9708-030 (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. D to
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
pe ormance of the work for which this permit is issued.
(A) 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 R any manner so as to becoml subject to the
orkers' compensation laws o Glalifornia, and a hat iI ould become
subject to the workers' compens Ion provisions of ed 'on 37, of the Labor
Cod aff ith comply with o o 'sions.
Date i0 Applicants
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:4
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, Wfor
ith ll Citand State laws relating to the building
construction, and hereby e,�S of this City to enter upon
' e above-mentioned proo purpo es. A
'r Signature (Owner/Agent) Date �+Ft
BUILDING PERMIT PERMIT 97OX- 30 CON56
DATE VALUATION LOT TRACT 11
DATE/"l � �h,►;t.fst3 1 i 2:17'1 �.,.
IS/ d
1011 &ITE
ADDRESS %l-rdQS it'157..� F�.itlA .
APN
OWNER
CONTRACTOR/DESIGNER/ENGINEER
Vfl..' 'A"i lt':r$11 t'tl bN1. 0 f /'
,t ti?•fit �. V
S!'.�tt.1' 001 d't'"t`1l ts!V'k- I%T,
i.�7.ri 1f• ,t �♦ • /f+ ,. ♦, •....r S'+•.
c l•+•!ffS - rl.•.
it.i�+,.j3t r . ;'1 ii1
1i.<'J. ilO�; i140
Nt:WI1Qk * REACH CA N,}mQ
NEWKWA'HE ACI1 CA 07662
f 7141",t -(S17 t `ttfft
USE OF PERMIT
til%£1
LQi 11, PLAtV 24t
t'l AIN i'H4i !'V3+1t1-'100(At1) JAY 71':b t''t.ltt MUt:11E'i..i:;8.Sl F 00% SA.Mh
PLAN
tY��itAUt^iE,;t�Si.►f�31C'1' 7$1.t'i! i1=' '
"TIMA.7717.0 CUST 1;3F CQNK ROC.' ION
561882.60
C'i:)N YIlt(t('i'll`tN l:1 101-000-419.000 :`sol
Pr;not t~s1r �.} (: 1141-006-A, 0-318 517A.71
i W011MICAL i•- -E 101-(?{14.x121-iro0 S79A)0
1 t.b(.`T1t1CAL i-1.1; 101 -(ft -4204)0 S15187
PI.UJIN411044-114-� 101 -000 -119 -OW 31413.f►U
3TRONO MC►TION FhX - RJ it) 101-t1W-?s1 A10 Sl 5.69
GRADING 1,70s 1131-404-42 3-M $20.00
ii ia'RA>IIAR .(C1'i1t2i K-11 225.000-443,342 5:l, IgAA
ART IN PC1tsf,K' t'i...ACI' N - T(FsII3 701-0OO.2554W 6442.21
$q jB T't;
�r
TOTAL PERMIT Y 1~:KS WKNOW
", 10.0.34
SEP 18 1997
4
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^ OX
RECEIPT
DATE- j
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION v
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Q
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
.7
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
/ f
Final
Final — —
BLOCKWALL APPROVALS
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
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL AP ROVALS
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:
of nr-r-iihann�w.0ertificate a.
uinto
Cit of La. Q .
Building and Safety Department..
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 comp/lance with the various ordinances .
of the City regulating building construction or use. For the following:
BUILDING ADDRESS: 78-905 ,SKYWARD WAY
Use Classification: SFD. Bldg. Permit No.: 9708-030
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 TRAM
Building Official
Date: 5-14-98
POST IN A CONSPICUOUS PLACE