9910-194 (SFD)LICENSED CONTRACTOR DECLARATION
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
ate rt i® 9 Signature of Contractors
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 isnot.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:
() 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
paeormance 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.
STAT
(This section need not be completed if the permit valuation is for $100.00 or less).
O 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
,gode, I shall forthwith comply with th �se p,,rovi�r�ions
gate: Applicanil;1 ~-_
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 property for inspecttiionon purposes.
Sign ure (Owner/Agent f � v' ✓ 'n- � Date 10 If -P'!
PERMIT #.
BUILDING PERMIT�L
DATE 1 VALUATION _wt�f5�`a. LOT y� TRACT
ADDJOB SITE
RESS 44-755 C.A1,LE .1UNITA tURR,7�ARA,
OWNER
CONTRACTOR / DESIGNER / ENGINEER
e `ar f p I I •t Y,,ri" R'r.'Sl 1iYtt 7 r n'4,5�. a �: L• !'� 7 ti'
.r,., 6121 �.•.
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7;' t+J€) A'1,'ze;i4tilFs t F':i`4iis "1A!
77 4a AVENUE OF THE S NU IS
P.hUM fYES1,', RT CA 027:11
PALM 1JESE'.R T. CA. !x"221 C
CM.4 Y203
USE OF PERMIT
S114GLE FAANFILY WRLU NG
Sk 0- LCA 66, PLAN 3C: PERM 1' .3 ►C)ES 1407 MCMASIDE BLOCK, WALL OR
4'L.it L.75% I{EfJttti"A' (Aq IME 014 i NUL f'44 LE IS".�'t1AW ;,E OF SAM. : PLAN
r("YPE,
2,292.00 3r
i'uFi. ,41PATIO .120.00 St'
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UARA LYC:ARPOWl' 63S.ltt) SF'
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. Q;.CINIATED COST OF NSTR�.15:"'1.I0�'
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.$������ ��• °�
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C;ONS"I:R UC710 I FFteas 101-000-4181--t3(O
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PF.,.AN C;E€F C7K FEE !014W-439-318 8 M2.86
A 1t CHANIC:A3, M3 101-000421-000
t, iLf:C;'I..IUCAb, fiEh 1tli-tictt> <1�Cf-4X}� $f.�3f),�s33
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Ct2INDThV, F-0
DEVE110,&'.ER Imp;saCT Foi\_-
KR,r cN PfJBla f'1.Acros - Rp—sic $+9649
yw
`~l taa_7'il"i'AL (_ )M8 R1 C710N AND MAN CHECK
:?,,3Ex 50
LESS 1'RE-PAID FEES
TO'F. Af , PERMIT IT .EE+ ERA OUT, Nd')6J3''
w,362.39
RECEIPT
DATED
I E
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR.
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
%/�
d ' `a'
Underground Ducts
Ducts
Slab Grade
/7r fo
Return Air
Steel
Combustion Air t
Roof Deck
2— i'0 . CO nd.
Exhaust Fans I
O.K. to Wrap
F.A.U. {
Framing
Compressor I
Insulation
3 _,I
Vents r
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wali Insulation
Condensate Lines i
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
•
r
If
Final _ �'
BLOCKWALL APPROVALS
Final I I I
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location ,
Underground Electric ;
Underground Plbg. Test I
Final
Gas Piping {
PLUMBING
APPROVALS
Gas Test
Electric Final
Waste Lines
12,
-Heater Final
Water Piping
Plumbing Final i
Plumbing Top Out
Equipment Enclosure t
Shower Pans
O.K. for Finish Plaster ;
Sewer Lateral
2 — y— Cc
Pool Cover I
Sewer Connection
Encapsulation
Gas Piping
i
Gas Test
Appliances
Final {
Final
Utility Notice (Gas) �t
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:
E
Certificate of Insulation
Your How bas been imialated with Qjt Tlixd, Rb&glm lnmlllaticq prmhu.:tk which we &dV=d
fi3r WW's =&W 9-=&ffds and WmwroWs Cnaw TKWWM=U.
cmubLiVAP, so it does am have to be neared
with fitc,:xiWrdanf that *iRId6c am swt beem anted
chak0aft bw dkeir cffi��vt�m ithaw�
with chcmoR26 tiat can curi6de wa4im."S oriumt Famnomii -no"bswb'mm'w'm=n6rwilIit
over tumc w may 6Aik
This also cotiF= that CattinTeed NWrGim lnmlaaoirhas. been pukakndly *sWkd in this hams
t6pwWdc the following themtal p v
"Job Nimm Sunrise Tri 25953 Pbii'#.- 3 ]%aft-. 3
Lat No.: 06, Job A:d&t.m- 447S6Cage Vift'Barbra, is QuiWa. CA
4p� Area: R-38 Umfimed
hvingAbove.,
InWder Wa&:
'Party waft
(2 Wen)
Conchka OW4. -or- R Seen Jenkins, - President -or -
Lou* Merola,,- DirecOr of Operations Officer
R-== mogarme to h.cid Am no higher the R- value, 14e grealer the insulating power.
Ask your budder [or do - bd dwa on R- mduc& Keep, this cad irate 'with your other
valued papers, If you ever sell this home, lois onfificam should be pasmd on to the bqw,
z
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Certificate of Occupancy,
City of La Quintal �
E
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:. 44-755 CALLE SANTA BARBARA
Use Classification: SFE) Bldg. Permit No.: 9910-194
Occupancy Group: R3 Type of Construction: VN Land Use Zone: LDR
Owner of Building: Oliphant and Williams Assoc Inc
Building Official
Address:
77-900 Avenue of the States
City:
Palm Desert, CA 92211
By:
Greg Fox
Date:
8-3-2000
POST IN A CONSPICUOUS PLACE