0111-031 (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
l0r6fessionals Code, and my License is in full force and effect,
License # Lic. Class Exp. Date
7 63 11S' F)
0 f 1
-Date 0 � _ l Signature of Contractor, 1 P S',
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).
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 lone 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 ?,PN) H INS. CC'( Policy No. F.CI4 1f,9t16
(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 a Labor
Code, I shall forthwith comply with those provision
Date: f ..,I °..ti ' Applicant .7 � 9 s
L Ri. _.e
�` pT, , ..
'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 purpose
Signature (Owner/Agent) sFrAZDate
BUILDING PERMIT PERMI0T111'iifJ1
DATE - " - VALUATIONt3,9 LOT _ , - TRACTJOB
ADDRESS 1%_ 5&01.9, 1L'v',i?:�'A FOOT 1
APN .?'7'5.29a-00 4
OWNER
CONTRACTOR/DESIGNER/EN (NEER
C"RV I.,A QLT",,r 0 L9
CRS' I A Q11114nk -? 01
200 i7 WA IUM ONAV&
2, 00 ��,y �9 rAM-U a'GUONY AW,
AA d�yy. 1/1�yyCE
B_,il pt71 �.t.�ALV - �ya4'' .B+s V,[rJ
/y �y
X"• S%C.O.e.'�71�i0. O CA 92023
t 3 b CRUs, 5433
USE OF PERMIT
Sin) , LOT 4 PLAN 1B. PERMIT DOES NOT 114CL DY,1p.,0C. WA. L.., " a
•:1•C3It MUi.'S`!3'LE ISSUA VICE.• OF aMAZ PLAN °! Y119
CU14JTOM CfaVSTRMTi7M21993,00 OF
PORCHPPA.'4ID 315.410 SC'
�1v a1 i D"0�3° 614.00 BF
E917 � ;� COW OF fMONFINUMDA
=AWA0
COAtOTAI T10?1 MME 101.000.418.000 $1,160,00
PLAN ckigcs. PTFE 101.00..0.439.318' 91,39.04-
k� 1.01-13,00,421-000 $112,00
1'1,1f 9F�t3FC# i 101.300-419-000 1f49, S
:iTR08,10 MOTION FSE r REBID 301-000-24.1-000
C ADINO FOR SAO
D1N7l9,W. J?drit IMPACT PER,
.SRT -111 PUBLIC PLACES MIT '27%)O P-445.000
4
2CTION AND PLAW MMS
NOVIBM
AXA PIP, YrTfts DIU. NOW
Q
$3, VAN
C9if OF LA QUINTQ
RECEIPT
DATE
BY
DAT NA
INSPECTOR
IV
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings- (�-
�dzg=Ducts
Slab Grade
,(p�
Return Air
Steel
Roof Deck
_
/ L
Combustion Air
Exhaust Fans
O.K. to Wrap
�, YM _ .
F.A.U.
Framing tf D� �� �p�
Compressor
Insulation
�70� 7?,��
Vents
Fireplace P.L.
-
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
_
(�
Drywall - Int. Lath
_ _
Final �5 !73 �f
T �
Final 63 —�` :.�
. 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
/f/3/0Z_
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
_
Pool Cover
Sewer Connection
/y�3�b/ (
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice
p/D�� 6<v
(Gas)
61J
ELECTRICAL
APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors S
Temp. Use of Power
Final77
Utility Notice (Perm)
Cert�fica tim... of ' Occupancy
Al
City"of-L'aQuinta.
Buildhil and Safet DepdrtMent_,�Mofg Y:.;
This Certificate issued pursuant to the requirementsof Section 109 of the Unifornri-Budding Code,
certifying that,,at the.time of issuance, this structure was in compliance with the various ordinances.
'-of the"City regulat_ing:biuilding. construction or use. For the following: „
BUILDINGADDRESS:' - ''56-019rWINGED 4FOOT
S
'Use `C lassification. .SINGLE FAMILY DWELLING Bldg. Permit No:; 0191-031' ;r
Occupancy Group: R-3 ;. Type of Construction: VN. Land Use�Zone:` RL' �.
Owner, of Building: 'CRV LA QUINTA,10 LP Address: •20.0 E.'WASHINGTON AVE.;;'
` City: " ESCONDIDO, CA' 92025
f;:By. STEVE TRAXEL c '
"'Date: 4/15/03.
Building Official J -
64
- x
POST IN A CONSPICUOUS PLACE ., ,