0208-238 (SFD)W
` 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
79671,40 X� UfiS�: "JAr2C
/Date 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).
( ) 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
performance of the work for which this permit is issued.
(W 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 ;TATS I UND Policy No. 14235x,3-02
(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
Geode, I shall forthwith comply with those provisions.
/Date: 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
.y;correct. I agree to complywith 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.
/S/O"� a.,
ignature (Owner/Agent)''Date ?/�_f i
J
KBUILDING PERMIT PERMIT#
• `
DATE 1 VALUATION. LOT TRACT
S,tQd.1~rU iib
s
JOB SITE
ADDRESS rl,- 35 COY1171F. CANYOW
APN t.
717p•210-00
OWNER
CONTRACTOR / DESIGNER / EN &NEER
BOB 1:1t;.''�31,11
LU:DINO;f°S t);nT-L:3NK GEHF RAL CaOl IZACl
do 45.120 SAN 13ABLO 4 24
45.120 $n4 P ADW OrM., 2.1
PAL N1, a.�;Wr CA 9.260
7PALM.10HIEWs CA 927,60
(760)566-6070 CIBU� 2274
USE OF PERMIT
1011140U. "MMMY
444? S.1s. SiFD. Plr RA11 [' 'O0EN NOT ANCIAJDE I:il,fXK WlxLL OR POOL.
CUSTOM C .4 TRUCTION '.442,00.21
PORCH/PATIO 1,$38.00 SF
GATLAW0, AR1'01t`_i' 1,021m ole'
ir61XXNKft 3 cost (3d1'
384,1041V
FWWWWrX 9101+E;i ly
C0143TRUC.`tION FER 101-000-418-000
PL &N Cli 3W 1011-•000-439-:31 iR,
FRE V IDSIT 101-000-439-318 S1b0(Itno
N1f Z1iAN1CAI. 11FE 101-000-421-000
L1., CT.R11C.A.1, FRE 101.000.42,0.0010
PLUMBIND FES 101 •-000.1419-000
S71'R0111r3MOTION FEET- RE,= 101.000-741.000 $33.41
OR11101NO 11721. 101.000-423-01N0 $15.00
,I)EVEWPER IMPACT ME WDS '.00
PRECISE PLAN 101-000-441-343 $100.00
3-00vt
ART IN Pi+1$` LIC" PLACM •- RESI1. 270-000-445-000
I>I,..t1S•'•SI..1SAL,r'V.iVSMU1..AF.iJX m"Yt D A'-/LA.tN CTWOK
Q D TZ0 PEZ-PAIDEM
41,000.00
p
DEC 11 2002
CITY OF LA QUINTA
FINANCE DEPT.
/�..r
RECEIPT:` ' x' '
DATE // f ,r
BY a --
DATE FINALEDJINSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
- O
Underground Ducts z
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
ti
Exhaust Fans
O.K. to Wrap
��Y�
F.A.U.
Framing
Compressor
Insulation
Q
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
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
ll- fj
p f
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
�� 2(=af ,&;?
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
_ _ _
_�
��'
Pool Cover
Sewer Connection
•� C !�
Encapsulation
Gas Piping
Gas Test
Apoliances
.�pD ��C �i�i ��.-S
_ _
,S=a2 ��Q3
Final
COMMENTS:
Final
Utility Notice (Gas)
C,- 1Qi---
ELECTRICAL APPROVALS
wiz„ �� 1��� , 2- 3— 6r3
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 Occupancy
4 xP
G OFT9� Building & 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: 78-435 COYOTE CANYON COURT
Use classification: SFD Building Permit No.: 0208-238
Occupancy Group: R-3 U-1 Type of Construction: VN Land Use Zone: RL
Owner of Building: BOB LICHTER Address: 45-120 SAN PABLO
City, ST, ZIP: PALM DESERT
By: KIRK KIRKLAND
_
Date: 11-19-03
Building Official
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