0105-051 (SFD)r
.'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
030-14 A B 19C
&w��k
Signature of Contracto r._
OWNER -BUILDER DECLARATION
.. t
I 6rebjy affinm.under penalty of perjury that I am exempt from the Contractor's
• License, Law' for the following reason:
;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 (Se:
c, 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). '
() 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.
! ( ) 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 WN AMERJOK14 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 pr visions.
Date: Z'A ii A t A .'p Ci nt �=�'-•--
11Narning:. Failure to secure Workers' Compensation cover ge is unlawful and
shall subject an employer to criminal penalties and civil fines to $100,000, in
addition to.the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth'
application.
1. Each person -upon whose behalf this application is made & each pe
whose request and for whose benefit work is performed under or purs
any permit issued as a result of this applicaton agrees to, & shall, ind nify
& hold harmless the City of La Quinta, its officers, agents and empl es.
2. Any permit issued as a result of this application becomes null and d if
work is not commenced 'within 180 days from date of issuance.o such
permit, or cessation of work for 180 days will subject permit to cance lation.
I certify that I have read this application and state that the above inform ion is
correct. I agree to comply with all City, and State laws relating to the b 'trT
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
/Signature (Owner/%\geti) -+* C �' -- Date (toed
BUILDING PERMIT PERMIT#
+r
DATE VALUATION LOT -y QR�.�^wal�L- y TRACT
JOB SITE
ADDRESS— --X23 — + - _
3 !O
f.}_-
}''5
7�,-QI%�
OWNER `"
CONTRACTOR /DESIGNER / EN INEER
XZSO WARDWW MITMI '15 0
2.2 80 biirARDLC3W M=, TTInr415o
CORONA CA 91721
CORONA CA 91720
(909)27'9 000 CBM 5761
USE OF PERMIT
�?P9V��
�? t�LOT
Iy�LUIX ULCyNKIA
S OPAZYMt3IrDOES 'NOTS
POOL OR 131tFVF AY MTROACH.
C11VTOM COA€3TRUCTION 3,211.00 OF
PORMYPATIO, 53$.0 SP
43ARMIUCARPOR F PF)
rjrw. Dp.AASrlIM giros oye +b.I`4J.LVmu'mno
266,14.8m
CONDIP U C TJON PEE 101-000-418.000 SIX64.00
PLAN CHECK FEE 101-000-439-318 $997,13
M 1�,°KANICAL Rt% 101.000-42.1.000 3118.00
XdEt.° R4CALF&Y 101-000-4 20-000 *173.70
PWA!1 M'o nk 101.000.419.000 S190.s0
STRONG TONG MLYTIaA13 MS., RMIO 101-000-241-000 ��►.�:
c. RA INO1,''F19 101-000,423.000 SX06
XhVRA3TRUCTUR 225-E100-443-342 $1,907.130
ART N PUBLIC PLAC99 - .. Mil 701 •-001.255.000 Star/
-
tJ1:T33-Ow°fiiJe'Et) 41X? T�T.N' C1
$4,831.130
X 33 PRE-PAM,11RUS
$0.00
MAY 1 0 2001
'STA,M'r��'M DUB IRf1W
CITY OF LA OUINTA
FINANCE DEPT
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
tt
INSPECTION RECORD
OPERATION
DATE
I INSPECTOR
OPERATION
DATE
INSPECTOR
' BUILDING' APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
{o
Underground Ducts
Ducts
_ _aVF—
Slab Grade
—
��! b/
/ / `
Return Air
Steel
Roof Deck_
O.K. to Wrap
Framing/�
Insulation
_ _
6
` /
�j'v
Combustion Air
Exhaust Fans
F.A.U.
Compressor
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final%��' t���
BLOCK -WALL APPROVALS
Final
POOLS - SPAS
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
Waste Lines5�2, f / p (
Water Piping
Gas Test
Electric Final
Heater Final
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
_
s ��ia /
Pool Cover
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)v� %L
XCertificate, of Occupancy
City of-L'a Quinta
Building and Safety Department�EMafTME°�
Phis 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
ot the City :regulating building construction or use. For the following � .
BUiLDIN'G' ADDRES-S:. 80-898 SPANISH :BAY
Use Classification' SINGLE FAMILY DWELLING Bldg. Permit No.: 0105-051
..�;., Occupancy Group: 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: 4/23/02
POST IN A CONSPICUOUS PLACE