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0301-051 (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 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 4he property, or my employees with wages as their sole compensation, w01,clo 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 ontractom-to construct the project (Seca 7044, Business & Professionals Codvs''�. '. ( )A am exempt under Section B&P.C. for this reason ate, A .+ Signature of Owner eO? ;r I Ye Jr + f ` WORKER'S COMPENSATION" DECLARATION I .hereby affirm"'sun'der' penalty of perjury one of -the following declarations: () I;'liave and will`'maintain a certificate of consent to self -insure for workers' compen, sation;,,-a&i provided for by Section 3700 of the Labor Code, for the perfoPmance of,the ,work for which this permit is issued. ( )'_; .1iave and,wlll 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, 1�6, all 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 provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. y Dat •e:- 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 authorize representatives of this City to enter upo"n"' the, above-mentioned property for inspectjon.purposes. ..t•r p Signature (Owner/Agent) ���'^ i7 ' I !,-� Date- 1' "`� •.. A' PERMIT PERMIT#�L ;�.�BUILDING DATE'.. VALUATION LOT TRACT JWtlTEl '�� r ADDRESS !M V�,t WlkIVA?IUGA APN 'YJLi�Q��r�c OWNER CONTRACTOR / DESIGNER / EN (NEER DAM LOGOS DA BO,13'14. 78710 AWE. NWA! TMIGA 78710 ASD '=v`.E7:AWIGA ]LA Q1}7AYTA CA 92263 ^ J.A Q•fXMTA CA 92253, USE OF PERMIT S,1NCUK P'iiMl' Y DWHJ=.iN 2M, I.F. M. ;PI'ti.MT DOES 1400 XR CLUIDE BLOCK. `t)J,P.L4 POOL, OR DITUVEWA AiaPI10A.f`H TRACT CON81R.UCTION ZMA UF PORCIM&TIO 190.00 IF 0 ARAOIarC Aid PORT 763,.00 OR IMMAIM) COST OF M-MIMUMION C:ciNIMIRUryTION FEE 101-0W418.000 9903.50 PLAN CHECK FEE "67.55 t+ E iiEPOW C 101-000.439.318 4230,00 1pp�2?,'7CppwwH A,1` ICA:4l11�.y1JPQEZ 101-000421-000-W-50 1 dyL.FaG l RI\i�,M1.V.i ,PAX . ..�,.i fJ-000,'yA�20-000 S3:J4 09- . PLUM2 IHO MOE 101-000-419-000 $226.:00 S i'Ii£1N0 MOTION N M - WIP 101-000-241-000 117. "i ORAD100 FEE 101-000-423-000 81:5.199 hMEL PER IMPAM MTF x1"; K00 PRECIS.9 PLN 101.000-441-345 ri°a200b0?� 'AM PLAN CIMCK $4,703.91 PRE F JYM F -PAIL WS 4250,00 ` jv*wrvn:DW Now z ea -- APR 15 2003' CITY OF LA QUINTA FINANCE DEPT. RECEIPT, DATE DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Forms & Footings Underground Ducts Ducts Slab Grade Return Air Steel Combustion Air Roof Deck Exhaust Fans O.K to Wrap? F.A.U. Framing Gt, Compressor Insulation Zdr 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 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 �-C(j Heater Heater Final Water Piping _ / Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection L� 2� j �0,� A5Z4-,r-_ Encapsulation Gas Piping Gas Test Appliances /,77 —0j'.* Final Final Utility Notice (Gas) ' /jJ 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: 3 I t " BUILDING SITE LOCATION FLOOD ZONE "AD" - DEPTH 1' U I 9 OF Tiu 78-495 CALLE TAMPICO LA QUINTA, CA 92253 _...._-.. - (760) 777-7075. * . APPLICATION FILE: Upon Step 2 app oval, original goes in "Flood Plain Development Permit" file; copy goes to Applicant PLAN (/ V — PCN (�y"� Please use this Plan Check Number (PCN) Foso REV -2 on all correspondence while plana 7/00 are in plan check • FLOOD ' PLAIN DEVELOPMENT PERMIT BUILDING SITE LOCATION FLOOD ZONE "AD" - DEPTH 1' COMMUNITY- PANEL NUMBER . / — ,,/ '7 / F /) U 7c.,/U 060709 0005"B Map Revised: 8/19/1991 (v• lT ✓ms s, t �1 Q PPLICANT I FORMATION SECTION APPLICANT NAME D✓� �, �d APPLICANT ADDRESS % (g, 7 /� ' V v y '� (MAILING ADDRESS, NOT THE BUILDING SITE)' / DAYTIME TELEPHONE NO. 76 O 5— 3 57 O�Q INSTRUCTIONS 1. A Flood Plain Development Permit is required by LQMC Section 8.11.040(A). The Applicant should complete the Applicant Information portion of this application and submit it to the Engineering Department along with the required documentation noted hereon at the same time the Precise Grading Plan is submitted to the Building and Safety Department for plan checking. 2. Documentation required for STEP 1 OF 2 APPROVAL prior to receiving clearance for Building Permit issuance • Copy of the proposed Precise Grading Plan for review and approval containing all information required by the checklist shown on the back of this application. 3. Documentation required for STEP 2 OF 2 APPROVAL prior to receiving Flood Plain Development Permit approval. Note, this approval occurs after, forms for the lowest habitable floor are set and before the Building & Safety c Department authorizes foundation .construction. ' • Submit a completed FEMA "Elevation Certificate" form to the Engineering Department. • Submit 95% relative density soils compaction certification to the Engineering Department. SSP 1 OF 2 APPROVAL The Precise Grading Plan submitted for this application has been , TEP 2 OF 2 APPROVAL All requirements have been satisfied. This Flood Plain reviewed and found to contain all data required to satisfy the Development Permit is approved. requirements of LQMC 8.11 The proposed dwelling is eligible to receive a building permit upon satisfying all other Building & Safety Department requirements. AUTHORIZED SIGNATURE , DATE AUTHORIZED SIGNATURE DATE La Quinta Engineering D artment .— `. La Quinta Engineering p rtment ��iSr•�YniT iNE�L! FILE: Upon Step 2 app oval, original goes in "Flood Plain Development Permit" file; copy goes to Applicant PLAN (/ V — PCN (�y"� Please use this Plan Check Number (PCN) Foso REV -2 on all correspondence while plana 7/00 are in plan check .CITY OF LA OUINTA SUB -CONTRACTOR LIST �O - ��� / �/� `()� O� JOB ADDRESS RMIT NUMBER 030 — 0_ 1 OWNER BUILDER CV* This form shall be posted on the job with the Building Inspection Card at all times in a conspicuous place. Only persons appearing on this list or their employees are ized to work on this job. Any changes to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result in a stoppage of work and/or the voidance of building permit. For each applicable trade, all information requested below must be completed by applicant. "On File" is not an acceptable response. /�r�,0 �S P Sr % / (/ p�r.'Vi / ? 4 0 ELECTRICAL:(C 10) Trade/ Cla ssification :' Contractor <' State Contractors License Workers Compensation Insurance ' Gity Business License d b 0 z — _ ROOFING (C 39) e z G �c, �70� c�0 �I 0,03 �� .�/ l!o S� l-1 �0� 5 37 7 F e3 # Company Name Classification License Number Exp. Date Carrier Name Policy NumberExp. Date License Number Exp. Date /y 1 (e.g. A, B, C-8) (xxxxxx) (xx/xx/xx) (e.g. State Fund, CalComp) (Format Varies) (xx/xx/xx) (xxxx) (xx/xx/xx) GLAZING:._.'1:7.)r.".::::':::,:r EARTHWORK',(C=12 (e.3'3�'DaJ�21��i,�rQi �� �' 20031 INSULATION'(C 21 `�` �� CONCRETE (C 8) _a 0 962 t` 83 r %" d �� _d. QZi 2 .G - FRAMING (C=5) a 7772 so a Ytk - Aqc Woo ev S 75'till " 3 3 %_Y Y9 STRUCT STEELMASONRYIC ,S`% Ar -G' ✓ 'F7100((;09 1— Zig. `3 29PLUMBING (C 36) �L a � � G d o D �� to U71 j t �% Ot' DRYWALL (C dP HVAC IC 20) /�r�,0 �S P Sr % / (/ p�r.'Vi / ? 4 0 ELECTRICAL:(C 10) C 0 0 y ��© - DO 3 -d d b 0 z — _ ROOFING (C 39) e z G �c, �70� c�0 �I 0,03 �� .�/ l!o S� l-1 �0� 5 37 7 F e3 SHEET METAL (C 431 L Y �-` 2 /y 1 GLAZING:._.'1:7.)r.".::::':::,:r 24 (e.3'3�'DaJ�21��i,�rQi �� �' 20031 INSULATION'(C 21 `�` �� C �- _a 0 962 t` 83 S tv -„ t� 5 5 1 1 D 2 SEWAGE. DISP (C-42) `-' PAINTING (C 33) " 3 3 %_Y Y9 S 03 ,S`% Ar -G' ✓ 'F7100((;09 1— Zig. `3 li CABINETS IC=6) - I Ci J I � 2 & G 7T I„' 1 I d �n�P �Jm 16-7 SJ 5� ( I r�l�l��;� T _ FENCING IC:14�............... //„ II LANpSCAP.ING..:(C<:2:7;)..;:<;.:;;..I e i' i,®/Y Certificate of Occupanc10Y 111 4 U-- 44 OF Building & Safety Department This Certificate is issued pursuant to the requirements of Section 109 of the California Building Code, certifying that, at the time of issuance, this structure was in compliance with the provisions of the Building Code and the various ordinances of the City regulating building construction and/or use. k! BUILDING ADDRESS: 78-680 "ENIDA TUJUNGA Y: z. Use classification: SINGLE FAMILY DWELLING Building Permit No.: 0301-051 Occupancy Group: R3 Type of Construct ion: VN Land Use Zone: RM Owner of Building: DAVID BOGGS Address: 78-710 AVENIDA TUJUNGA City, ST, ZIP: LA QUINTA, CA 92253 By: KIRK KIRKLAND Date: -MARCH 16, 2004' Building Official 1. POST IN A CONSPICUOUS PLACE