9910-196 (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
D\e .�� �A/" 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 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
Sec on 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. f ryT
(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.
Dlte: Applicant
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 inspection purposes.
/ �r.�
Sial a ure (Own er/Agent)%,,I- ., � Y,' <° ,,.�¢� Date r��
BUILDING PERMIT PERMIT #
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SITE
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APN
OWNER
CONTRACTOR/DESIGNER/ENGINEER
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RECEIPT
DATE
BY '°
DATE FINALED
INSPECTOR
INSPECTION (RECORD
OPERATION
DATE
I INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
p_
<
Underground Ducts
Ducts
Slab Grade—/(a
—'9
Return Air
Steel
Combustion Air
Roof Deck
a . I .
Exhaust Fans
O.K. to Wrap
_
L M4
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
f kc
Drywall - Int. Lath
3. "L-1 - pd
Final
\
Final
POOLS - SPAS
BLOCKWALL
APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
I
Gas Piping
PLUMBING APPROVALS
_
Waste Lines���—� j�
Gas Test
Electric Final
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
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)
Certificate of Insulation
Your home lies beets inwUmed with CuuinTeed Ftber&w hose] d m grodacts„ which ase &MVmed
for WWs safely standards wd tomwmWs energy rago remeaRs
Fib� is inwpudc aril tmae0 so it &a aur bane to W bwed
w" 5reaet m&m &mph AM wM hWv lose their cftmmm over tmze; It has not been bemd
with clsemisals do can vunode widug or meal Ftbesglass wdl not absorb main= nor wM it
scale ewes time as may on= insulating mumala
This alae Ontifies that CertaiuTaedPiber Gl= Imulatian bas been professionaft iastallod is this hnme
to Foville the Mawingthemoal paft=nae..
Job Name: Sonrim llrach 25953 Plan S. 4 Pham 3 4. ,
Lot No.: 67 Job Address: 79-453 Nneyo Hr:, La Quints, CA -
Ceibne Area: Ft-33 UnbQed Garage Ce-ng:
With Llv ft Above
iateaior Walk:
Overbang�: Rderior Waft- R-13 Ute
`Party Wslla: BVieh Lielog Ab°'�
SabcontraCon. Olin A on Co, Ina '
OMs, vbMW. nt= a MM (aO sago tam #40M .
Conchhe Ortiz, Secretszry/I' mmrer -or— A Scott JenRios, PresWat-or—
f Lou Merola, Director of Operalbfts.Oj*er
R means resistance le heat flow. The higher the R- value, the Wearer the jumdamg power.
Aslc your bolder far the fad thmt on R- value& Keep this cubficm with yaw other
valued papem If you ever sell this bnme, this oemficate shuut4 be passed on to the buyer.
Certificate of -Occup
an cy
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: SFD
Occupancy Group:
R3 -U 1
79-453 NUEVO DRIVE
Bldg: Permit No.: 9910-196
Type of Construction: VN Land Use Zone: RL
Owner of Building: OLIPHANT AND WILLIAMS
Building Official
Address: 77-990 AVENUE OF THE STATES
City: PALM DESERT, CA 92211
By: GREG FOX
Date: 7-31-2000
POST IN A CONSPICUOUS PLACE