0111-033 (SFD)LICENSED CONTRACTOR DECLARATION
d 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
17 63 187 NEI 5/31/03
Date Signature of Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury'that l am exempt from the Contractor's
License Law for the following reason:
( ) 1, 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 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.
SeI have and will maintain workers' compensation insurance, as required by
ction 3700 of the Labor Co de, for the performance of the work for which this
permit is issued. 'My workers' compensation insurance carrier & policy no. are:
Carrier 7.1 dNj fl ')110 CO. Policy No. Z0 4.23"l iod
.(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 t Labor
Code, I shall forthwith comply with those provisions
r
Date: i t in Applicant
j Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706 Jr
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director^of Building and Safety'
for a permit subject to the conditions and restrictions set forth on his
application. t •
1. Each person upon whose behalf this application is_made & each person at
whose request and for whose benefit work is performed under or pursuant to,
any permit issued as a result of this applicator agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes nul[ and void if.
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days, will subject permit to cancellation.
I certify that I have read this application and state that the above information is.
correct. I agree to comply with all City, and State laws relating to the buildings
construction, and hereby authorize representatives of this City. to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) sr R. °�� �• J..tDate 0 �V
`-. PERMIT#
BUILDING PERMIT -g�
DATE VALUATION�x a99,tW LOT 6 -- TRACT 78 ' 8
JOBSITE
ADDRESS 'ai1J! liAfr'J YA dJ rCY
APN 175 -M -M
OWNER
CONTRACTOR/DESIGNER/EN (NEER
c7t vi -1 AQTJW, -.1k. n LP
CRR L.ta QUWfA ? 0 LP
200 SMAImlF3'�3YaGTON A31X
200 E WA.MMK1'.t" N AIM,
nC1awl"ywo CA. 97025
PSCO1+333= C.A. 92022
(� 4`$L# 5413
USE OF PERMIT
UFO 1,17f 6 P1,,KN 2ArR1FV- PETUM T VOLOSS NOT JNCLJJDTt; 0LAX :
wA %, 1 d?Ot,,fSPA OR DRIVE; WAYAPPROACH WK P14AN C:HFW .FEE
FEDUC'I'IGH FOR MLiLTYPIA, ISSUA.Wt 4 0I0 SAME PI? AX TYPE
r
MVTOM CONSTRUCTION m°"40.0 JF
"Moo :gyp
PIMAIT F= b1 f]WAAMY
C10'"u` RUCTION FRE 101-000-418-000 0-418-000 Sifiximo
3'f:.A •CIiFZK.MIZ 101-000-4 3:9-3 a S' $764.19
_MT;.G,"NI4.:t'a3�.K.E 101-000-421-000 312330
=C3`RM@ AL, WX 101-000,420-000 X545. t1i
P LUMBII-40 FEE 101 -000 -419-000
T rR.0,140 MOTION PER p KEU)
s 1'�I>Fa cG; t 01-000.421,-000
0Z111f`F%0PR191 IMPACI s [Ei:+
r r�iq f {
f
:MM3 TAL C";CD�d"./`�. a . 3.' .. w
.j��> l Cn. S . .
- KV 19 ?nni LIPS* Xb 1'$
$.0100
CffVGFLAQiII : ` `I�':�" t?�-r_I. IN DU��.I�tOW
$4,,310,10
Y F +
RECEIPT
DATE
BY
DAT NAL
INSP OR
t, e ,
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
. MECHANICAL APPROVALS
Set Backs
Forms & Footings (/�,
_
%?j/ !
Underground Ducts
Ducts
Slab Grade
� �/
��
Return Air
Steel _
Roof Deck ��/� i-
—
Combustion Air
Exhaust Fans
O.K. to Wrap,�
—
F.A.U.
Framing
_��
� �
��
Compressor
Insulation
p�
_
lh—
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall _
Exterior Lath
Drywall -Int. Lath
Final�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
I
Gas Piping
PLUMBING APPROVALS
Gas Test
_
Electric Final
Waste Lines
/�/S�( N
Heater Final
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
11474
Utility Notice (Gas)
61PUVO1217/1 6N
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)
iJ
a
eiot Ica te-..,o ccqpan,,c
Vch of La, QOft toy:, . _
Budding and Safety Department �M�Fti
This Certificate issued pursuant to the requirements of Section -109 of the4Uniform 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:. �' : ' 56=027 WINGED. -FOOT '
` Use "Classification: r SINGLE FAMILY DWELLING , _. Bldg:. Permit No.:. ,; 0111\=033 .,
' Occupancy Group: R-3 Type of Construction,:,, VN t, LandUse Zone: ,RL
Owner of Building: CRV LA QUINTA 70 LP Address: ,200 E. WASHINGTON AVE
,i L • .: j City: ESCONDLDO CA 92025'y
-
7
fb' By: DANIEL P: CRAWFORD JR...
Date: 4/30/03
Building'Official
POST IN CONSPICUOUS'PLACE
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