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0111-039 (SFD)LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of 'itapter 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 761114 V B_ Datet, "� 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). ( ) 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 oneofthe following declarations ( ) I have and will maintain a certificate of consent to self -insure for workers' compensation, as provid;4-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 XMITH THS. C:Of, Policy'No. 'Z94 1 - (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,,,700 •f the Labor Code, I shall forthwith comply wit t������e provision �'�+ / Date: /��~' APPlicant✓ii'(:�..c.+. t'.°c,•l,c�; , . 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. 44- • M :r 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 Ilk 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 inspectiooctpurpossees. Signature (Owner/Agent) �g'el.- K-+� %✓ t � � Date + A �" BUILDING PERMIT PER 01 DATE VALUATION LOT rte— TRACTf� JOB SITE ADDRESSal�f!I+C�1� APN OWNER CONTRACTOR / DESIGNER / ENGINEER ' OI;Y:C KQ11111_rl-A.70XX CT."ifI.P.QU:£N1A-ICI CILP, 1,CI0 t`„ WAM•1�o'C�`ANAVE 200X W ` .MOU014MS' CA 921325 ESI CO;Eu'•i DDO CA 92025 C.HU 54,13 USE OF PERMIT IMMIX +' I.AIA![! Y DWr'Ri: MICS SFO : )AX17 3•PLAN 2 V. 1 PMMA T 0 ONS NUf INCI, U01 8Lo CK,WA114I, :P'OOKBPA OR DRIVEWAY APPROACH '15 z°o PLAN C 1iOCK IPM REDUCTION Ih01k, MUi.,'I'iP1X ISIjUA110E OF S.AN9 PLAN `f~YP8 / CUSTOM CONSTRUCTION ,,481&09 9F PORCi«NATIO 748.00 M? 0AfiAF,fi3lU:6M''M 060.0 :IF ES 11MITED MET Cali Crraffa71 RUCInON 294,599.69 y��TTj+�sjs•�t,�^1��i• jy (� Q �j / {� 0,0NII-T UICTION x'1`.1-. •Tv1_�°�E 00.4'18-00 9 si.m.09 PL,d>N Ck1It:CK PIAL 101-000.439-312 MECH"IC.AL;ZE 101 -WO -421 -OW $123,50 rti,fJ;;e1EIS:�3I.ft $(?�-tii2C)•+'211 �i13 $I9�i.e Yyloul+tart161 OFF, 101-0 00-419-000 $292,25 dw FFIE RESID x101.-.t0�pO��0-?41-�0lt00 Q���/��.�6 tS�n1�]°SeQ��p3��Wt ``Crr,.yr¢l¢�11l�:ayv{� w Cb.E?X9j.NOP ISi. i0d-00&,4 (...r'I-000 $2(e,60 . aDVE'9,.0PER IA/.iPAC'► ME $4,9tr.9jr ART:W k=U'BUC PLACF8 - RUM 2,70-000,445.000 SM1159 :[6C1 'IOM AitdD P AYI'.0 THC,''. u,310.18 LESS Ph4>.A2D FIM $0.00 NOV 19 71M �'''.�':r II'�0.:s[�'A�!'SJ!S';I,����k� ��1.� .1�fiK)•�4l WYOFLAQUIRTA ' �,e�d�4��.� i 1 9.hr RECEIPT DATE BY DATE FI &LED IN EC INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings ���v(Z _ (Z D (o¢( Ducts Slab Grade ��/ Y p�f� Retum Air -a- Steel _ _ Roof Deck //� % O.K. to Wrap *' �// Combustion Air Exhaust Fans F.A.U. Framing��lp� yQy8Q8Qdp Compresso Insulation��a�- Vents Fireplace P.L. —�i�jLN10Y� Grills Fireplace T.O. Fans & Controls Party Wall Insulatidn Condensate Lines Party Wall Firewall Exterior Lath 'J'l�� 7Oo��,.•'�•, Drywall - Int. Lath�q VI Final`i7G� Final _ `-'-�3 _ 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. I I Gas Piping PLUMBING APPROVALS Gas Test _ ''/ Electric Final Waste Lines /�©� ver 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/a (,N/�Z9�� 6�(/ Encapsulation Gas Piping Gas Test _ Appliances Final COMMENTS: Final Utility Notice (Gas) � � /J � !7,/7/O/ 6. 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) i t Cert�ficatey�jof O.ccu anCY' } 4 - � qtr �• ti ' .- ,, _ o I .: � ,,, ., - ` � � �.°'' � ` , - - .' �<.Cit of La_.'Qu'-`innta I o -Building and Safet De artment �� 0 g Y ;�. p_� 7r_ . , u ' r . , - - r � .~ , � � - _`~ n 109 of the Uniform Building Code / ti ' - This Certificate�issued pursuant to the -requirements of Sectio 4 " g `r -a 3 certifying that; -.at the,tiine of issuance,'this structure was -in coir►pliance with the various ordinances l t '. ',�' of the City regulating building construction or use. For the�following , BUILDING ADDRESS:;. y56-015 WINGEDFOOT Use Classification . - SINGLE FAMILY DWELLING ..: ? _: Bldg: Permit No.: 0111-030 { .- VN Land Use Zone:' RL Occupancy Group R=3`= Type'of..Construction: , (Owner of Building- CR_ V LA,QUINTA'70 LP `r' ;. Address:, 200.E: WASHINGTON AVE n ° City:, ESCONDIDO, CA 92025 l b' c�vBy: ',DANIEL, P. CRAWFORD JR: Date: 4/24/03 Building Official - y P0$T IN A CONSPICUOUS'PLACE ;