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0208-208 (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 86114 B I tD/3 I /x( /Date'+r' 0, Signature of Contractor'f ���- OWNER-BUILDERDECLARATION 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). ( ) 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&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: ( ),1 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 y 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 FtaO�DRCIK90 INS, Policy No. 221,.A00642 (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 the Labor Code, I shall forthwith comply with those provisions. E3ate: - r Applicant— Warning: pplicant Warning: Failure to secure Woryer`sCompensation 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 toAhe building construction, and hereby authorize representatives of this City to.enter upon the above-mentioned property for inspection purposes. ,p .i Signature(,Owner/Agent)' �+��� ��Date" BUILDING PERMIT PERMIT# DATE VALUATION Aqq gg;JJryry {{ww���,((yy LOT TRACT 1 11.e7fr4 /d'2.!50 JOB SITE ADDRESS 78-7'(9',�,j af5`AGHMUaS'.H APN 646-070-00 OWNER CONTRACTOR / DESIGNER / EN (NEER 1)AV71) SIACCtrLLC ROBE '1 MME 91-5111 EV'ICH COWT R LI 10. 74-923 IRV ] J #ix .14 MI�c () Crl�4t C°A3i�i'0N LANE, IND,UxF r I.S CA 92210 PALWI. ZinTRT CA 92260 (a SO)S36.9112 031,4 3747 USE OF PERMIT 911 Q1Y, F"RY DiATEL WO X85 S.F. SOD. PER Mi'f' DO.L'S NO'I` INC LdU )F BLC)C 'WALL, POOL Or". DRIVI-WAak"APPIWAC:f-I dJ i ACTc:ONVRUCTION %485,00 uP 1PARAOWCARP011T RCWPATIO 126.00:IF 812.00 SP ESTI3+�.f�'�: ED C 091' 01r C:Cy:IV'Nr3ZRUC<T10.'�T g�r�;g��,�y.}�.d. '�[�o [��y••�, �� T. 8'J.SdSI.s.Y.J. Y FYI 1fTf.. mumlZy r;,C?13,0TIR ICTION FEE 101 -M-41 "00 $8.23.00 PLAN CHECK FIFE, 101-000-439-318 00.86 i- E L' UOSI`I' 101.000.439.318 • 809 !! EC:HANIC:,A.L.FIX 2f31-ilQfJ-+tsi-C10© $90.00 ELIXTRIC'A L F9B 101.000-420-000 $131.92 PLUA BIAIO I+RIR 101.000-419-000 $II34.0 STRONG MOTION FF$ - RUID )01-(100-241-000 fl a," fJR.Pli7YNO IaF9E 101-000-493-000 $13.00 DEV E1141PC.R IMPACT FEX $3,403,Ot) PRECISE PI:.A14 10T-000,441-345 $!CiG.00 WB -TOTAL COIF ITPJ ' bC-°F' ON .01D PLAN CIM -'`K $4,445.05 L703 ;PRE -PAID n RU -;8.5(,100 / L Y' 0 i Af, r'' S.mmu .C.' .SsD:.. s m.;A`n .L! `6J 9'Y $4.195k..S RECEIPT DATEBY DATFINALE INSPECTO L, V INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE j. 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 Drywall - Int. Lath Final —� Final " 2O — POOLS - SPAS BLOCKWALL Set Backs Footings APPROVALS steel Electric Bond Main Drain Approval to Cover Bond Beam Equipment Location n Underground Electric Underground Plbg. Test Final Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines — Z Heater Final Water Piping Plumbing Final _ Plumbing Top Out Equipment Enclosure Shower Pans Sewer Lateral _ Q _ O.K. for Finish Plaster Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test Appliances 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) • a Coil Certificate of Occupancy 4 ISN= G OF'I 9�� Building Y p & Safety Department This Certificate is issued pursuant to the requirements of Section 109 of the California Building Code, certifying that, at the time of issuance, this structure was in compliance with the provisions of the Building Code and the various ordinances of the City regulating building construction and/or use. BUILDING ADDRESS: 78-765 SAGEBRUSH AVENUE Use classification: SINGLE FAMILY DWELLING Building Permit No.: 0208-208 Occupancy Group: R3 Type of Construction: VN Land Use Zone: ,RM Owner of Building: DAVID SACCULLO Address: 74-923 HWY 111, #114 City, ST, ZIP: INDIAN WELLS By: GARY SHOWALTER --r'" Date: APRIL 20, 2004 Building Official POST IN A CONSPICUOUS PLACE