0111-217 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
cti.4iter 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
:E31LAt»�,,,---"�
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
1
( ) 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 ,STATE YUNa Policy No. 046^t wn,,'n
(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 thepworGrs' com pensatio�n,rpr-6'0 sions of Sectiop'-4.- 00 of the Labor
Code, I shall,fort6iwith comply with those provisions.
[Date: l(. {,8 Applicant-
Warning:
pplicant Warning: Failure to secure Workers' Compensation coverageriswunlawful .yand
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. r
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 nulluand void if
work is not commenced within.480 days from date of issuance�ofks'Gch"
permit, or cessation of work for 180 days will subject permit to 'cancellption. rr
I certify that I have read this application and state that the above it
correct. I agree to comply with all City, and State laws relating to
construction, and hereby authorize representatives of this City to
the above-mentioned property; -for inspectton purposes.
l
Signature (Owner/Agee - 1 Date
V
BUILDING PERMIT PERMIT#
DATE VALUATION LOT OIL II_211 TRACT
If 50
JOB SITE
APN
ADDRESS 491.RIAN SHO MU
64.10%400-007
OWNER
CONTRACTOR/DESIGNER/ENGINEER
1:D DE���".iit rDW 11.0,11 N 11
OWK113 ("i`iNIMP0011.II.ow
PODox 17; 6
! 9.295 RMC110 LA t�e)R i"iA DR,
LA QUINTA Chi 92233
LA Q','.WrA CA 922
(760)771-1941 Mui 2996
USE OF PERMIT
S,M a LOT ;101f') AN ter IRL P MUTDOES NOT IN L,UM H1.,0CK1WAL.?_y
P004 PA,ORMwMEVAYr'1PPMACH
C:6JSTOM C0143°1RUCT1014 5.4393,00 SF
PC'3t+tMUPATIO 590.00 3p ^
t1<AAAMCAR1AC?R`1' x:3:00 3F
�1
��niT�3�, ITT42) Ci'osr OFC0.11i�.j��TJ�:`.! IOX
2$2,10coo
y,. `[�j�� ��Y-pI }f�l'P� {£ e�l�{'��'(!�}�
mty
Cf9M71'RUC71.10M'ME 101.-000.418-000 sj;nom
PLAN CPitsJC'3::ME 101-000-439-318 $26-4.23
MEC"aW11€W,111M, 101, t000•421.'•C)c $.4011,90
d?LEICTIUCIAL Fkys 101-000-420-000 021104
11I(A31NGFLE101-000.4419-000 $Z0S
iS1OLHO rvOTIOvr FEE -G Y2 $296
O11AW90 :FRIE 101.1000-4423.000, $20.00
Dl WLOli PR 1Mf'.(1CT ME $1,407.00
AWC IN Prr� ICC PLACEW - REM 270-e910-443-000
4
s4
SuB-`.�1�'j'All, C}Ot3METC'j-50,11 PJ9D�P�'9I�.,AW C� HECC'V,
$4k211,50
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of LA
"RECEIPT
DATE ,
ell t
BY
T'��•:�'
DATE FINALE 7
SOC_
INSPECTO
._
rJ
INSPECTION RECORD
OPERATION
DATE INSPECTOR
OPERATION
DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
/0 - Z 4
Underground Ducts
Forms & Footings '
,tom .
Ducts
Slab Grade
-%s -
Return Air
Steel
{rr /� - �j
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
�2 Z
F.A.U.
Framing
_�_
�. _ _ _
Compressor
Insulation
_ Z
Vents
Fireplace P. L.
Grills
Fireplace T.O.
_ _
Fans & Controls
Party Wall Insulation
Condensate'Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
��
Final
Final
- /9-"O
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
Footings
,i —zz— Z
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Waste Lines
Water Piping,
3
Vf ,,�_ _
Electric Final
Heater Final
Plumbing Final
Plumbing Top Out
1
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral]
Pool Cover
Sewer Connection
!iv
Encapsulation
Gas Piping
—
Gas Test
Appliances
Final
COMMENTS:
Final
/�— -
Utility Notice (Gas)
�i
ELECTRICAL APPROVALS
Temp. Power Pole
- 6,2_
Underground Conduit
Rough Wiring
_
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles'.
_
G.F.I.
_
Smoke Detectors
ley
Temp. Use of Power'
Final_
Utility Notice (Perm)
P1
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: 49-095 RANCHO POINTE
Use Classification:. SINGLE FAMILY DWELLING Bldg. Permit.No.: 01.11-217
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: LA QUINTA CA.
By: GARY SHOWALTER
Date: 09/18/02