0111-038 (SFD)LICENSED CONTRACTOR DECLARATION
Y 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
7651 WV 50,13 I .� �t
1 "� I ✓�-
._,
Date 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 nwn4 of the property, am Pxrlusively 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
WORKEWS 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:
Carrier ZENITHINA A C0 Policy No. ZN27943%
(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 the ./Labor
Code, I s�all�forthwith comply with o_,se rovisions.
Date: ,f"!"f�i�e'i Applicant��!! ,tit-� (���i
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
ion urpos
the above-mentioned property for inspects.
���� p��
Signature (Owner/.4gen � � Ly_ t 1i0" Date �
-
BUILDING PERMITPERMIT #
DATE VALUATION tat7u^w�.Wil LOT TRACT 27
JOB SITE r! .-
ADDRESSMI % �I���x FS.
APN
7`F�a►-,ii �:�
OWNER -
CONTRACTOR/ DESIGNER/ EN (NEER `
CR➢ rX A,,QUDt 1A.7011 1
L"Yi2VI.A.QgWY "!0I1P
W) It- AMM49TOR AVE,
200 F? 'WMPN'(i'1XXN AW .
INW014LtDO CA 92025
CA 920213
C,%Wi 5415
USE OF PERMIT
"IMPT .fIFAG.T .l .%, 4fqgry
v; JT 17. 3�S rT�1�IpE�l+iIT f.3�Cp�s�lw�,,ap�/vK,�T XgNC1r.��?.rJE,14UX11K
plgpe�.+ h.
Nj.J �� ` A xp �p
vYd'�II. ,Lf''�t, b�'i+'h�;�USPIA OR S./RI IrWA APPROACH, di`�A Pl..'7.S`! CHECK �P, E `
Ekn?13UC` 10,N FOP AA'19JITIPLE OF ISAMR, PIAM TYPE
CUSTOM Co?d'aTm'd"(Al 21985,00 ale
PORCi-I}`1'.ATIO 335.0 F
01 �Rt9.C5WA,Itk''OVI 04,00 SP
EWMD COYr OF COMINi7C.TI',OR
250,46ZAQ
�'6�'ea,1s��jfs(":9.' WY
j�+j"j q'�z�p9'ixUT�(4� y� (���y�ry� 1 j /� $11160100 { { jQ c
5. t`.��'A'NA�A.i`I.\i�l!'•5�ION FRE J01,0\✓0-418�''600 19a..160i00
KL.d�x CHEVIX FFIt WI -000-439-3,18 $239.€14
WK,FANICALF f531�X3G1t1"�3• i�Ct�ICt "�I? .EIII
EUX-, TICAL FEE 101-000-420-000 $177.%
PLUMBING FEE 101-000.4,49.000 $194,25
.iT RONO MOTION .MVM - .'t_F1 Slb 1011-000-241-000
0RAMk3O RY, 101 n000-493.0
1)zV"S'.L,0J13T$R IMPACT FTIZ
5IF-S IN F1JDIAC a'«SC.PS - ROM 2 r't940-44 5000 $120,10
1'AM I'I"C'kY01C. t
$3,969,46
9lOV.19 �� LE F.RILPIM"..�
?. 1
$0.00
PTIM11. V7. TE NOW
'ES Dt
S3,90.46
CY®F LAQUINT
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L
RECEIPT
DATE
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BY
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DATE NA,
-572a 3
INSPEC
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l
�M
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
TINSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs _
Forms & Footings /%p�j /2% (/ /
Underground Ducts
Ducts
Slab Grade vvll /�_/ fit/
Return Air
Steel
Roof Deck oWrap �/�—
Combustion Air
Exhaust Fans
77/W � /��/�
F.A.U.
Framing _ r _ _
Compressor
Insulation _3o/p,
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall Q
Exterior Lath
Drywall - Int. Lath
Final
_
Final ,(�% jai
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
Gas Piping
PLUMBING APP OVALS
Gas Test
_
Waste Lines ��lQ-Q/
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/�l `
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final �!
Utility Notice (Gas) /
/"
ELECTRICAL APPROVALS
Temp. Power Pole
9
Underground Conduit
Rough Wiring
IleLow
Voltage Wiring
Fixtures
Main Service
Sub Panels ,
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
Final _
Utility Notice -�
(Perm)
C ertificate, of
O� G
City Quiff,hta
ofLa
- 5
'Building and Safety'Dpartment MOFe
This Certificate issued pursuant to the requirements of Section 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: 56-047 WINGED FOOT
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0111-038
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL
Owner of Building: CRV LA QUINTA 70 LPAddress: 200 E. WASHINGTON AVE.
City: 'ESCONDIDO, CA 92025
77
By: DANIEL P. CRAWFORD JR.
Date: 5/7/03
Building Official \
POST IN A CONSPICUOUS PLACE