0003-139 (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 forcepand effect.
License # Lic. Class // Exp. Date
tit �U1:.y .t� • P/1 � � ,� t /1317/,Ltfi
Date " Signature of Contractor
OWNER -BUILDER DECLARATIIdh
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&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 Policy No.
Sl".ATE 1440125-99
(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 ma ner so as to become subject to the
workers' compensation laws of California , and agree that if I should become
subject to the workers' compensation p visions of<Section 3700 of the Labor
4.
Code, I shall forthwith comply with tho prvisions�
Dater Applicant
Warning: Failure to secure Workers' Compens I h 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 prop:X?
spection'purposes.
� J
Signature (Owner/Agent) Date
BUILDING PERMIT PERMIT#
TRACT
DATE VALUATION LOTi
{l��
JOB SITE _ i ,�
ADDRESS 5�a6 t Otl M, .'17.x. �4�6!KJYEu—
APN w q
OWNER
CONTRACTOR / DESIGNER / ENGINEER
78 -UO CALL ESTADO 91-E 201
79.080 CALLS FSTiM. SIE. 201
LA. QUINT A CA 92253
1.A QUINTA CSA 92253
(76(1)771 ••2567 C:B1.0 . 5407
USE OF PERMIT
SINGLE .FAMILY i W-fi . LiNG
SFD- LOT i^5 FLAN 2, PERN ix,DOE5 NOT DiCLLJDE Lt: Q�.WALL Oi.
v0M, 751,.o PLAN C. HIA,'K F.HE (2 k';1:1U(:'4'1CJ_N' ON MUf.,'1'.il IX ISSUANCE OF
SAivil:: RL. AN T YPE.
CUST01ILVI <1GNM7RU-__1101N 4,716.00 SF
rokCivpKrlo &10.00 sr
(iALACiFJCARf1E). T 873.00 SF
-EST aENIATED COST OF CGFINS. PUiCT.ION
�95d09,20
PCIUMI e. FEE SiiM.11!iA.RY
CONS'i`Cd,Ue;" 1'1C3N FEE. 101-000-418.000 31,675.50
P1I1\N(;WrKrK17101-W.-439-3DP.
1,001ANICAL FEE 11-000
1tiLEC;'.i IOCAL, FEE 10.1.-000-1020-0()0 $266.52
P UN4.13f Na YEE 101-000-419-000
81'kONOMOTION FFE-RiFMO i(21•.(1f1f3- 4j-(i(S(1 Sia S7
,:• L
GIRAIDW O t r::�., 101-000-473-000 a".0.00
DEVELOPF,R (f PAC,NL FFX- $i.907.00
Art':! IN PUBLIC €I.LACES -1 ESE 701-000-255-000 15
i
fit T ,70TH
l,t"':tis rm'ms
$0.00
`j;'O`f AI.1 sr'ERMIT l+lT+E,S UCfEN6.3W
$59372.9:5
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings AVA—
Slab Grade
AN
Ducts
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
Insulation
/
o ��a
Compressor
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
–per
Drywall - Int. Lath
Final
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 -
a,
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 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: R-3 Type of Construction: . VN
55-450 ROYAL ST. GEORGE
Owner of Building: MARVIN HOMES
Building Official
Bldg. Permit No.: 0003-139
Land Use Zone: RL
Address: 78-080 CALLE ESTADO STE 201
City: LA QUINTA, CA., 92253
By: RICHARD KIRKLAND
Date: 1/18/02
POST IN A CONSPICUOUS PLACE