9904-244 (SFD)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
ate S I Signature of ContractorL
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
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:
Carrier r, q{� Policy No.
ST
An y
(This section need not be completed if the permit valuation is for $100.00 or less).
() I certify that in1he 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 YSecttion 3700 of the Labor
Ce�de, I shall fortwith comply with those t rovisions. �
FSate: `
Applicant—
Warning:
pplicant 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.
Signature (Owner/Agent) �'� Date
I -..✓ Al
PERMIT #
BUILDING PERMIT
y!04-244
DATE i 1 �J f / a VALUATION $110,292.9f) LOT 40 TRACT M19
JOB SITE
ADDRESS �il J����9 � i �i wl� E��
APN 769792-001
OWNER
CONTRACTOR / DESIGNER / ENG114EER
iRDd + RI 1 T
,01„t D.A�N D AT,C
'4'rt L� 'f1 •G�1t. P" T.T-
.t �.,.Lu �� �.�t.c; r,�l r, ���,.
7n-120 CALL.6 I gfADO P104
78-120 CALX, Ez-.fADO, #104
LA QUHQ'A. CA 512253
LA. QUIN A Cts 922.53
t'c5fil7'71.._5579 C,1I;ff 5029
USE OF PERMIT
S1.1tifOLi;VAt>fi11,
L01'404PLAN .2A.Fs.4=1CK Vi'feLLS OR.
F°i3C1t.: PLAN (;Tl l K f1012,°ZION. OF :4+IR lir; :>-UQ-.i? 7S%FOR lVl.1.`X.'Yld'LE
ISSUANCE 0 SAt1V1r,, 41.A "f YP&
TKAC' T CON; R'U T ION
ter.?ltt;WPA.TTO 184.00 a
QA1ZAC fY4 A1?Y0WY 9>a3.tf1► .r'
ENT IMIATED CONT OF C'QNiS,"MUCT10114
33,21011.9-01
i`E!RNi'll., FEE, sC110'Q"NiARY
CONS'PR%iCFION FM 1011-000-418-000 $4�1.U43
PTINlJ?rte: lot -000-439-318
i.MMANICAL IEt” $53.511
L. Lt. C"3"R1C:f1[:1< r, $113.47
PLUMBING FEE 101-000-419-000 S139.50
SI'R.clr1•t3 MOTA0N FE Vt. R 3. 1D t 014101? -241 -fl" S?.83
(MADING nE M-0004..34000 $20.00
UNlr':tt %sIrit01(1'TUtREi Ffi8 2254)(1-445.342 $1,9.31.53
c Tf.3^'`1Y.Yr.A.1, i.0 15I'4ti:ii'C I+ iJ ANII P 1, 3?�;r;TT?��R
�r2, f)91
i@9�73
LESS
/441
r0'f*ATA ; TRM1 FEES PUa NOW
MAY 0 3 1999
i
:RECEIPT
DATE
BY l
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
4Ducts
Slab Grade
ReturnAir
Steel
Combustion Air
Roof Deck
ST
Exhaust Fans
O.K. to Wrap
_ -
P.A.U.
Framing
.- / —
Compressor
Insulation
y-
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
- Q
Drywall - Int. Lath
$ i
Final
Final
POOLS - SPAS
BLOCKWALL
•
PPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final f"
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:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power'Pole
Underground Conduit
Rough Wiring •,
Low Voltage Wiring
Fixtures..
Main Service
Sub Panels
Exterior Receptacles
GT.I.
'Smoke Detectors
Temp. Use of Powe6
Final
UtilityNotice'(Perm)
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: SFD
Occupancy Group: R-3
78-310 DESERT FALLMAY
Bldg. Permit No.: 9904-244
Type of Construction: VN Land Use Zone: RL
Owner of Building: JIM DAN D,LLC
Building Official
Address: 78-120 CALLE ESTADO #104
City: LA QUINTA, CA 92253
By: STEVE TRAXEL
Date: 9-23-99
POST IN A CONSPICUOUS PLACE