9612-023 (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
DatelI 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$rovided 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:
Cartier 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 in any manner so as to become subject to the
workers' compensation laws of California, and agre!_Vt if I should become
subject to the workers' compensation provis on��f Section 3700•of the Labor
Code, I shall forthwith comply with thosel"rovisions.
Date: r/ Applicant-
I
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.
BUILDING PERMIT
DATE VALUATION 5190,4ft(10 LOT
PERMIT# ' CONTROL#
tl �j TRACT ?F4204413
JOB SITE
ADDRESS 114440 WA CARN :EL APN
OWNER CONTRACTOR/DESIGNER/ENGINEER
-11), DES#st T DEVfLOY'MPNrl" LP SF'ARIKS Ct:93+tS k.3Ci±'SOT
79795 RANCHO LA vVI.ly"a A. DR.
L.A QUINTA CA 92253 LA. QCJINTA 'CA 92253
(d 19)771-194!
USE OF PERMIT
SiNG1.8, FAMILY DWELLING
PERMIT FF*S,' RFJ1 kiC;`' .AX ART IN PUBLIC PLAA-li4 CRE -AT O
5„',26.G21?hR AC':itV70\6W WITH Mfv[tMTYD VFLOPP}W3Mr
C US TOM C'ON STFt.l. UCTION 2.285.0-o w
t7{Jt2� f%F'l� jQ t 15.00 S.F
0At2.AQE/C°, ARPt.)Kr 555.00 .4,
cosi- Or cmwgucr,10N,
► �ltiat.� FRE, St)l,Il M01
Pf,AN CHEVK F'FF
401-0W-439-318
$795.62
CC YNS7'.�'st:lOMON Ff.!t
101-0*41 R -W
5 5K.�iU
MECHANICAL FU
403. Ct1(14�121 O(:'J �
�.11z.s�i
T�GGC yitl rlf; f s ,
101-000-4'2104fO0
J3.t!3
>aE.CffUcctfrif�•'t� pfd
lf)i.dt[IO-�i'i-ROU
SF41.t.t3�J
f'( hilimt+`!'F'1f)1t!-I.?-fcl�'y)F)l-0[if)-��4J^W
I(A-t)W/Q 1VJ0
$2(i,flt►
f:l+`};1•:
'h510(6-443-342,
reit"t' D41':T%Gt.1�.i.%C�'�J':LA.i;'i!3 - L2,t��:1b"'
701r1:FCli)••255-(3Ui�
;i1�lG U2
.SRT IN ff''B, BLIC;' Pi,Ac; F3 » :itf 34!
701.
51313•7T)TAL C(�1V5"t' �i4,T4'C.�N �lND P)._ N fwREC
LESS PRE-•PAII) FEE.
TOTAII PERM .Ni'EW$ 4)(T.E NOW
I certify that I have read this application and state that the above information is j
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby aut oreze'representatives of this City to enter upon
the above mentioned grope for insp, action-purposes.r�f +A I' )
j fit, REC, ' DATE FINALED INSPECTOR
Signature (Owner/Agent)//� ,/ ' Date /�G EIPT DATE BY/
$01,711,05
4226,02
,•45.03
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
—
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
(_ bGC
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
. (�
Drywall - Int. Lath75Z
.y.__
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 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 7 7/at
Utility Notice (Perm)
COMMENTS:
v a vmll ICJ I
HEATING & VENT -A/C
FIREPLACE
ROOF
BOND BEAM
O.K..TO WRAP
GROUT ❑ 4' ❑ g,
FRAMING
INSULATION
PRE -ROOF
COVER NO WORK
f10Vuuel .
JOB COMPLETED
TPRAD Dnu/E!r,
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
7/96 TURN ON UTILITIES OR OCCUPY BUILDING
Certificate of Occupancy
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: 78-840 VIA CARMEL
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 9612-023
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL
Owner of Building: T.D. DEVELOPMENT
Building Official
Address: PO BOX 1716
City: LA QUINTA, CA., 92253 .
By: RICHARD KIRKLAND
Date: 6/16/97
POST IN A CONSPICUOUS PLACE