9605-136 (SFD)N _
LICENSED CONTRACTOR DECLARATION •
I hereby affirm under penalty of peryury`.that I am.licensed under provisions of
.Chapter 9 (commencing with Section7000):of Division 3 of the Business and
Professionals Code, and my License is in full force and effect.
License # • Lic. Class Exp. Date
39"075
_ .
Date �t` ��'v�"' Signature of Contractor-^�''%-�'✓�-
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).
:( ) 1, as owner of the property, amexclusively. contracting with licensed
contractors toconstructthe project (Sec. 7044, Business &•, Professionals
Code).
O 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:
CarrierPolicy No. -
t:1'a-�►+riNtCi:s`!1
(This section need not be oompleted 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 CaliforniAn, d4gree that if I should become
subject to the workers' compensatlon,provlslons of Section -3700 of the Labor
Code, I�sh 1I forthwith comply with those provisions.
Date: -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. EaclYperson 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 asesult 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 autho�ze'r'epresentatives of this City to enter,upon
the above-mentioned prop rty for inspection pur uses 71-2.
Signature (Owner/Agent) .`�”` Date'
> f
PERMIT# + CONTROL# -•
BUILDING PERMIT i
9641, 436 3465
�'
DATE VALUATION ` LOT TRACT
til �f6 / $2.04;"2.70 27...cr�i✓i S'fI iI
JOB SITE �pp y��tp� p�py
ADDRESS �4-.31S �'Y1tAo GUO l�'AJL7T
APN
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OWNER
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CONTRACTOR / DESIGNER / ENGINEER ,
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F�tii3iii��lIv1Ct.�'C1Ut op, #201
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10-MitiTt DA..VUNCr 'CA 92201
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RECEIPT ;`" —
DATE
BY
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
OX to Wrap
p
F.A.U.
Framing
Q
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
1
Drywall - Int. Lath
Z6 PY--
Final
Final
BLOCKWALL APPROV LS
- -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
d
Encapsulation
Gas Piping
Gas Test
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:
Certificatecupancy
Oc
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City. of. LaQuinto s
Building and Safety Department FMOF.
This Certificate issued pursuant to the requirements of Seciion 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:. 54-375 WINGED FOOT
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit. No.: 9605-1.36
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: R-3'
Owner of Building: RANCHO CAPISTRANO Address: 79-687 COUNTRY CLUB DR #201.
DEVELOPMENT
City: BERMUDA DUNES, CA., 92201
By: DANIEL P. CRAWFORD JR
Date: 2/19/97
` Building Official `
POST IN A CONSPICUOUS PLACE
BIG