9908-105 (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# N, ' Lic. Class,' E p. Date
Date Signature of Contractor
.. g c '
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.
.1 'F �se° C4,e% ik^fie `�Y 55=5413
(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 worker's' compensation provisions-of.Section 3700 of the Labor
'�ode, I shalljfolthwith comply wit h t ose
,provisions.,'
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
co fect. I agree to. comply with all City, and State laws relating to the building
cpnstruction, and hereby authorize representatives of this'.City to enter upon
he above-mentioned prope f inspection pyoses.
Signature (Owner/Agerit) '� Date- �)
j
BUILDING PERMIT PERM'S
.'
J/
DATE,,,,/ VALUATION q� LOT. TRACt
JOB SITE ry/, 9t s
ADDRESS ;t�r f'`ai� .i♦� ��. i"./�L,O...��w�`�1
APN tt
'7..�•>.2r'0+7'v`11f 3
OWNER
CONTRACTOR / DESIGNER / EENGIINN�E�EpRL�g
Yt� E A
.T',��.. .iR SE .i9.o"'N i L.�ay.eiatw�...
q�'p�v
i'01.Tiw ISMI A tSVi-+3 ��It.illY�iYS, TUNIC.
670 Iv, .I�.R%atiV:'HEA1) AVE.,
670'N.JUUGWBEAD AVE. ,
SAN 13.C;RNA_1LI.9EtvO CA, 92401
SAN T3ERNARDINQ CA W240:1
( '))R894)?21 CRT.f# MI,
USE OF PERMIT
.
SINGLE PMULY D S°�5.,UNi-i
.
F.[3 ••%' fvf i"C s ,: �3i��T i1V�c;'L { If:a>r ,it +`sL: iAL13 C'il 1'tX. 'I'I.AN
cul -CK P%1:i-i K1,J_)tff;;Fu vsn FOR fVIUL i'.iPLE, 1.,18V&-4CTo0F SAfkAK.PLIUJ
AC 1,12104.00 8F
QAtiX0frY0A.C4`.K?IT'1' 457AKt SY
vi.�'l H'rq.Y i.► A t/6 1AlL V':i d.l1N;F '�".�� 6
- 'TA 4%1`6
00�
pp►►yy;;��"_ ����qq-'p• {(.'�;7� C� q�;� �q,!ytwy";�1"y,
.9..Ci�lWR.R E 1'�Jri�. .V�iNll7�Al�� .
�'1�:Gt'ir'!a'"�1l:'.AL 1•'�'ti, - �.i121-d31t0•A�t-t}a^�) $°;�.`►fi
$..i4,78
P1,i1t41B.i40 PME 1014 0419MO
`g�'ft:?WO �uS01'i0 ' ; -241-W
(TRADING FEE 1F?iw{if3f� ,�?..339t7Q 3"f3.t10
P}t-C:iSES,PLAN I.01.-00-441-345 SiUt3.Utf
I):h'pxELC)t"ER 1114PAC1' M $r1,9070t
f J$?� 'c.:Pi".d«�.'f.;S?N 9 :�'.t,[C:6'L`J�l Ov4DPUAN Ci:
i !
'+,` rte' Via: {tti
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0 .N�9)
r'. ' TOTAL, P4;RN11.WX F. lt'S .l�U E NOW
RECEIPT
DATE
B1'
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & FootingsDucts
Slab Grade
D
Return Air
Steel
Combustion Air
Roof Deck
y Y
Exhaust Fans
O.K. to Wrap
Z — —f
F.A.U.
Framing
- l e o S 7
Compressor
Insulation
Fireplace P.L.
.�9a c�7
Vents
Vents
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
57
Drywall - Int. Lath
Final
Final
70
POOLS - SPAS
BLOCKWALL
AP ROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final I
I
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
COMMENTS:
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)
Certificate of Occupancy
City o.f La Quinta.
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 compliance with the various ordinances
of the City regulating building construction or use. For the following:
BUILDING ADDRESS:
Use Classification: SFD
Occupancy Group: R3 Type of Construction: VN
52-745 AVENIDA VALLEJO
Owner of Building: FOUR SEASONS HOMES, INC.
Building Official
Bldg. Permit No.: 9908-105
Land Use Zone: RC
Address: 670 N. ARROWHEAD AVE.
City: SAN BERNARDINO, CA 92401
By: STEVE. TRAXEL
Date: 05-02-00
POST IN A CONSPICUOUS PLACE