9708-027 (SFD)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
v—ru LAI
/Date Signature of Contractor
OWNER -BUILDER DECLARATION
I hereby 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).
( ) 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.
(V) 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 I. ,f0 #,ID Policy No. w 4737 -1'7
(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' compen,tion provisions of Section 300 of the Labor
Code, I s all forthwith comply wit hose provisiont N '
JDate: Applicant -
7
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 tt
whose request and for whose benefit work is performed under or pursuant to '
any permit issued as a 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 prof" rty for inspection u..LpWes.
ignature (Owner/Agent) 'Q / Date -1 / M I!
BUILDINGPERMIT PERMIT�027 CDNTRDL/t
DATE VALUATION i�x 1 ��} LOT ly TRACT
JOB S1W
ADDRESS t7i.:WAIAVARD WAY
APN 609-480-041
OWNER
CONTRACTOR/DESIGNER/ENGINEER
::;. INC
€'.0,430X 5140
P,O.13(A 5140
N6XV)it.T 8EsA0J — (,"A 92662
NEWPORT ARM' 11 C'A 926%,52
(714'4'5441517 call#
USE OF PERMIT
i,4) f' EE, i+i.rit4 381E.
PLAN t'!111C1k:..Hsem" (2(MtJt" EI) BY 7 the h'0R M(A.`I'IPIX I381: F,; SAW,
Int.AN TYPE
3,ov.K) s
t:lAlt Ad.: 0C'AR] `OK l is 74r.tji' Sl''
s. :!N'VrR114 T ON FEiti ttll _004).4i14-000 st,113; CAI
14.aN1' 141-14 IK 1 il; if!l.1i{Nt 11W.'AIft #'tt :•f•
.-NVY: } IriNt.VAI, -a t : 10.1 40)' ,UN 000
4:1-1:1'IYt1e'Al,1°1i{ 1 Iir1.O k -130-0W
is ONz111114 i K+1 I411-(XW)-4t9AH)0 t!!ltikt
"4140 WEI Fv 0TI[ON l;t;l:.. f?1•XJ0 101-O(X)-",it .0M 16
1et�1�i2't2 �tr2'1;1; 4011.64) 421 C.'lt4Mf
1fit-R.A.`t11kl It' lOkls PU1 2 i1(N}
ART tN 1'!)1.41.11" 11I.At-1-8 , RE'Sii, 701--000- 4`515-W(-) $'l'?`� 111
t
i
i"f',Alj,t°f.tN`') !ti~i'It)N !+4Ni) I f,f\itiIC'I)'Pt'I�':
S66 7W 09,
LESS = rZr 1'A1D F1 .%'
VI M1
SEP 1 S 1997
',t'01,ii1,1'1r.#tMIT PC Of1F NCAV
,ino. 10
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Slab Grade
a
Ducts
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
0. K. to Wrap
F.A.U.
Framing
2
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
v
9
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
Sted6
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
D
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
../s- ,
Appliances
Final
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)
COMMENTS:
Certificate of Occupancy T
..City of La. QuWnta54
Building and Safety Department 0Fti°�
,-
This Certificate issued pursuant to the requirements of Section 109 of the Uniform Building Code,
certifying that, at the time of issuance, this structure -wasin compliance . with the ,various ordinances
of the City regulating building construction -or use. For the foll6w, ing:
BUILDING ADDRESS: 78-880 SKYWARD WAY
Use Classification: SFD Bldg. Permit. No.: 9708-027
Occupancy Group: R 1 Type .of. Construction: VN Land Use Zone: RL
Owner of Building:' STARLIGHT DUNES LLC ,' Address: P.O. BOX 5140
City: NEWPORT BEACH, CA 92662
By: STEVE TRAXEL 4
Date: 4-21-98
Building Official
POST IN A CONSPICUOUS PLACE