaliM1&P..irat!.f
�y kr. ,�}�•�,�(p�1'yf7•r •g�l�y� j�x,,�
3: .SLN,R.11��'�i11L JIl RL�1 e7�87J?li f4VY073iX 7L
���t�a�T1�t��`r,:i�►x� �•i;� 1f.�1�OJt3�4'!�-(�L�(t ��,�0.0D
PI.MN C:HL�CKIV RQ%rCtQ(1-�#3y-31� �b��l.2�
NIEC:HA` 91CAI 1174 9140,50
XLECYRWALIME 101-000-420-000 2i .mi
PLUMSINO FOP 301-,000-419-000 S20125
S TROP+iO Im8i:y9°'YM ;2",ER - PER 101-000241 -.000 $28.21
ORADS'NG _Rty. Y Q1-f,300-423R4WO 820.00
_
O�r'ift�lr4PI1�" i"Q�i�.t'►f,:`P �'I� �i,�"i'/.D�3
MT M PUBLIC PLACE -31 R.&QFC 270-0 00-445-000 0 S20S.37
d'.°M`Q?d1'J IO[� �,A�:t"J ', AR MEM
$4,01.$0
LESS TIXE�PAW DMS
$0.00
TOTAL MOOT FEES DUE N(YW
IVA V)
5 -
••
RECEIPT
RECEIPT `
DATE ) / 1
BY< t
r
D EFINA ED
INSPE/JC/T/�y��p
rf r%
SJ -
INSPECTION RECORD
OPERATION
j
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs ; I
3- L
Underground Ducts
Forms & Footings I ;
_ z _ z
Ducts
Slab Grade i }
)5. _Z
Return Air
_
'� 3
Steel i I
—3-2—
Combustion Air "
Roof Deck ; {
Exhaust Fans
0. K. to Wrap ! ij
Z
F.A.U.
Framing ii.
j.�j -�
Compressor
L _ -
Insulation
7--
Vents
Fireplace P.L. +i
Grills
Fireplace T.O.I (
Fans & Controls
Party Wall Insulation +
_
Condensate Lines
Party Wall Firewall I i
_ _
Exterior Lath
Drywall - Int. Lath I i
-
S
ji
I
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
steel
Set Backs i l
Electric Bond
Footings ;;.
Main Drain
Bond Beam ; i
_
2
Approval to Cover
i
Equipment Location
f I
Underground Electric
1 f
Underground Plbg. Test
Final +I-%�
•�( �,
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines ] [ G ;O
3- 72- Z
Heater Final
Water Piping ; I
_ _
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans j f
O.K. for Finish Plaster
Sewer Lateral i I
Pool Cover
Sewer Connection ) i
_
Encapsulation
Gas Piping I t
Gas Test J [
Appliances ;
f
Final
it
is
COMMENTS:
11
Final
C2 -'z4
Utility Notice (Gas) I t
-=�—
ELECTRICAL APPROVALS
r.
Temp. Power Pole ! i
Underground Conduit
Rough Wiring
-
Low Voltage Wiring 1,
Fixtures I.
Main Service J
Sub Panels
Exterior Receptacles
G.F.I. ]I
Smoke Detectors I i
Temp. Use of Power.
h
ji
Final
--
Utility Notice (Perm);
"EF
t".
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:. 49-135 RANCHO POINTE
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0111-215
Occupancy Group: R3 Type of Construction: VN Land Use Zone:. RL
Owner of Building: TD DESERT DEVELOPMENT Address: P.O. BOX 1716
Building Official
City: LA QUINTA
By: GARY SHOWALTER
Date: 08/13/02
POST IN A CONSPICUOUS PLACE
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