0105-058 (SFD)LICENSED CONTRACTOR DECLARATION
:U) I hereby affirm under penalty of perjury that I am licensed under provisions of
'1-
Ch apter,9 (commencing with Section 7000) of Division 3 of the Business and
In
N 111;.,x' , •,;•,Professionals Code, and my License is in full force and effect.
License # Lia Class Exp. Date
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Date y�t � Sign ' ure of Contractor°,
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OWNER -BUILDER DECLARATION
-I ,herebyl 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).
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:
(.) .l 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.
( L) 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 shouid become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code', I shall forthwith comply with those p;ovisiQns.
Date: i�.: � In. Applicarii. �ti'-a,•
,,^arning: Failure to secure Workers' Compensation cge 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 fort his
application.
1. Each person upon whose behalf this application is made & each at
whose request and for whose benefit work is performed under or pfye(
to
any permit issued as a result of this applicaton agrees to, & shall, fy
& hold harmless the City of La Quinta, its officers, agents and as.
2. Anypermit issued as a result of this application becomes null d voic if
work is not commenced within 180 days from date of issuanc of su
permit, or cessation of work for 180 days will subject permit to cair cellation.
I certify that I have read this application and state that the above info
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.
-wl Date4+if7(OwA
;Signature
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BUILDING PERMIT PERMTN
DATE VALUATION LOTf331i�J TRACT
$240,34 30 rl� .r�`—� 28960
JOB SITE _ _ _ `—'
ADDRESS "-
APN�V '
OWNER "
CONTRACTOR/
s C,`I EX I-10 19
CM J3X 14'az
22811 `ffARDLOW MR"'I " f=F,150
2281DWA? M. W +CMC7_Y M.7r1k: )l50
t:C3 Ol�� CA 91720
CtaRONA. CA 91720
(PO9)279-40 0 MzLft 5761
USE OF PERMIT
SFU • LOT iia •'.I—Q4 2"L • PERMIT DOES NOT INCLUDE 81=K WALL,,
POOL Olt DRIVEWAY APPRO.,AClii. 15%R.tiAW CHECK REDUCTION POR
M1; INIPLZ ISSUANCE OF SAM RLA1I TYPE.
:11,510'sl Ck' NSTRUCI'IaN 2, ov Sl'
;
PORCH/PATIO 300.00 fir
GARACriCARPORI l?,739,60
+LK7Xbf.Y.dAJ RD 4Of.9T'6AJC 1✓{.ON rrMUMCON
2'18,W,..?0
F I�Y1TJ
C10)..M13ilt:TlON FEE 101-000-418.000 $11161.00
FLPX ("HE MX FRIE • 101-000-439-318 4 39.tlFS
AdI.,,t;.`P..e NI%.NI 1M' 101.000.421.000 1111.30
2LT3.C`i13Z;AL Ftp' 101-000-42-0-000 $1M so
PLUMM140 i+Ya 101-,000.419.000 . 3 189 75
- wo $24.83
STR:ONO NOTION I=- itlMID 101-000-2411-
GRADPAO M. 101-000 423-000 $20,00
1'ALFRAOS'l'R"•.LC'fU:•EE :FEE 225-000-443.342 V,907-00
_
MT 143 PUBLIC PLACES-- k7.011101..000 -M -OW
A O
SU I tI AL CON IMMYC ION AND PLAM Cl fiM
$3,953.61
1 AY 1 0 2001 LEE -33 :MF -F -A m. F103
CITY OF LA OUINTA
FINANCE DEPT
RECEIPT
DATE f
BY
I
DATE FINALED
INSPECTOR
ii •
fir'+
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
_ _
Return Air
Steel
t Combustion Air
Roof Deck
�f 2�` _
Exhaust Fans ,
O.K. to Wrap
/(�_z/0�
F.A.U.
Framing
%�!8 �j� _
Compressor
Insulation
d!!/j_3
/
i Vents
Fireplace P.L.
_
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
_
Exterior Lath
DrywQall - Int. Lath
Final
�j
A-0�_r//�i r�%�
Final
r
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
Gas Piping
PLUMBING
APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
OX 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
c
Final
J
Utility Notice (Perm)
O
6 Certificate of Occupancy
City of La Quinta
Buildingand 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 .fo/Ao wing:
BUILDIM ADDRESS, 80-859 SPANISH BAY
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0105-058
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL
Owner of Building: CENTEX HOMES
—r&4 ,
Building Official
Address: 2280 WARDLOW CIRCLE, STE 150
City: CORONA, .CA., 91720
By: "BILL GORDON
Date: 4/22/02
POST IN A CONSPICUOUS PLACE