0105-059 (SFD)J
W
I—
7k LICENSED CONTRACTOR DECLARATION w.
I hereby affirmjunder penalty of perjury that I am licensed under provisions of
Chapter 9 (commencing with Section 7000) of Civision 3 of the Business and
Professionals Code, and my License is in full force and effect.
' License # Lic. Class Exp: Date
:: 7:4094 AS. IRC`+�' =yfi 03- M1l2I'
1 k1
G�ate � err:Ina Signature of Contras to'r,
.D
ca OWNER -BUILDER DECLARATION
Lher6by'affirm under penalty of perjury that I am exempt from the Contractor's
License -Caw 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 t'6,.construct the project (Sec. 7044, Business & Professionals
Code).
C'') () I am exempt under Section , B&P.C. for this reason
L
N Date Signature of Owner
CNI
WORKER'S COMPENSATION DECLARATION
I hereby affirm' under penalty of perjury one of the following declarations:
() I haveand 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
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
Code; I shall forthwith comply with those provisions.
Date: f« sa ; APPlicanYs �. r U 11
Warning: Failure to secure Workers' Compensation co e� ge,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 Safe
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 p ant to
any permit issued as a result of this applicaton agrees to, & shall, em fy
& hold harmless the City of La Quinta, its officers, agents and a ye s.
2. Any permit issued as a result of this application becomes null a ld voic if
work is -not commenced within 180 days from date of issuanc of su64
permit, or cessation of work for 180 days will subject permit to ca ellation.
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.
Signature (Owner/A'jent)1.
il y Dates? fnana
BUILDING PERMIT PERMTk
DATE VALUATION LOT d�,S^�E:SO„� TRACT
� _
2 ,2s 3 69 2€960
JOB SITE �
ADDRESS
APN
80-971 SFS. IR DAs'
�;�-��-032
OWNER
CONTRACTOR/ DESIGNER / EN INFER
a ;"tt"I WkaDI. w Com= ffuru 1 x)
2280 WAW' WIN CIRCLE, fF,1 S O
COROMA CA 91720
CORONA CA 91720
(909)2-k 94Q 0 t IA 5761
USE OF PERMIT
NOT) -113`i' 60 PLAN 4,11' • PERMIT WES NOT INCL0D.E BLOCK '€x',43:24,
POOL o19.DR3xEIV1YAPPROACH..9% PliN tHWREDUCTION FOR
g✓cC4FPtZ RNUAVlC OF SAME FA1TY?K
��yy=,,//inn3���{xyy`l��Ir'YvG}}����}}��.p�Cd'�rC//}ppN+�y'frtRUC` ION ?;3�31,000.�
r'1P10.11.Lb�1'�`8..1'IO 454,60V
0A1 MMARPORi CEO) W34,130
B!"WAIDW C -109f OF c(3n.w.il'RTC..rIO1V'
2WM 4M
C.Gi'rJMidCTR ;N it U.' 101.,000.41E^000
PL” CHwx; FE13 101,000-.39-318 $24R."
Mls.0 IC.& = 101,00042.1.000 391.00
a+,..T.WJ'I2is;."AL FZE 101 -OW -420-100 x$176.33
PIOUDING i}", 101.000 -419 -MO $249.75
,S`TR0WOIb9OTICV, IFEE• dib 101-W.)-241'-000 $26.43
ORA0INO WE 101.000.441.000
Am. f PFsUTXUCTS12i:#.ts "It 223-000-443-342 $1,907,00
ART Y2S 701-000-255-000 $,160.71
W O
$4,047.41
i AY 1 0 2001 XI) PRF-FFM
MOD
:`MAL ft.RWM YMS VUE NOW
S4,047,41
CITY OF LA OUINTA
FINANCE DEPT
RECEIPT
DATE
BY ,
"7
DATE FINALED
INSPECTOR
l �: r
OPERATION
DATE 7INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
_
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
_
/�_.'Jr�//
Exhaust Fans
O.K. to Wrap
_
F.A.U.
Framing
Insulation �a/��
/ _ /%�
�JO/ �jr
Compressor
Vents
Fireplace
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall Int. Lath
-
�d7_L_,s
Final
Final
_ .��e®
POOLS - SPAS
BLOCKWALL APPROVALS
steel
Set Backs
Electric Borid
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
I I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
a6
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
-
O.K. for Finish Plaster
Sewer Lateral
_
Pool Cover
Sewer Connection
�Q��
Encapsulation
Gas Piping
Gas Test
_
Appliances
Final
COMMENTS:
Final?�S
G1
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) -
This Certificate issued pursuant to the requirements of Section 109 of the Uniform Building Code,
..certifying that, at the time of issuance, this structure vvas in compliance with the various ordinances
.: Lof the City regulating building construction or use. For the following:
BUILDING ADDRESS: 80-.877 SPANISH BAY
"Use Classification: SINGLE FAMILY DWELLING Bldg: Permit No.: 0105-059
-,e,Occuparicy Croup: R-3 Type of Construction: VN Land Use Zone: RL
Owner of Building: CENTEX HOMES
Building Official
Address: 2280 WARDLOW CIR, STE 150
City: CORONA, CA., 91720
By: BILL GORDON
Date: 4/24/02
POST IN A CONSPICUOUS PLACE