0105-068 (SFD)LICENSEDCONTRACTORDECLARATION
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
s�#(yy ✓� t YY))Lic. Class Exp. Dy
ate 1 (p
�:FT.� daicf . (iJ "•••^ �T �'� :Ino n9'Ta%F. '-••�
Date 7 Signature of Contractor
e.
„..__ . ��•r� OWNER -BUILDER DECLARATION',
I hereby affirm under penalty of perjury that I am exempt from.the Contr'actor's
License Law for the following reason:
( ) I, as owner -of the property, or my employees with wages is 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).
() 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 v{hich this permit is issued.
.,Syr) 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.
�35••��-X42`19
(Thissection 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..provisiorasrof Section 3700 of the Labor
Code, I shall forthwith
comply wtt t d,osem.�
isio�n's
-
Date:49 ' Applicant�'
„Wprning—Failure-to-secure
�
Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and. Safety
for a permit subject to the, conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose, request and for whose benefit work is performed under or pursuant to
any prmit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Ouinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize represen,S t ves of this City to. enter upon
the above-mentioned property.for'inspectiof(purposes.
Signature,.„(Owner/Agen'4l� "�, _ Date ! •'
BUILDING PERMIT PERMIT#
1 {
DATE :. y / VALUATION LOT. � � l,�j y% TRACT
it ._tF7 r> / ' _ ► 37 1-2 .
JOB SITE
APN
ADDRESS
OWNER
CON`T�R�gA�C�T�O,RR/pDDEESIGNER//EN IIN/E�E�Ry
yy��+y� rr�� yy�� +y� d �yy+-�gg /���s��ryryry .�`p �y
.IPA:I.G,Tdf R00X )DFV (lal� T'Atl3,77'N 1 COMPAR 3
�r / /y�'
L'•lC7t'�L.,ih,'VV w .1.+.l: vm,%.f5'}J,a_% I r 1..1,1.b1'$R`1i@ 3.
5140 AV.04'DA �7i';MS
5140 AVRMA LEN MIAS
CIAIZUBAD M 92008
CARLSBAD CA 92008
USE OF PERMIT
SIFT) • LOT 177 PLAN 38 a PERMIT DOPS DitYC INC2,1=ir BLIJCKWAI ,
]POM. OR DRIVEWAY APPROACH, iso/o PLAN CHECK ME AS'F'1G1W FOR
46i]VrIPLE ISSUANCE C31' SAME PLAN TY PF
C.F TOAA CONSTRUCTION 4801,00 3F
PORCIMATIO V7100 SF
C#:A.d GMARPO'RT CSM 10150.60
r
- M "1 c`�i9IATM COST OF Ct3.t'i:s? $XMON
- 236037,7160
,[j p yet }(' �p /
+o's7"3wcuC"r1owv 101-000-=418-000 5101S0.00 -
Y UJ4 t';4fi.tGC'.i, 9'Eg i 01-000-439-318
Iv1EG"RANICALFRY 101 -OW -421-000
ELECTRICAL, M?F. 101*000-420-OW 8164:�Cd
.PI,.CdNINNO RUE 101.000-41 9-000 $180150
.xTExONO MOTION FZ9a RES1D 1011-1=441-000
C4Rifal7YNG ff X3 c3a «6U�!=4 a" ?tJ0 8 0,0A
ICtS:+Jr9�taC7i�1? '. IMPAC7 ",E $E,St07.s10
T IN PCD181,?C' PLA;CEV - RESIL 701 -000-255-000 990.94
Rr AR -90TAL 9, iiC°��0�' �.�$:I�:C;+��3 C'�,IM
$39$4.4.57
{� A6 1.,803 P1: WF`;A13? PM*LS
u
A4)
T y : F tE ..11M MES DUR NOW
JUN o 5 2001
CITY OF LA OUINTA
+
DATEt]NALEO
3
I PE OR
:;;� '�
fl,
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS.
Set Backs
Forms & Footings
���
'/��—
Underground Ducts
Ducts
Slab Grade
D �G,�,GlL
Return Air
Steel
Combustion Air
Roof Deck
_
jf
d�
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
D 6
2(q/jj�
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
_
Drywall Inert..
-
,Lt�h
Final
_
Final
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
Waste Lines
�j�?//Qj� a �i
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
aQ/ 6
Encapsulation
Gas Piping
Gas Test
Spy dGG6Q��r
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��
�j�'`10
Utility Notice (Perm)
i
((0)
t fica to of
r Occupan
CY a
City of La
. �.
c Building and ,Safety Department �� O -F
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 following:
BUILDING ADDRESS: 57-475 SEMINOLE DRIVE
Use Classification: SINGLE FAMILY DWELLING ti Bldg. Permit No.: 0105-068
Occupancy Group: R-3 Type of Construction: VN" Land Use Zone: RL
Owner of Building: ASHBROOK DEVELOPMENT Address: 5140 AVENIDA ENCINAS
COMPANY
City: CARLS6AD, CA,92008
By::' DANIEL P. CRAWFORD JR.
Date: 1 /28/03
Building Official
POST IN XCONSPICUOUS PLACE