0006-126 (SFD). I
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 # w Lic. Class Exp. Date
/
780230 BtSJ,+ /2(
Ad�
j/`'ate 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
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 CLARDIDON r0511% Policy No. WC DIM33
(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
Date10YG:;; t� Applicaht %i!'t'.tr' GC�•Gl� I Y
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 upon
the above-mentioned property for inspeeflon ptjpoMe
Signature (Owher/Agent) !�
PERMIT #
I BUILDING PERMIT
VALUATION LOT
E� 000&2� TRACT: Y
DAV Y
$ 79„302.70 22 3L 3'S9
JOB SITE
APN
ADDRESS 0524M AVlr.=A VAUXTO
773.-324-005
OWNER
CONTRACTOR/ DESIGNER / EN (NEER
Foo m6mils 1,10MES, WC,
P 81 CO1dSmu-C"'iI6 WC
6701;1, ARROWHEAD AVG
db%P S 1 BUM.)I S
SAA1' BERNARDWO CA 92401
SART BF"ADIATO CA 92423
(909)7w5sn CHLO
t
USE OF PERMIT
`�4+7W-FAN91,Y DWF1 U3g03
5FD-PERMIT DOES NOT INCLUDE BLOCK. WALLS OR Pn_ OL
w �
•
TRACT (,1011STRUCTION 1,218.00 8F
PORCHIPATIO 165,00 SF
GARAWC.ARPORT (SI) 9,2'V180
`Z
5 rf. WOOD FENCE: 26Mo0 LF
�
9B7C:ttl�SA`= COVr OF V,0N 'MU•C:Ii0N
79,3W.70
PF1WrM NUMNWRY -
001`tOTRUCTION PRE 101.000.4.18-000 S$49,50
PLAN C.HWX FEE 101-000-439.318 $467.35
t S
MECHANICAL IEE 101-000.421.000 s#2.3t1
ELECTRICAL FEE 101-000-420-000 $115,99
PLiXMATNO; '•z 101-000.419.000 $128.75
STRONO MOTION FEE RASIID 101-000-241-000 3793
0RADINC.11*` E 101.00Q.423.000 $20,00
DEVELOPER IMPACT FEE $I,?o'3Ao
!PRECISE PLAN 101.000.441.345 3100.00
PEE DEPOSIT 1011.000.439-3.18 •$Z3o.00
t OUB,.'t a AL CONSMU'C ION',AND PLAN CTWICC ,
$3,349.82
LESS PRE -PAM Y=11
4250100
A10TAL PY-R'r TS'M VUE IV OW
$130)9662
r
A
RECEIPT'
DATE
B-(/ j
DATE FINALED
INSPECTOR
�. v
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
Slab Grade
_ —� 5
Underground Ducts
Ducts
Return Air
Steel
Combustion Air
Roof Deck
' 4v
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
-01?
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL AP ROVALS
POOLS - SPAS
Steel
Set Backs
ze,a CILO 57
Electric Bond
Footings
Main Drain
Bond Beam
+ $
Approval to Cover
T6 5--u-0) iar
Equipment Location
Underground Electric
Underground Pibg. 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 y
(,gyp
Encapsulation
Gas Piping
Gas Test
p
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Factures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final Orr P—T
Utility Notice (Perm)
COMMENTS:
4
City of 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: 52-850 AVENIDA VALLEJO
Use Classification: SFD Bldg. Permit No.: 0006-126
Occupancy Group: R 3 Type of Construction: VN Land Use Zone: RC
Owner of Building: • FOUR SEASONS HOMES, INC
Building Official
Address: 670 N. ARROWHEAD AVE.
City: SAN BERNARDINO, CA
By: STEVE TRAXEL
Date:' 04-24-01
POST IN A CONSPICUOUS PLACE
92401