0005-187 (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
69`'i 11? BIiTC
Date 0 1 '2 D1 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 SUM FUND Policy No. 467-99-0000120
(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 a Labor
Code, I s all4p fi ith comply wit those provisionss!�a^^j"i
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, 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-mentioned propert for inspectionQpu�rposes.
Signature (Owner/Agent -�"�// Date 1114-141
d
V.
BUILDING PERMIT PERMIT#
DATE VALUATION LOT �•7 TRACT
$138,SMAO 100 25953
JOB SITE
APN
ADDRESS 44-67oDo
cAuxPiActi.
bit4 2t3-0ti9
OWNER
CONTRACTOR / DESIGNER / EN (NEER
OL1PH#1`d'P ANIS W LLIAW ASSOC.; THC.
OLiPkiAtU AND WM. JA1vI.S° ASSOC., WC.
77-900AVFAM. OF TBE, �UATES
77.900 Al��'% T OF TkI� .`37I'AM
P1t.1:M DFSW T CA 92211
PALM. D Sir•:tii' Cly 9221,'1
(760)3452626 M-01 5203
USE OF PERMIT
SI14'(3L�. FAlt6IL'SC 171iv�.1.TNCI
'
S1+i>aLOT 100 PLAN 91M I? .RN1IT DOES MOT fNCLUDF. BUCK''WALL OR
POOL. ALL OTHYR. PERMITS WiLECi 7S"%o R9DUCT ICON TC.-- PLL N CHRCK
IZE FOR MULTIPLE ISSUANCE OF SAME PLAN TYPE,
TRACT CONSTRUCTION 2,292.00 31'
PORCHIPATIO 120.00 Sr
0AiiAf;1.'t!G°.ARPORT (SP) 17,504.80
ES'T1MA:= 0101 r 011' CON9=41=1:ON
138,W.40
PST 1") RE SUAS Ry
CONSTRUCTION FEE 101-000-418-000
PLAN CHECIC FEE 101 4= 439-31 $162.96
MECHANICAL M. 101-,000-421-000 $66.$8
MIX.CTP,ICAL FE2 101-000-420-000 $150.40
PLUI+, BIND FIM 101-000.419.000 $169."1
STRQ140 MOTION IEE 4 RESID 101-000-2-41-000 $0.86
GRADING ISE R 101-000-42.4-000 324.00
DEVELOPER. IMPACT FEF: S1;907.00
a
SE t TE3AA > CalmR.uC71ON Aim I'1..W amcm
$3,266.20
1MB PI 1�-P.&M TEEM.
$0,00
TOTAL MAWX MS DIMNOW
$3,2.1' 620
,RECEIPT NA INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
Set Backs
Forms & Footings
APPROVALS
40
MECHANICAL APPROVALS
Underground Ducts
Ducts
Slab Grade
Return Air
Steel
0
Combustion Air
Roof Deck
1 �� :F'-
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
S _
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final O(
Final
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
��2,Z
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
_ _
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
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)
COMMENTS:
Certificate of Occupancy
City of La Quintal
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: 44-670 CALLE PLACIDO
Use Classification: SINGLE FAMILY DWELLING
Occupancy Group: R-3 Type of Construction:
Owner of Building: OLIPHANT & WILLIAMS
Building Official
I JIRI
Bldg.,Permit No.: 0005-187
Land Use Zone: RL
Address: 77-900 AVENUE OF THE STATES
City: PALM DESERT, CA 92211
By: KIRK KIRKLAND
Date: AUGUST 23, 2001
POST IN A CONSPICUOUS PLACE