9708-029 (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
PIUfeSSIOnalS U6de, and my License is in full force and effect.
License # Lic. Class Exp. Date
I
/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).
( ) 1, 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 subject to the
workers' compensation laws of California, and agree that if .I should become
subject to the workers' compens I- provisions o Section 3700 of the Labor
Code Ifo th comply with os rovi ions.
f Date: i 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 hereby uthorize representatives of this City to enter upon,,
he above-mentioned prop for inspec Io po
tr
Signature (Owner/Agent) Date
CONTRO
BUILDING PERMIT PERMI4so1
029
L'ATC VALUATION .r1J,9*Z.(AW LOT t{( TRACT ,�9
�l
JOB SIYE'
ADDRESS W , � - i ]� � �f }i�#
APN 649-490-043
OWNER
CONTRACTOR / DESIGNER / ENGINEER
F, FARLIGHTf, DUNE""
P.O. BOX 5140
P.0, BOX 3140
N WPOWr t3r,1#CH CA 92662
Nf,-WF>s'()WI' 8 AC1}. CA 92662
USE OF PERMIT
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SEP 18 1997
10CAL t%RMIT BUTS OUR, N(AV
$5,100-4
CIS OF Lha 0 UIN a
,,
RECEIPT
DATE -
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION I
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
3
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
1,41
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
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
Final
Final o
BLOCKWALL AP ROVALS
POOLS - SPAS
Stee6;
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
y
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) X27
COMMENTS:
Certificate "of Occupancy
Citv-of La Quin-ta
G
Building and dSa.fetyDepaTtmentn OF-�ti°�.I
L
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: 78-900 SKYWARD WAY.
Use Classification: SFD Bldg. Permit No.: 9708-029
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
Date: 4-30-98
Building Official
POST INA CONSPICUOUS PLACE
r