9609-137 (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 }t Exp. Date
:u1+Jt1 i7
tl /
ate Signature of Contractor
OWNER BUILDER DECLARATION d'
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
Sec on 3700 of the Labor Code, for the performance of the work for which this
permit is;i�suecl'.,• M,y;,,workers' compensation insurance carrier?;& ,p, y; 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 bec &,,subject to the
workers' compensation laws of California, and agree that f I should become
subject to the workers' compensation provisions of Secti n Z00 of the Labor
Code, I shall forthwith comply with those provisio s.
�ate:114� 1� r�r�v Applicant .
Warning: Fdilure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and c vil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on r his
application. I . ,
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.-
/gnature (Owner/Agent) + •(--! Date
r
BUILDING PERMIT
DATE i(1/221e)4 VALUATION �.6y�:�I1.60 LOT
JOB SITE
ADDRESS /4•-4b:� Jl'gV1%_vU Ofi
OWNER
y CH"(, r:G 1' A'141C t/1 V (Z ky 1'1
al. / 1... r..l l... �IF,t /rllj INCt
78.23 ;1HOI G AVE'
LA QU1N1'A (.'A1 99"25:1
USE OF PERMIT
S1NO1, - TAMIL, AWAi::1i1?D
1 K.11t;1' CANS 1 ii.R),.; i
PERMIT # CONTROL #
W4119-0.5.7 4238
TRACT
APN OWA Ntl-112 N.
CONTRACTOR / DESIGNER / ENGINEER
17 A iur,t(3r h''P'r;!'t'lxotrrml
119,10 PALM DR., VN1'I' ISG
17Es41:1t 1' 14tJ1` 51�1ttN�:;, CA 92240
41142.9-,1,49 } Cf3 H .13,15
WE:NDE LL W 1'C1TK ARCii1'17.CT
PO R(•tX 1!4"4I
%:,S~F'tMATIr".0 CCA. T OF c:YaNSTiiifi(:;T10N
49,521-66
PERM IT l+b. V, SIIN4All AkV
CONSTPUCT(ONVfii
tQl-1fCt3 41$-OCi(i
$414.30
1"1.AN r'lf iCK FrX,
101 -OW .41? 1-318
$354:22
I4 OMN1CA1. FTX
1.01400-421.000
fi i;.4n7
1:I.F.(rrRiC.At. FE11
U -C?(}!)
101 -WO -420-M)
Sti7:l
PY.i NIFIiNG FIE 3. -
1017-0004W.000
$97.50
&.1"CING n 101110N FE1i - !i'..i1L
101'-21114Jft.
$195
CRANNG VIM
1101 -OW -123-000
$20.00
IMFR ISTR C11JR17.FFM
72_54= 441-342
3f,11d.7i1
TIR :f.."'ISRKAN
101 -WO -441-;45
S23.t
RECEIPT
SLFB 7MAL CONSTRUC" ION AND PLAIN CTIECK
LESS PRE-i'A11YPEES
D �n
L'-`� l'#�a3ii4 IT FisKS ME
OCT 2 2 199,6 ,
Ry
—DATE `_— BY
DATE DATE FINALED I INSPECTOR
$2,16;},33
-$250,00
$1,914.33
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
Compressor
Insulation WZZ 92Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
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 APPRO ALS
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 Q
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)
COMMENTS:
/,%,�Jf%/�i ��y /x��
����
(�
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:
Occupancy Group:
SINGLE FAMILY ATTACHED
R-3 Type of Construction:
78-465 INDIGO DR
Bldg. Permit No.:
VN Land Use Zone:
9609-137
R-3
Owner of Building: BAY CITY ESTATES INC Address: 78-233 INDIGO AVE
City: LA QUINTA, CA., 92253
By: DANIEL P. CRAWFORD JR.
Date: 6/5/97
Building Official
POST IN A CONSPICUOUS PLACE