0111-216 (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
Pibfessionals Code, and my License is in full force and effect.
License # Lic!Class y Exp. Date
Date ` .{ ��r Signature of Contractor �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:
( ) 1, 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 OTATE E FUN.D Policy No. 046-0001M
(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 provisions of Section 3700 of the Labor
Code, I shallsforth4ih comply witKthose prov�isions.
Date-,/- i _Li 1�.1pp r .•
A licant`
Warning: Failure to secure•Worke&s' 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 appli :atop 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 hereby authorize representatives of this City to°enter upon
the above mentionedpropertyfpr inspection purposes.
Signature (Owner/Agent) r'� f r Date's
,w (
BUILDING PERMIT PERMITk
DATE VALUATION LOT •� TRACT
_
49 294,57.2
JOB SITE
ADDRESS : 115.�iV�.ANCHDPOWTE
APN
649-100-007
OWNER
CONTRACTOR/DESIGNER/ENGINEER
BOX 3 716
79-295 RMCTIC)
L.A.PO
Q.UZrrA CA 92.25:3
LA Qt3i ..A CA 92233
(700)771 1941 CBV,,,' 2996
USE OF PERMIT
VV - WT 49 PLAN 10. PLJ2.1+UT %3S:ES NOT fk4Ct rj CDelG.IC*,, WAL;L4
M,X, SPA OR I?RWRWAY APP RO,r X-34
CUSTOM CONSTRUC TIO11 V443.00 SI!
kORM6?i1,TIO 3eiif, SP
0ARAW4:ARPOM. 11p.a0 or
C Fire 13«r1���•.t�a ���.at.<�
1=1.,;AW CHECK ire. I 0 _000-4 3 8 $308.3
MECHANICAL VEE 101 •.000.4.21.000 $116,60
Xl"e 1TRIC A1.. 6t'&Z 1531-000.4 €i-DOO $246.71
PLVAMBING i?Fi? 101 <WO.419d, 00 WS100
S `3'1#,iJXID .UO TION FEE - R ID 101-000-24-1-000 $35.14
ORAI RIG EPEE, 1014300.423.000 120.00
)EVEPWIT3Z 1MPACY FEZ si090,7.00
-ART 114 PUBLIC FLAC
4
�. -T SM.L1C,°AUM AND Irl–W CMIX
�T`3e3 PRE FEES
$4,6159.03
$0.00
2x01 -ni mrr irns now
6
' t
RECEIPT
DATE
B s
DAT NA
INSPECT
INSPECTION RECORD
OPERATION
It
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
' APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings ; i
=3 _ _
Ducts
Slab Grade
zj
Return Air
Steel ).{
_
/�= )__2_
Combustion Air
Roof Deck,
A.O.K.
Exhaust Fans
to Wrap 11.
�/. _ _
F.A.U.
Framing 1 i
Zy _ Z
Compressor
Insulation
Vents
Fireplace P.L. j I
Grills
Fireplace T.O. ) {
_
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall 1
_ _
Exterior Lath
Drywall - Int. Lath
Final
Final
L
POOLS -SPAS
BLOCKWALL APPROVALS
steel
Set Backs i
Electric Bond
Footings I ±
5 - / % - Z
Main Drain
Bond Beam I !
Approval to Cover
i
Equipment Location
1 {
Underground Electric
1;
Underground Pibg. Test
Final t
Gas Piping
PLUMBING APPROVALS
Gas Test
Waste Lines
_
Electric
Heater Final
Water Piping i
_Plumbing
21Y Z
Final
Plumbing Top Out i;
��
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral ' 1.
Pool Cover
Sewer Connection
Encapsulation
Gas Piping 1 i
_ _
Gas Test
Appliances I
Final
i1
Al
COMMENTS:
J ���✓
Final
Utility Notice (Gas) I
-
ELECTRICAL APPROVALS
L3
Temp. Power Pole i;
Underground Conduit
Rough Wiring
C51 -I- -21
Low Voltage Wiring +
Fixtures [
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
'i
Final
-
Utility Notice (Perm)
�f •- _
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: R3 Type of Construction
49-115 RANCHO POINTE
Owner of Building: TD DESERT DEVELOPMENT
—dry
Building Official
Bldg. Permit No.: 0111-216
Land Use Zone: RL
Address: PO BOX 1716
City: LA QUINTA CA 92253
i
By: GARY SHOWALTER
Date: 09/03/02
POST IN A CONSPICUOUS PLACE