0308-212 (SFD)} LICENSED CONTRACTOR DECLARATION
1 hereby affirm under penalty of perjury that I am licensed,under provisions of
H I Chapter 9 (commencing. with Section 7000) of Division 3 of the Business and
14 co Professionals Code, and my License is in full force and effect.
=) M License # Lic. Class Exp. Date
Ci 7 01 D39LLI
tett; 1r':a31U a
r
Z r_ Date _ r r Signature of Contractor.A
J U �' OWNER -BUILDER DECLARATION
Hd r— I hereby affirm under penalty of perjury that I am exempt from the Contractor's
CD License Law for the following reason:
Z_ ( ) 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).
cY) () I am exempt under Section , B&P.C. for this reason
LO
C\; 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.
( e) I have and will maintain workers' compensation insurance, as required by
Sel5tion 3700 of the Labor Code, for the performance of the work for which this
permit is isued. My workers' compensation insurance carrier & polic no. are:
Cartier ••; TY,, T UND Policy No. 11��0"foal �0d
(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.
Date: - A Applicant 1/1'1
s b,
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, inspection purposes:,
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Signature (Owner/Ag ent)j�%`t ►✓' Date
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BUILDING PERMIT PERM'0�-12,11.
DATE VALUATION w �51,4`54.4wE,D LOT 1 � TRACT.
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OWNER
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AUG 27 2003
t.
GlTY Or LA QUINT,
FINANCE DEPT.
RECEIPT
DATE
BY •
DATE FINA ED
INSPEC
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
_ 3
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
p
Compressor
Insulation
Vents
Fireplace P.L.
Griffis
Fireplace T.O.
Fans & Controls
Party Wail 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 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
3
Encapsulation
Gas Piping
Gas Test
-
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring JI/ JV
Fixtures
Main Service 114,
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
:Ojj Certificate of Occupancy
4
G OF TYBuildin9► Y p & Safety Department
This Certificate is issued pursuant to the requirements of Section 109 of the Cafiforni79-926 with
the provisions of the Building Code and the various ordinances of the City regulating building
construction and/or use.
BUILDING ADDRESS: 79-926 JULEE CT.
Use classification: S.F.D. Building Permit No.: 0308-211
Occupancy Group: R-3 Type of Construction: N-V Land Use Zone: R-L
Owner of Building: PM RENAISSANCE LLC Address: 9968 HEBERT STREET STE 102
City, ST, ZIP: SAN DIEGO CA. 92131
By: G. SHOWALTER
!� Date: 04/06/04
Building Officia
POST IN A CONSPICUOUS PLACE'