0111-220 (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 # Llc, Class Exp. Date
67464 T11� ' " . ^' t�7131 /2C
Date* Signature of Contract r r
/ ; . , f 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).
( a,) 1, 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&RC. 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, STATE4�f�'OD Policy No. M6 bUti�3:38
,.(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/worers' compensation, provisions of.,Section 3700 of the Labor
Code, I shall4orth.with comply/with those provisions.
Date:; ' - ' 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, indemrify
& 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 cf suc
permit, or cessation of work for 180 days will subject permit to cancellatio . ",
I certify that I have read this application and state that the above information i
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 proper for inspecilonNurposes s s; ,+
Signature (Owner/Agent) �'f -^-"D te'+ '
' r!
BUILDING PERMIT PERMIT#
DATE VALUATION LOT Ol-11__'12 i TRACT
-: . /+ / >• a 110115.00 53 2?457•
JOB SITE -
APN
ADDRESS 49-0701?ANCHO 1'0VTrE
(49. -MV -00-7
OWNER
CONTRACTOR/DESIGNER/ENGINEER
t'L7�1�1: Imo' MM OT`MENT
9PARKS C l Xi iJ'_"a"TCiN
PO BIOX 1716
79-195 WT4CM0JAQUJNTADX
1A QMiTTAA. 92231131
l Aq=-rA, CA 921253
(760)771.-1941 031.01 2996
USE OF PERMIT
SLOT 33: PLAN 31x] 1, 11`it RN11`i'.' DOES 'NOT 610,UDE 1H, 0CK 'W A U,3, .
POOL, SPA. Opt T' SRkVZWAY+!`►P€'RCD.r CH
f.
CUSTOM CONS'> RUCT101J ,3,"„5.00 SF
PORCHIPALTIO 5$0.01) SY
'
GAIL GROCA,RPORT 69.1100 OF
fMAMBM CCS 010 C;0ygS9RUCn01q
1��:�bp►-
F 1 1UdT. ' .1✓u`lti�.Jr yT0. .RSYYJ R $
CONSTRUCTION RUCTION 101.000.411 8_000 51,280' ?D
PLA14 (13iFICK IVIS 101 -b00 -4 -RP -318 18 :264. R:3
MF,Ct:%141'A1,, E 1014000,421 -M) $149.10
Ki='TICA , fO 101-000-420-000 $2! 5,04
PLUM81NO FFZ 101.000.419-000 $202,25
J'7"W140 MOTION FAE -12. X0 101-000-2 41 $13.21
OPADDIG FRY 101.000.423.000 $20.00
1XV710PER IMPACT MR
ART 1W PUBLICS k'ibACM-1$l!,:s`1jC 270�000-445�-000 t110S.27
C ANST.ELLTC""1.ION AM P{{1dd�sX��Cqy'++}���t.�;{IryC�
,2"yyi./1.50
�
�7 u113 PREP S -14
y,9
tlT,6!!m .Y
TMAL FMMIT VENN WE NOW
Cid�Of-LAN 211d�i;Yi�
g,��;.��T• r
RECEIPT
DATE ' ° "+ BY
DATE FINALED
INSPECT
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
-OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
-1 _ Z
Underground Ducts
Forms & Footings
Slab Grade
_
L� �- �� — L
Ducts
Return Air
/ _ -
Steel
_
Combustion Air
Roof Deck
���_� -
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing x
— _
Compressor
Insulation
Fireplace P.L. n
-
Vents
Grills
Fireplace T.O.
®�
Fans & Controls
Party Wall Insulation
/J�
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall -Int. lath ��
C��- //
;*
Final _=-
BLOCKWALL APPROVALS
Final
I(v- 2
POOLS -SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
6 3 -
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Waste Lin
Gas Test
Electric Final
Heater Final
Water Piping
Plumbing Top Out
/�
Plumbing Final
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
3- 22r - L
Encapsulatiorl
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
'
-
Final
Utility Notice Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground CondLit
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:
Use Classification:
Occupancy Group:
SINGLE FAMILY DWELLING
49-070 RANCHO POINTE
R/3 Type of Construction: V/N
Bldg. Permit No.: 0111-220
Land Use Zone: R/L
Owner of Building: TD DESERT DEVELOPMENT Address: PO BOX 1716
Building Official
City: LA QUINTA CA. 92253
By: GARY SHOWALTER
Date: 09/06/02
POST IN A CONSPICUOUS PLACE