9609-142 (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. Datep
,/Date jf��_ Signature of Contractor -
� f
OWNER -BUILDER DECLARATION �J
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:, MyliwOrkers' compensation insurance ca,q,erg& 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 belome subject to the
workers' compensation laws of California�t and agree th/t if II should become
subject to the workers' compensation provisions of Se tion 8700 of the Labor
Code, I shall forthwith comply witI4.those provisi ns: /
Date: z/ 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
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
/S., e'above-mentioned property f9r inspection purposes
gnature (Owner/Agent)-^7` -
BUILDING PERMIT PERMT#
DATE VALUATION LOT 960V 1.41
110/21016S41.4 301.1f 3
JOB SITE APN
ADDRESS 79467 11N3 W0 0.14
IOWNER
CONTROL#
TRACT 4243
60441 10-02,1.
CONTRACTOR / DESIGNER / ENGINEER
HM' tf!'Y ES"I'f�i�.�l"S t{i1:1r�:�.:KA) WR -2 1'3:'1'{iFS, Ci. iti'f.�"Ici -rr.
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LA Qt.iOTI-A CA 92253 C''A 979240
I USE OF PERMIT
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SUB- I'AL CONSIR UCTION AND PIAN CHECK S1y$62.67
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0 C i 2. 1996 I
RECEIPT BY1 DATE FINALED INSPECTOR
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SUB- I'AL CONSIR UCTION AND PIAN CHECK S1y$62.67
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0 C i 2. 1996 I
RECEIPT BY1 DATE 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 WrapF.A.U.
Framing
Compressor
Insulation d/� ,�
Vents
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 APPROVAXS
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING APPRO ALS
Gas Test
Electric Final
Waste LinesHeater
Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral 2 G
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 PowerJ
Final
Utility Notice (Perm)
COMMENTS: pp
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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:
Use Classification: SINGLE FAMILY ATTACHED
Occupancy Group: R-3 Type of Construction:
Owner of Building: BAY CITY ESTATES INC
Building Official
78-467 INDIGO DR
Bldg. Permit No.: 9609-142
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