0003-041 (SFD)t 3+tgKr�94:.1.+1�:f;YtY`1Y�d1JlCSrd2l+C1�fY35:tf.Y,.,�•• IAF^�i frif i
LICENSED CONTRACTOR DECLARATION t'
I hereby�affirm;under,penalty,of pertury,that I;am Nib
licensed under,provisGins of
~ CD ., Chapte ,+ .(commencing,with�Section 7000) of Division 3 *6f.the Business ands
fP
Wr ` r Professionals Code;'and my, License is in full force and effect
M� ILicense #s`a�ltix}'�o- '� ` �Lic: Class3 i Exp:
Vyy.V4iry=.•tr./,.�_q. ',a'�t,•, �F 1 (�[�/1 r/�(
Ya'iVw��\;i ��i R.�i .:Y y�611�✓ f"'j "'r 1'''r �RAi ..'�. B :y'.•, yl: .1f i`r09/70/.61,
o�Z r`4 Date-
0
ate Signature of Contractor
„wJ(D�;r :y , OWNER BUILDER DECLARATION''_ . .
W' W I hereby affirm under penalty of pertury.that I am exempt from the Contractor's
s�af • `License Law for.the following reason: ".
"+� " I` as owner, of the property,, or. my employees, with wages, as their sole
rr compensation will do the work, and the structure is not intended or offered for
;sale (S66.170441" Busyness &'Professionals Code)
amiexclusively`contracting with licensed
y ` xw :rcontractors to'construct;the project (Sec. 7044,"Business ", & Professionals
t+K . Code)
c') O I am exempt under. Section B&PCr for this reason
F'.. Lc� `Datrn
=Slgnature of .Ownerq0 C\I `
053,
WORKER'S COMPENSATION DECLARATION
Lo�Ithereby afflrm under penalty of perjury one'of the following declarations:
Q" I have and well maintain a certificate of consent to self -insure for workers'
,77%47s0 ( )
O) J� J compensation as provide. or by, Section 3700:of'the'Labor Code, for the
AJ,Q�y performance of the work forFwhich this permit Is issued.;
m
011 674 (,) 11 have and will . maintain workers compensation insurance, as required by
Q , t Section 3700 of the Labor Code ,for the performance of the work for which this
Hpermit Is;Issued,My.workers' compensation insurance carrier & policy no. are:
Z ti Carrer > MDEMMTY INS. Ole' Policy No. 040447650
ago l �'
s ' +Q " «(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,
1 shall not employ any person in any manner so as to become subject to the
nt workers'; compensation laws of California, and agree that if I should become
)_subtect to the workers'. compensation,provisions of Section 3700 of the Labor
3 C6
e; I shall forthwith comply with those provisions. }
,�*r Ir�lgte ,�,.., Applicant
3k ,C 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
4 } of the Labor Code, interest and attorney's fees.
- .r z • .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.
g% 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
•�,tc. 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
N t +the above-mentioned property for inspection purposes;
. IgnatOre (Owner/Agent) Fi !� / �•,:+ /./�?-- Date��
ra•� �Pr e c PERMIT#
'•�U;� �BUILDING�PERMIT�� �µ
�
a„i.i i i,T' ,' N
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K".: ..� ,;.'.., :� �,.,y _ .y+
DATE,,, ;i, # .VALUATION sy,rt n nlw'�LOT-__ . „�••s , ,�.•+;f',�'.,; RV ,TRACT�,�
S
24��0��
',►•:, ' ••iy;S6'.. r}Y1,,pp
^:� r ..�•..da,}i .':'i�aY(.;-r-, v�.�t}, etW�Q0+�V.VV,. �/f :.v►f� .
s' . ?!, �.
• t '�..f. `' OCJf/J�3'
r!2� T�-.r ,-• J�1!• •.r•,..'v±^�':`'. J -�i��- `',pr>ti ,«Cy '���r•J F�'�r,y�L�.F`.l. Y+ �.i
JOB SITE,a-.• .•`•T.ry �
ADDRESS 7-ht
APNAIq tf'r t.
T
J
OWNER r CONTRACTOR / DESIGNER / ENGINEER [a• ` i :� x
r
`
C -IrVAL PAMC HOURS INC,Ct. rrAL PACIFIC HUW.ZS
4100 MAC ARTkWR k3LVD J#200 • F 4 3 OC1 A��' t'�t7:I�Elit 'z V� W12 ,
NE PO f BEAC��i � � CA , ,,12660': ' ii 'C31,c i B ii t C A X92660
'(949)6'22_
Moo
USE OF PERMIT
SF'CD- PERMIT t' DOES NOTINCLUDE BLOCK WAL,t ' OR Pf?Of `t, t '+v
k.
8F
CUSTOM CONSTRUCTION 41838.00
PORCHlPA.TtO :: 6'70.00 SP
0A.RAGEMARI ORT 6�S.U!► IIF'= :x z' ':; 1vA .
-
f ,,
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Fs' AT.f A COSEC Ci2F COlt11:•'�i�Uarlo t. �, �.� x4—
PE']C t` FEE SUMMARY.
CONSTRUCTION FEE 101-000-418.000
PLAN GREG° FUZE 101-000-+139-318
FEE DEPOSIT 101-000-439-318
MECHANICAL PEE 101-000-421-600..'.
t I v�+ti (f•
F.LSCTRICAI,I�NE 101.000m4204000
PLUMBING FEE 101-000419-000 .
«
RESIN 101-000.2411.000 S401! � ,,i •
Sq RONO MOTION FEE • - ,0S
"I
OPADINO ?SEE 101-000-423-000 Sy0 00 t: rx Aj
�''
D sEVELOPEA IMPACT FEE ..., • -. _..� �,• >- -,_. ,;.�SS+9410® ,; :� �' ,a, s?+�',:
AP,T IN PUBLIC PLACES • R it 701-000-255-000 $73 1 3S
3
suB-a)( YrAL CC.3mmLJC."Y" -ox AmD PLA1'3 CI-4walk
i .iS 1"1 -Plal7 PW ;:'� �,>� j.5000
' .:fit r�``,`'•�' �:c�;; . '�
'M
5�".:
IAL All+ Pk"—r' :1;`nS :O'47R N OW
In
RECEIPT
DATE
BY if f
DATE FINALED ,
INSPECTOR h i t,ymy"L91 w
t? 4
__. __ ...1 ._k.;'Cs_w,y�.l"'t'xt�>r'lF^.�S•'A'�i'+�t.___. .. �_—,_...�_. _
ij
. INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs • `% - Gt3
Underground Ducts
Forms & Footings v
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck G+
Exhaust Fans
O.K to Wrap
F.A.U.
Framing(fid
Compressor
Insulation Gc1
Vents
Fireplace P.L.
Grills
Fireplace T.Q.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath . Gc3
Final
Final I
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 I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral , /
Sewer Connection =�5�� �(/`'
Pool Cover
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:
ti
JTY LA QUIN
F �'.. TA
boo -° BU
LbA &SAFETY DEPARTMENT
777=7012 .: ;
JUL 0.7 ECTION REQUEST LINE
777-7153
iC a u—F ,
fed' ApI7' -IC HOMFS INC .
Owne
ContractofCAPITAL PACIFICHOIViES INC
00 3 D4
Permit Number=
POSTON JOB'I CONSPI UOUS hLACE
INSPECTOR MUST.,,Si N.ALL A'PPLICABL SPACES
FMPE
WALLS ORPOOL
TYPE .OF INSPECTION' DATE INSP.
FOUNDATION A SETBACK
FOOTING STEELEf .1 c5e 1-0111
MAIN GROUND SYSTEM
GROUND PLUMBING
PRE;GUNITE
DO NOT. POUR, CONCRETE;UNTIL ALL ABOVE;HAS BEEN SIGNED
CONCRETE SLAB
JOISTS 8 GIRDERS
ELECTRICAL. GROUND WORK
DO NOT•POURCONCRETE UNTILALL'ABOVE HAS BEEN SIGNED
ROUGH. ELECTRIC;. "Q.
,
ROUGH PLUMBING
ROUGH GAS *& GAS TEST ' J
HEATING .& VENT - A/C
FIREPLACE
ROOF
BOND BEAM
O. K:' TO .WRA'P >c} y� l
GROUT , 0 4, . • O 8'
FRAMING
INSULATION.
PRE -ROOF .
COVER NO .WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL-, INTERIOR.
EXTERIOR.LATH
POOL PRE PLASTER
FENCE 8 GATE
EW R'SEPTICTANK G�
FINALS
ELECTRICAL
PLUMBING
FINAL GAS TEST y
HEATING - A/C
HOUSE.NUMBERS
JOB COMPLETED
TEMP POWER
ABOVE APPROVALS DO, NOT.INCLUDE RIGHT TO
TURN ON UTILITIESOR OCCUPY BUILDING'
l
I
Certificate of Occupancy
City of La Quinta
Buldn� -and . Safety=Depar.trnent
This Certificate issued puirsuantto� the "tequ-�OMen'ts of Section of the UhifbrM pildInF: �qoa�e_
comp/lance with the various ordinances
me of issuance, this structure m comp
certifying tpa� at. time
6it�. ti 1111 wing:
the re�yla fi4 building.construction or um For the
of
BUILDING: ADDRESS-.: - �-78=85.5 PINA-
Use Classifibation: SFID... bldg. Permit No.:, '6003Tr 41
Occupancy- Group: R3 Type of Construction: VN Land Use Zone: RL
Owner of Building: CAPITAL PACIFIC HOMES INC
Building Official
Address: 4160 MAC ARTHUR BLVD#. 200
City: NEWPORT BEACH CA 92660
By: KIRK K.IRKLAND
Date: - 5-4-01
POST IN A CONSPICUOUS PLACE
in