0006-209 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
":3hapter 9 (commencing with Section 7000) of Division 3 of the Business and
ProfeAionals Code, and my License is in full force and effect.
�. License # I Lic. Class _. E p. Date
638535 11 r � 1�V1��' .
aD t O "� "� Signature of Contractor - 1
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjuryt9'am exempt from the Contra�Y2
License Law for the following reasonr
( ) 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&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.
"(x 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 :II'ATE FUND Policy No: 22999.0000671.
(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 Sion 3700 of the Labor--
Code',
aborCode, I shall forthwith comply wit��t oose ovisi0 s.
%„Bate: 12 X4.10 Applicant-
/
licant 4pl,
PP //1 s
Warning: Failure to secure Workers' Compensation coverage is unlawful a
shall subject an employer to criminal penalties and civil fines up to -$100 000in
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 th�e/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 t7at the above information is
correct. I agree to comply with all City, and State aws relating to the building
construction, and hereby ayfhorizp�representati/es of this City to.enter.upon
the above-mentioned propevy:fornspeeti.on .pose/s ?` "! ��s° ✓
t Signature (Owner/Agent) ''^ Date C/
V
� • ��' lr� G �. �'� Vii-
BUILDING PERMIT PERMITk,
DATE l VALUATION LOT x'09
TRACT
X -00 MIMM 6
JOB SITE
ADDRESS' „
}5 AVIPMDA JUa RRZ
APN
773-154.020
�
OWN
CONTRACTOR / DESIGNER /EN 1NEER
p. UIN AllWAIMS
AGEL Vflty0
P.O. BOX 450
78.080 Call Estada
Ste 204
6
IAQUINTA CA 92253
LA QT.7DTfA
CA
9225-1
(760)5(4.1866
CELE
859
USE OF PERMIT
€#Ili 4u,, Ffiaxm • I)WES T. NG
SI 13 -PERMIT DO&Z NOT INCLUDE.. RIA)CK WAU S OR POOL
TRACT CONSTRUCT10N 1,921.00 SF
PORCH/PATIO 33.00 SF
0AR OEW,A_RPOR5 (Sp) 94860.00
5 PT. 'WOOD nNC_V 200.001.1°
ESUMAIRD f.'O♦5"I' 01!' CONSTRUC370N
r�
89,12520
C014STRUCTION FU 101.000.418-000 $599,50
PLAN CHECK FEE 101-000-439-318
MECHANICAL FU 101-000-421.000 50.00
___9n 101-000-4210-000 $$X24
i�L MBINO 171 K 101.000.419.000 3110,75
�T
I�..%DINOFEE 101-000.423-000 $20.00
r n� �
'_' ,cDWE.60PERIMPACT ",9
c,
PRECIS49 PLAN 101-000-".1.345 $100.00
�
FU DEPOSIT 101.000.439-318 _$2250.00
SUB -TOTAL C014S'i'2'UCA-014AND F;L,A9 CI ffiv ;K
$3,421..56
LESS PRE -PAID FlWJ
-$250.00
TOTAL 11MVI! Mb DUE NOW
f
V3,171,6
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
$�-��%�� .gam%
Exhaust Fans
O.K. to Wrap8'�
y� S'r�
F.A.U.
Framing
•Insulation
=���
Compressor
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wail Firewall
Exterior Lath
Drywall - Int. Lath5
jq_
Final
_
/<� �
Final
POOLS -SPAS .
BLOCKWALL
APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. 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
_
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final _ y
Utility Notice (Gas) i Z�aw
ELECTRICAL APPROVALS
Temp. Power Pole 2-E-00
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)
Certificate of- Occupancy
City of La Quints
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
ollowing.
BUILDING ADDRESS:
Use Classification: SFD
Occupancy Group: R 3
51-905 AVENIDA JUAREZ
Type of Construction: VN
Owner of Building: LA QUINTA PARTNERS
�d!j" l
Building Official
Bldg. Permit No.: 0006-209
Land Use Zone: RC
Address: P.O. BOX 450
City: LA QUINTA, CA 92253
By: STEVE TRAM
Date: 11-22-00
POST IN A CONSPICUOUS PLACE