9708-031 (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. CI Exo. Date A
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.
(>[) 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 suVct to the
workers' compensation laws of ifornia, and agre o become
subject to the workers' compensa n provisions of S c on 700 o he Labor
/Date:
e,�th comply with t s v' ' ns.
f J Applicant
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 at*
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 herebyi\- thorize reptese afimes of this City to enter upon
4siginature
e above-mentioned prop pect] pLfor insrposts.
err(Owner/Agent) Date'
f.
BUILDING PERMIT PERMI`' CONTROL#
70*031 5699
VALUATION S343,717.0 LOT 12 TRACT 23773-2
DATEE 1 shl
JOB SITI�
ADDRESS 78-84S S1i " iti3 V1JA "
APN 669-480-046
OWNER
CONTRACTOR/DESIGNER/ENGINEER
D'i NIRS'I,ir""l�E.)fi.l
5ItIC
P.O.1 OX 3.140
P.O. BOX 5140
NIM POR1" t EACH C -'A 92662
NBIV.1,101 1':BEAC..'14 C.'A, 92662
(714) 754-1517 CUM
USE OF PERMIT
LOT 12, a'1_AN M
x'1.A14 OfMC'K P13- kl004_7 :) I3 7.51 1-C+12 f410131i'L.E I3,1AX OF 1; AME
PLAN TYM.
TRAC i 40'N3'l1W V10X 2,425.0.6i I'
f'r;,JR(1111lVP Ti i 105011, .'yf
OARAQ1-JC'rlltf%f)1C1' 441,00 3
CION8111RUC 1'IoN FM 1014M),418 -WO 786 YJ
P(.AN z tTF?r . VfT 101.000-1139-Aig %164,48
1,16CI IA.NICAL IT.16 lot -WO -421-000 $ 'l. rra►
1 f ECO ICAL 14M. 1.01-f1 D-42G-t7W S.I4�.lti
P,I.T.tAi131IdO FFF 101-000-419-13010
9, W. >N4'1 MOV€:aN FI -1' • 10 t-4)f-2414ft t,
f;")G Fnn, 101-000-423-000 520.00
iW1kA:4'dktliti.,`l'(:14`•. FUX 225-000-143-M2 S3,157,22
ART 1N tgJNt 1C: PLACT,3 - :f F81C 7014)W2:4s-Ilt)U SI04.
p
1W(__
TRI TC'3'k)1V AND P1,A N C3p
LESS TAID H ES
WOO
SEP 18 1997
. � O e. i,ilQ'SaD
RECEIPT
DATE '
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs 1
Underground Ducts
Forms & Footings 4496U
ucts
Slab Grade 0
Return Air
Steel
Combustion Air
Roof Deck /
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing / 9i
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wali Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath /
Final
Final3 z y
BLOCKWAL A PROVALS
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
Gas Test
Electric Final
Waste Lines
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 161111 f
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 ��ow �1
Citk
of La Quanta
��M0F .
Building. and Sa'fety.Departme'nt
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: 78-895 SKYWARD WAY
Use Classification: SFD Bldg. Permit No.: 9708-031
Occupancy Group: R 1 Type of Construction; VN Land Use Zone: RL
1.
Owner of Building: STARLIGHT DUNES LLC -Address: -P.O. BOX 5140
City: NEWPORT BEACH, CA 92662
By:' STEVE TRAXEL
Date: 4-3-98
Building Official
Q2
I
CS
Certificate of -Occupancy
T ��ow �1
Citk
of La Quanta
��M0F .
Building. and Sa'fety.Departme'nt
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: 78-895 SKYWARD WAY
Use Classification: SFD Bldg. Permit No.: 9708-031
Occupancy Group: R 1 Type of Construction; VN Land Use Zone: RL
1.
Owner of Building: STARLIGHT DUNES LLC -Address: -P.O. BOX 5140
City: NEWPORT BEACH, CA 92662
By:' STEVE TRAXEL
Date: 4-3-98
Building Official
Q2
I