9910-197 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that 1 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
697117 B 10/33�l/j2(X
D\e j1116/" Signature of Contractor
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 avid 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
Secti n 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.
STATE F LrJl) 46 99-00lDti 120
(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 . t oseeprSisions
'late: V Applicant A, -
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
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STg ature (Owner/Agent)A/� Date 111-1011'4
PERMIT #
BUILDING PERMIT 64
DATE �'� �1 VALUATION S14S LOT , TRACT 25953
JOB SITE
ADDRESS l! 79 435 NUCVO DR'M APN 04-". 2 T
OWNER
CONTRACTOR / DESIGNER / ENGINEER
OLIFIHA'N"r AND "tfi( LL1,A.MS ASSOC'., INC. 01APHAN7' AND WILLI MS A.KAX., INC.
77-900 ANTENUC OF THESTATES 77-900 AVENUH OF THE STAXES:
PALM DESERT CA 92111 PALM DESERT Cit, 92211
(760)345-262+ C8LS 5203
USE OF PERMIT
SlNOLR FAMILY DWELLING
8FD- LOT 68, PLAN Sea. PERMIT DOES NOT ".c.19)6 i X)CK, WALL. OR
;POUL 75% REDUCTION V UX ON ( IJLTII'l..ls' I'MIJAWE OF Add-, FLAN
TYPE.
TRACT C)NVMLK.TIODI h480.00 :'
PvRC1_JUPK.f1U '79.00 Sig
(.'-ARe1&WEfAKIX>Wr 6_%AAJ 11EE
ESIIAIATEDCO.$'TOFCONS7'RtfCrION
E"ERKI7 FRE SUMMARY
CONIVFRUcrioN Fm
10140)_4184M
S331I..p0
P1: A:N C"3?" -Kf?.
W411ANICAL FE
1QI 00(34:1 000
315{).00
1sl.iX_7WCAL FEE
€01-t)OD-42.4.000
$146.42
:PLUP48I NG PW
$1601W
iT'ftONCT M7YT ON Fl F - RFRIT7
101-W 1-241 400
319.813
GR ADINO FRE
101-W-423-00
SZ.00
I)EVCSLOPER. iIv€k'Ai T FWi 31.907.00
Ma !N PUBLIc PL./AL hs - ILII: 701.04{3-253-x}00 $121.40
R-1- ff8-IXTrAl, V011 tr,I R1.XMON AND PIAN CNEC:"K
LESS PRE -PATO FEES
TOTAL, P&RMI r993 DUE NOW
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RECEIPT DATE I itty-1-DATE FINALED INSPECTOR
$0.00
$30IU7
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings Y1
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck y , or _
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation -t - Z q -
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath - 13- 06 ArL
Drywall - Int. Lath
Final `
311 Cf�
BLOCKWALL APPROVALS
Final
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final I I
Gas Piping
PLUMBING APPROVALS
Waste Lines _ d 6
Gas Test
Electric Final
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral 2 — to
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) ���.
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Certificate of InsUdation _
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Your Boma has been insulated with CertainTeed Fibe4lass Insuleion pion, which ere designed
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for tpWs safety standards and tumor oWs enuff requite
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FiNigJam is inorganic and them fore pummumfly noncombuslOft so it dues not have to be treated
with fim4emidaat chemicals that will !unary lose thear cffwiiveness aver time. Ithes not been heated
~
wish chemi—ls that can csmode wiring or metal Fiberglass wrU not absorb moisture nor willit
settle overtime as may other inanlati® maleda
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This also ceati8es th *Cc lainTecdF Glass Iasalatiam lyes been pmoTr�sionalty ias9alled iu this home
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to pmovid a the following thermal pe o mance_.
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Job Kam: Sonrisa Tract 25M Plan #: S Phase: 3
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Let No.: 69 Job Address: 79435 NuemDr.,Lm-QmIm#&CA
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Ceiling Area: R-38 Unfamd Garage Cer7mg:
y
With levhag Above
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Inhrior Walls: Overbanga: Exterior Walla: R-13 Untsfled
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With Living Above
par" Walls:
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Sub actor . OJ Immkifibn Co., Ing
6908 A— Co 91703 (66)14 WO LUMM#4"7o9
S*me
Conchlto Ortiz, Secretaryllrwwrer -ter— R Scott JenA ins, Presl*m--or
Lou Merolo, DBrector ofOperatWin Officer
R- meanie resistance to heat :low. TW higher the R. value„ the greater the msW acing power.
Asir your builder tier the fad sheet on R- values.. K0ep thin otatificate vri(h .your other
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valued papers. Ifyou eversell ibis horns, this cerdficate should be passed on to ttm buyer-
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*Certificate,of
Occup
ancy�. .�
City of. L Quinta
!
Building and SafetyDepartmentw
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: 79-435 'NUEVO DRIVE
Use Classification: SFD Bldg. Permit No.: 9910-197
Occupancy Group: R3 -U1 Type of Construction: VN Land Use Zone: RL
Owner of Building:. OLIPHANT AND WILLIAMS Address: 77-990 AVENUE OF THE STATES
Building Official
City: PALM DESERT, CA 92211
By: GREG FOX
Date: 7-31-2000
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