9609-138 (SATT)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 Contractors i
/ 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
pert rmance 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,iss.GedS fVlyRworkers' compensation insurance car ier98 fpolicy! 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,
I shall not employ any person in any manner so as to
beco a Aject to the
workers' compensation laws of California, /and agree that if I;Aould become
subject to the workers' compensation proylslons ofJSectio 3700 of the Labor
/ode, I shall forth 'th/ :comply with tliose'�irovision
ate: 11f/ Y (Applicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties andtcivil 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 representativesof this City to enter upon
the�above- mentioned prope t1f rinspectionurp ens -),h A
I'll
bSignature (Owner/Agent),ice ' �� ( Date9Q" 4'
r'` (✓7.
'BUILDING PERMIT
PERMIT °°NTR°`#
4239
DATEi�fzrr,r, VALUATION i°),2R.t5lB LOT
TRACT
JOB SITE
ADDRESS Pi-463IiVOW00 VIA
APN
OWNER
CONTRACTOR/DESIGNER/ENGINEER
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USE OF PERMIT
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$2,16433
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S2,1 64.33
OCT 2 1g6
RECEIPT
DATE
BYDATE
FINALED
INSPECTOR
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 7
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wali Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath wlizoi
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric*
Underground PI . Test
Final I
Gas Piping
PLUMBING APPRO ALS
Gas Test
Electric Final
Waste Lines J
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:
7/.,a
9 !� y
D���'r/" �N
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 of La QU*inta
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: SINGLE FAMILY ATTACHED
Occupancy Group:" R-3 Type of Construction:
Owner of Building: BAY CITY ESTATES INC
Building Official
78-463 INDIGO DR
Bldg. Permit No.: 9609-138
VN Land Use Zone: R-3
Address:
78-233 INDIGO AVE
City: LA QUINTA, CA., 92253
By: DANIEL P. CRAWFORD JR.
Date: 6/5/97
POST IN A CONSPICUOUS PLACE