0003-121 (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
J+i.•i`12:1 tri' n � A At��tiili
Date Signature of Contractor
v
OWNER -BUILDER DECLARATIO v
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 clothe 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 Policy No.
awl' R �+r r� 1�,+•� •� .n .e enc rs�.
(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 Califol ia, and agree that if I should become
subject to the workers' compensatio it isions/,of Section 3700 of the Labor
Code, I shall forthwith comply with thr se prowsio n,'S;
Date: ApplicantY, 1/ i
. / � J i.' ,1/
Warning: Failure to secure Workers' Compen tion cove age is unlawful and
shall subject an employer to criminal penalties ind civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorii representatives of this City to enter upon
the above-mentioned property foN spection purposes.
Signature (Owner/Agent) 7 Date
BUILDING PERMIT PERMIT����
DATE VALUATION LOT
0 TRACT 2t 34,8„$
ADDRESS - w'L X31JOB SITE
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APNEA-�!!f{✓-t�
OWNER
ENGINEER
CONTRACTOR / DESIGNER ENGINEER
78-090 C Pti- E ESTI dDO S'JT 201
1ii-080 C.e3LLE E DIVD0 SM.. 201
LA QUI NTA CA 92253
LA QUINTA CA 92.253
i7�S01771.? "/ CR 1.4 W7
USE OF PERMIT
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RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
/
F.A.U.
Framing
Compressor
Insulation
/
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
6 6
Dlywall - Int. Lath
fid
/
Final
Final
POOLS - SPAS
BLOCKWALL
APPROVA S
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
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
IJ
Encapsulation
Gas Piping
Gas Test
Ap liances
IT Z
/
Final
COMMENTS:
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)
T
U �
October 9, 2000
To Whom It May Concern:
Pursuant to the 1997 Uniform Administrative Code, Section 303.4, Building Permit
Number 0003-121 issued to Marvin Homes for a Single Family Dwelling at 55-535
Royal St. George has been extended for 180 days as of September 14, 2000. This permit
shall not be extended again.
Greg er
Building & Safety Manager
C: Permanent File — 55-535 Royal St. George
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:
55-535 ROYAL ST. GEORGE
SINGLE FAMILY DWELLING
R-3 Type of Construction: VN
Owner of Building: MARVIN HOMES
-r-et., 14M47
Building Official
Bldg. Permit No.
Land Use Zone
0003-121
RL
Address: 78-080 CALLE ESTADO STE 201
City: LA QUINTA, CA., 92253
By: DANIEL P. CRAWFORD JR.
Date: 7/31 /01
POST IN A CONSPICUOUS PLACE