0203-264 (SATT)LICENSED CONTRACTOR DECLARATION..
�Chereby affirm 6nder.penalty of perjury that I am licensed_ under provisions of
Chapter 9 (c(?mmencinq 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
7W9$ = A C8 HIC r 9/10/03
Date' Signature of Contractoro
n.
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 STATS FO -AD Policy No. 160361642
(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' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those Provisions.��s�
Date: �""IX7).4 Applicant " . 11"1X2te" Ab -
Warning: Failure to secure WorkerO 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 upon
the above-mentioned property for inspection purposes. '
Signature (Owner/Agent) Date 6' _Ole L,S
BUILDING PERMIT PERMIT#
O Jdt�C,',4
-DATE z VALUATION LOT I HAL, I '
S 1 9U3? 28601
74JW
JOB SITE 0 I
�y /
ADDRESS •�7�4=FC�i�V7�i. C S
APN -
OWNER
CONTRACTOR / DESIGNER / EN INEE2R�e�iR'`
vr� A y
74760111MHW Vis, t 119-200
-16.6M fWKWAY I I'1
1NDTAIMELLS CA 92210
1,QUftTrA CA 92253
(760)711 -3 45 MIX. 2180
'
USE OF PERMIT
2MIX ]FAMMY AWA '11 D
SPA 4 HLY30. 0, UNITf7, PLAN I.A.. I ERMIT OCIES NOT INC.Ll DY!,
POOL, SPA, MOCK WALLS, OR. DRIVE'?Wt Y APPROACH. 75% R1SDUCT1014
IN PI AAI CHUCK FEE FOR. MULTIPLE ISSUANCE OF, SM.9 PLAN TYPE,
TRACT WNSTRUCTION 1900A 3F
EMU= COST OF CONYMMUMON
Is kmwrM summ" '
CONSTRUCTION ME 101-000.418-000 $383,50
PIIrl' e' lEC.% PNe 101-.000.439-318 9}v.,8
MEC:.INI W`{2.?., FEE 101-000421-000 $39.50
V.9cTRICAL%ALL 101-OM420-000 $65.26
PLUMBR40 TU 101-000-4105-000 U9.50
STRCI!140 bfiDTI014 IEE - R&SID 101-000-241-000 $4.53
LiMIX)PEFI IMPACT M. $1,569,00
SIX -B -1-04-A, 60 .PMD PLM r—
$2,24134
e
MAY U 3 2002
CITYOFLA'QUIMTA
FINAHC MEPT_ ___----
RECEIPT
DATE
BY' J
DATE F!XALEP
NSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
- fly 'O
Underground Ducts
Forms & FootingsQ-d
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
D — a ?
Exhaust Fans
O.K to Wrap
., �r3Z�
F.A.U.
Framing
Compressor
Insulation
.d
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
•� Z S7
7
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
13 t -d 5-7
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) — - o
COMMENTS:
Certificate of0ccupancy
City of La Quinta,'
�-
Building and Safety, Department OF..�
This Certificate issued pursuant to the requirements of Section 109 of the Uniform Bu#ding 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 fol%wing:
'BUILDING ADDRESS: 47-740 SUMAC STREET U-37
Use Classification: SINGLE FAMILY ATTACHED Bldg. Permit No.: 0203-264
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: CR
Owner of Building: MIRAFLORES, LP Address: .74-760 HIGHWAY 111 #200
City: INDIAN WELLS, CA 92210
By: STEVE TRAXEL
Date: 03-21-2003
Building Official ,
POST IN A CONSPICUOUS PLACE