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0111-036 (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 Date �t r :. 1"''f Signature of Contractor'" OWNER -BUILDER DECLARATION t. 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 oroaertv, am exclusivelv 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: Carrier2.041114.. r9k%`C'O. Policy No. ZN254,14Wt (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. ortkith comply wit oV provisio �d Date:," Applicant -,r te. , �% Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of. Building and Safety for a permit subject to the conditions and restrictions set forth on his application. 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Ouinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information. is correct. I agree to comply with all City,' and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspectio pur, ose '. i'` / r 1 Signature (Owner/Agent) %� A^^ '"' r L-4 Date) _w BUILDING PERMIT PERMIT# DATE VALUATION t4f pR7� LOT ' " T _ -. - TRACT M?38 JOB SITE ADDRESS "i"1± �b�F�s�I�."*% r APN OWNER CONTRACTOR / DESIGNER / EN INFER C't V LA QMNTA. NT . 7 4 LP 200 Ff..�'Ypv�;,A�SIMTO&ON AVK 20O����,��'y�Uyy�A',R..t3�d�.:Ii:;HAVE1 ��ryypp gryypptryry@y CA 92025 .g p' MCCIIVADED0 L.2"1��d 02'ar iti o i 5413 USE OF,PERMIT 51'IV - WT 9,118-414 4k f9ETVAIT VOM NCYi fNCLUDJr RWCY. WAL T A, P00148PA e: PMWKWA.yi.' AFMOACH 5% PLAX CI WK, FF—F, It FFMIC TION° - FOR, kf:C I.T)PI E ISSt.?ANCY OF SJ bdZ PLAN TYPE C60TOM coNw'6'aue':'1' aN 3;CfA.0 r 3F PMCt3PAT:10 749.00 rte (,#rSF'ts�;Cli�'C.fMP'Oiw`T Cteb,to. up :. D t".0 off (,)F C`()�d+'V"'�'({�t'`')'i':'.:�'$'i')A �°.a�!'� -0 .y,� I� j{�� �j p�yry,,��t�t j 7 P.NVA,, J' W .ilA:r-1 S�1 NiNJM1MA .i t?rI'8`31.I C171HON FEE 101-000438-000 9113.22.00 PLh,N (11f131.',Cf ..t1'EE .:000-439-3'1 & $269.0 Id..F;C:f-YANIC i..WE 101-000-421-000 f.. £�1Lt 1021-C0i�CJyf0-4q 20-t�,(yl�E> FJ. rV;`'�r��Ttqq��w' gC:i�}i 101-000n-419-000 PL+�v-tV}9114o nw, 1 0.i ^V00n-4 i 9-000 M.0NO MO'S )ON IPME a RESIM 101-000-2112 � O O INO F9E 101.-000-423-000 It °:113 PUBLIC PLACr01- WIE Z70-000-445-000 0-445-000 52; 3,5© s$ s. err ..irte'°c AND;lANCMIX' NOVt (,� (�.( ' IV09��� 1"'9'2�Q1 'I.�..u's'T-Tn"Pw,k1DI' S $0M CITVOF L QUIFF 't Y.q 'I' FATI E'S INLTE NOW $4,110.18 is RECEIPT DATE BY DAT FINA D INS E TOR W. INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Forms & Footings Q,� lOf �� Underground Ducts Ducts Slab Grade Return Air Steel Roof Deck O.K. to Wrap 5L� �j� D29v i� Combustion Air - Exhaust Fans F.A.U. Framing y p?i / _ Compressor Insulation _��� �ppp Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath -Final Final 0M0,�4 POOLS - SPAS BLOCKWALL APPROVALS Steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Pibg. Test Final Gas Piping PLUMBING AP OVALS Gas Test Waste Lines TY m�� Q/ _ -l 6� Electric Final 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/rLa- _ 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 G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) f Certificate f- , o Occupancy o 0 Citybf La, Quinta,_ Building, and SafetyDepartment OF ->ti This Certificate- issued pursuant to the requirements of Section 109 of the Uniform Bui/ding. 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: 56-039 WINGED FOOT Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0111-036 Occupancy Group: R7.3 Type' of Construction: VN Land Use Zone`:; RL Owner of, Building' CRV LA QUINTA 70 LP Address: 200 E. WASHINGTON AVE City: ' ESCONDIDO, CA., 92025 By: DANIEL.P. CRAWFORD JR. Date:. 2/28/03 Building Official POST IN A CONSPICUOUS PLACE