0101-135 (SFD)LICENSED CONTRACTOR DECLARATION
,.I hereby affirm under penalty of perjury that I am licensed under provisions of
u 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 Contractor—
OWNER-BUILDER
ontractor
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
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.
k;TAT,B FUND 1614122
(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 Seca;;;�"
70of the Labor
Code, 1 g all forthwith comply with thos provi$18ns/ Date: d!e.0 APPlicant .n�" ,�%A.,�'t°
T-7- Ir
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 reque'st'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 f
the above-mentioned property for inspection purposes.
Si nature 'Owner/Anent) ( ' Ca Date 11, 0 r
9 BUILDING PERMIT PERMIT#
DATE ! VALUATION LOT tid TRACT
JOB SITE' • .. (
APN
ADDRESS
X1.98 LAUREL irl�.�..r�
i�1!-' 34 i-EE1 9
OWNER
CONTRACTOR / DESIGNER / EN (NEER
251'.195 AMURAROAD 9204
293,95 AGOUIVUROAD42,04
AGO ►:DR,t HU12, CA 91301
AGOURAHaLS, elk 91301
' .
($1 S)F19.4600 rv.97.j:
USE OF PERMIT
S1?7V P)AN214 ;,.t3`; 4 PYIPAUT 130 1hle' 1. T INCLUDE
CMWAY APPROACH -75% PLAN CHWK r1%
IU.i?1',+UfOT1014 FOR RU1.TIPIX IS"50t NCE OF MME PT,,,nN TYPZ
ov
i'Cf12C:if P1 'I'ii1 240.ou s
C):ARAIDYW.#1,i3:T'ORI T (,Si 9,x&21.60
i
N.M.AppdM COSKOF C 01f(++�pRppppC-(77
PERMT MOR SUMMARY
PLAN CHECK FF.F1 101-000-14391-318 $179. V
MLYX,4 f PJCAL FEZ
1'MO':10WrION.10 KYSID 101 -000-PA 1 -000
M ADWO PI -19 101-000-4,2 O4fC0 '► .tZCt
1W1?t �aSTRUCTURZ,FE2 �� 225-000-443-342 $],#07.90
i
SUR -TOTAL CC3�11y~ "RTX,`r1QX AND PLM 0119M
$3,350.61
JAN 12.2001 < --
.o9 0 8LA
RECEIPT
DATE 1
BY
DAT IN
INSEZ9R
�r%
INSPECTION RECORD
J..
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings /fi pl��
Slab Grade VV
Qi`Zg fa f _
3 �5(J��
Underground Ducts
Ducts
Return Air
Steel,
Roof Deck
77 l0! pr
Combustion Air
Exhaust Fans
O.K. to Wrap
Framing 0/ _—/z /4 -
Insulation
/ _ _
�_
�/
F.A.U.
Compressor
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lathb
Drywall - Int. Lath
\
_17
_
Final
/�7� 3
Final
POOLS - SPAS
BLOCKWALL
APPROVALS
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
_
Waste Lines �Q�
Gas Test
Electric Final
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection/g
U.,
Encapsulation
Gas Piping
Gas TestAppliances
_
Final Final
COMMENTS:
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 1.2tk_ g t:
Final
Utility Notice (Perm)
j
Certificate of Occupancy
City of La Quinta
Building and Safety Department
COPY
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
ollowing:
BUILDING ADDRESS:
55-198 LAUREL VALLEY
Use Classification: SINGLE FAMILY DWELLING
Occupancy Group: R-3 Type of Construction:
Owner of Building: LA QUINTA VILLAS LLC
Building Official
►yj►i
Bldg. Permit No.: 0101-135
Land Use Zone: RL
Address:
29395 AGOURA ROAD #204
City:
AGOURA HILLS, CA 91301
By:
DANIEL P. CRAWFORD JR.
Date: 1/17/03
POST IN A CONSPICUOUS PLACE