9907-539 (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
PAW. 03814(x
f f r
Date �f f Signature of Cont acto �
OWNER -BUILDER DECLARATION. J •' .
I hereby affirm under penalty of perjury that I am. exempt from the Contractor's
License Law for the following reason:,
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).
O 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.
1 have and will maintain'worke'rs' 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:
Cartier y p• y p �� Policy-No.,ryp yrs V�(yC �y.
11YIX-1- 4r V AP,,'ANY L.fst �YB InIJG.b�.'D V^y7.L
(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-Californnla; andt•agree that if I should become
subject to the workers' compensation provisions•offSection 3700 of the Labor
Cde, I sh II f rthwith comply�,with thoseWvisions. i
Date: � Applicant_ +�� �
Warning. Fai re to secure Workers' Compens tion coverage"unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000; in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application -is. hereby made to the. Director of Building and Safety
for 'a permit subject to the conditions and restrictions set forth on his
application. .
1. Each person upon whose behalf this application is made &5 each person at
whose; request and for whose benefit work is performed under or.pursuant to",4,
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Anypermit issued as a result of this application becomes In and void if
work -is not commenced within 180 days• from date of°issuance of such
permit,'•or cessation of work for 180 days will subjbct permit to cancellation.
I certify that I have read this.application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize replresentatives of this City to enter upon
the above mentioned property for inspection°purposes.
,Sig lure (Owner/Agent)--% Date �•� '
/ �✓
PERMIT #
PERMIT
BUILDING
DATE - i�� _ _w
aj VALUATION 5.213,7 11,24) LOT � TRACT 7990
JOB SITE �,y�I
ADDRESS V.418.�►1,1 d�.�!':ya fi�,d�l.
'
APN
'Ti�i - :T
OWNER
CONTRACTOR / DESIGNER / ENGINEER
�. r•.Itr r.,..�R`��i7(i..�.,r
•w )�f'�.6..��a.�wa'.i.`I.1.:+.3
C:C1RC: NA CA 91710
(X)RONA. 4'A 91.710
USE OF PERMIT
WALL OXKJOL!
C�UMIOINJ CONSTRUCTION, -13140.00 AsIr
POJ.tCRflr�X6. K) 3�7C9.L 4>
Q.ARA•iiW,C.F4lfblx01<J' Er% .flat Pak' '
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FLF:a$'I+ WAL I�:. �4ji-+ J0-42(1
PLiA413111443 R� 1lil )f1t) Y.it3-f3 $i«+C9. T�
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.
INFRAMLtt "i (IRE FEE
ART 01 PI:fSLI 'PLACE—S -ki .),p` 7014}O(3_:SSS•-�+tirJ
>f l AL. C30N-FM0JCn�10N ANT) PLAN � ffE-CK
ME I VY„i'y9
y
RECEIPT
'.yK
DATE
BY {�` i
DA F pLE
INSPE O
9
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
/0 6
Ducts
Slab Grade
G;
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap_4,g 41f_
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wail Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL
APPROVA S
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final I
I
Gas Piping
PLUMBING APPROVALSGas
Test
Electric Final
Waste Lines
f.
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
3 �j
Appliances
Final
COMMENTS: 17 V57
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.1.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
cate,,o f Occuan'pcy.
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;This Certificate issued,pursuant to -the -requirementsof _Section 909 o f .the Uniform Building Code,, `
certifying that,: at the dnmb,of issuance this. structure. was in comp/lance. with the various ordinances
of the City regu/a_ting bui/ding construction or use. ?`For the fol%wing: s
BUILDING ADDRESS:,- -80-418 SPANISH BAY-
C Use Classification: SINGLE :FAMILY DWELLINGS .` Bldg.,Permit No.. 9907-539 J=
_ 7 '
�Occupancy.Group: R-3.;' Type "of Construction +,VN Land Use Zone: RL 1
a Owner of Building. 5 CENTEX HOMES =" Address • 2280+ WARDLOW CIR; STE 15'0
-� # „ City: CORONA,.CA 917204~ ..
_By: Y -DAN IEL P:CRAWFORD''JR:- - - -
Date:' 3/12/03
,
_ Building Official r ,
sv ' POSTININ_ A CONSPICUOUS PLACE -