0010-078 (SFD)'r ,A LICENSED CONTRACTOR. DECLARATION
I &eliy 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
Date rl i' i.. Signature of Contractor � t�I
DOWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that l :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
-
()
lam 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, fog the
performance of the work for which this permit is issued.
r(1f) 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 Policy No. '
(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
Vde, I shall'forthwith comply-with`those proVigi6ns.r ',
e: l It X r Applicant—
Warning:
pplicant 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 ay�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 pur'po'ses,
�gnature (Owner/Agent) 114 Date ,rr
BUILDING PERMIT PERMIT"
DATE VALUATION ,- LOT ~�JQ? '��TRACT
JOB SITE
ADDRESS
APN 310
6775
ee,6l,-014
OWNER
CONTRACTOR / DESIGNER t EN INEER
COROM CA 91720
CGROXM CA 91720
1900279,4000 CPU' 5161
USE OF PERMIT
NfIri.1,DT 14 PIAN a%CR&ERMiT VC7ES NOT MIt::1. UOY,
f
MiNOM CONSTRUC-MON 21M.1100 3F
PORMPATIO I soo7.0i+ Sit'
GARAOiH' CARPORT (3b) iR,"JS�3.C�D
Jr4VY.RSro (U fIlV.LpIAA1.:6
i:`dNF1'iR19t;:'SION FIX 10 1-i11%10-41 U -00t1 S1b141,00
Pl,kYN CHWX >Is'9': 101-00"39-31a 39,56.32
MUI C)"1CAL YEE 101-000.421-000 31H.50'..
ZLM, "TE2ICAL 11F,?, 101-000420-000
P>f,,1MINO FFIX T01.000-419.000 313191,E
SMONO 110TION FEE RESID 101-000-241-000 -000 $.74.0
GRADING RZ 101.000-433.000 $20,00
?Nit`RAU M.1.121't.i1t,N.,10ZE 2255-000-443-342 $1,907.00
;
=t 1Dt1'13131.?OF'1Gk: 11i1 �i?J�UCiQ�2' aGt*0•. WWI .
' BUS TMICAf.,'1roh,JCi'14c.GMIL%Ly AND P1J[•iitl 11.3.F1tuM
.4,670.6 `
14ESS PRE -RAW FnS
$0,00.
TOTAL PERMff 11W9S DUE NOW
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
%
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms& Footings /%-2
Slab Grade ry
`��
_
Underground Ducts
Ducts
Return Air
��_Z�
Steel
Combustion Air
Roof Deck
O.K. to Wrap
l -3d -
_
Exhaust Fans
F.A.U.
Framing
8/
Compressor
Insulation
_ ��r/(j /
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls y
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
_
lG! L
Drywall - Int. Lath��_��
1
I
Final
�/�
�lG_�Ap!'Qdl/
Final
POOLS - SPAS
BLOCMALL APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Waste Lines
/
/%/�/�
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
���3/
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)/�
Certifi f
cate o Occu .anc
City of La Quin.ta
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 fol%wing: ,
BUILDING ADDRESS: 80-790 SPANISH'BAY
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0010-078
.-Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL
Owner of Building: CENTEX HOMES Address: 2280 WARDLOW CIR, STE 150
City: CORONA, CA., 91720
By: BILL GORDON
. s .
Date: 2/8/02
Building Official
POST IN A CONSPICUOUS PLACE
i
!ti
Certifi f
cate o Occu .anc
City of La Quin.ta
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 fol%wing: ,
BUILDING ADDRESS: 80-790 SPANISH'BAY
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0010-078
.-Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL
Owner of Building: CENTEX HOMES Address: 2280 WARDLOW CIR, STE 150
City: CORONA, CA., 91720
By: BILL GORDON
. s .
Date: 2/8/02
Building Official
POST IN A CONSPICUOUS PLACE