0010-090 (SFD)LICENSED CONTRACTOR DECLARATION
.1 hereby affirm under penalty of perjury that I am licensed under provisions of
6rap`er 9 (commencing with Section 7000) of Division 3 of the Business and
Pessionals Code, and my License is in full force and effect.
h,'
�x Ucense(P# p Lic. Class Exp. Date
{ate 1/21( y A♦
Vbate Signature of Contractor+ ! t
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 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
i performance of the work for which this permit is'issued.
1 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 Policy No: .
9';fiAT9 COUP IRS"" W, B�9;d3�`7�p0
(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 shall forthwith comply with those provisions.
pate:a t>/'2 4 f r -,r • Applicant%
Warning: Failure to secure Workers' Compensation coverage is unlawful'and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided forin Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions- and restrictions set forth on his
application. ±n
1: Each person upon whose behalf this application is made &'each, person at °
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a.result of this, applicaton agrees to, & shall, -indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2: Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of.issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read.this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for.inspection/purposes =t {
✓/Signature (Owner/Agent){�- '� �CeZi, Date _12112i✓l'
y `
BUILDING PERMIT,PERMIT#
DATE VALUATION LOT_ TRACT
JOB SITE
APN
ADDRESS
47405 VIA, ORVT
OWNER
CONTRACTOR/DESIGNER/EN INEER
.i'��^►�;.sir,��k�i••��'U�`�x'�'3�E�t'Y�,S�1'.°
3JC9�'at.�€11V'.{�1'P-�t3��+'�'�1�F.C.�37i9t"..t�rl�+��t�Ai�..'
P.fs,LMDFZMT CA 92211
YALMLINSEtt�: d'w',A, W,211
('76OWDS-3495 (MV1 6131—
"' 11� ;
USE OF PERMIT
5�.+t`i:`��`.i..aL.•.5°dSiX!J�..Rr JJ tff$�C:�.II°7iF
{ .
VD -LOT 179 PT. -4,14 2TIt- PE. NIT DOES 140 rNCLUDIR BLOCK '
3'23AVY CONSTRUCTION 7,409.0 3F _
P0K'CWAAVO 126.00 SP
CARAOMARPORT a;21n, 10,5,44,00
`COST OF C�i� �d.t7'6.,Pd:��+.k�
1•�:�:���.�t�}
y y�y' yy yp4 pry.p�pya ,py.�XOTIMNM
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9:�ONSI 7�=5A el.101 N FRE , Y 0 8-,00EA-s 1 O"Ff'i7�� �`lel3-ieeQY
311" CHECK FEE 101-04139.318 S661.53
M. ECH(?eMC.AL FEE 14'31-M-4.2.1 • Kid S9f), �b
°"�t i?.S:'#°Sn.T�/:9.I�.,f�. '. • Z (�'1-•'QQ�C^wr4`e",C1^�?f�' 3 SIaCM..�(I
PLIUMBI"HOPC F, 101-0 00-419-000 %168.54
S TFf.G'}7dI;1:vILYi'1CIN ,PM « RPSID 101.000-24.1-000
OkA f7I %IIS }� 101-000-421-000. m2S9,t1tf
r3�t':'��C.OI'�Jt, I,PAYa:�sC'!' SEE $]SS+iY7 Off,
o
S 013 -*1WAL CON ITWU�N ANT) PLAN (n- M,
9 3,117 9 -6 1
J. 315I:''EC&P .3
$0,00
PA1DjtoTm,- mmTrus Un 'i ow
q.�
JAN 2".6' 2001
g
Grp Y V8'�� "
RECEIPT
DATE' j'
BY. 4 / ,
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
t BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
�/
(�J�
Underground Ducts
Forms & Footings
Ducts
Slab Grade
�vZ—t�%
Retum Air
Steel
Roof Deck3�
Combustion Air
Exhaust Fans
O.K. to Wrap l� l
F.A.U.
Framing
_ _
6,'�_
Compressor
Compressor
Insulation
Vents
Fireplace P.L.
//
Grills
Fireplace.T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall -Int. Lath
2�
Final Z8/� ��
Final
POOLS - 4PAS
BLOCKWA
L APROVAL
S
steel
_
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location -
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final '
Waste Lines
_
��
//�
Heater Final
Water Piping
b�
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
/Pool
Z�
o
Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
2
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
�5;/
Utility Notice (Perm)
�.# . MOUNTAIN
ARCHITECTURE
ARCHITECTURE & ENGINEERING
ING GEAR CITY AIRPORT •SUITE A-1
P0. $OX 6167 • BIG BEAR LAKE,' CA 92315�'
"{ (909) 585=6311
• 12/26/00 �.
City` of La Quinta '
Department of Building and Safety.
La Quinta, CA : z
r e' '
RE: Northwest/Southwest
Plan 2A, Lot 2178
: - • , ... +�--+'^� .Y !7-ar,....• .�: hT. _�,..�'_""_'ti.'. �.... - l•�TF. ww ..., �'�i - � .L2C - � � - ,-� - -a
Gentlemen
I have perfotch ' ed the structural observation on the above referenced, and find that the building
is innformance with the approved plans, with the exceptions of 5 item_ s as sketched
y
out in the a 2' sheets. ,
If you have any questions,, please call.
Sincer y,:e.
F TAIN ARCHITECTURE
' t
�ca�p ARCy,
ohn . Acosta, AIA
Lice n ed Architect -v '
JOHN F. A ,1
NO.
BEN. •3001 Q'
pR
s
4 '
CALIF. LICENSE #C24055 ••ARIZONA LICEN5E #28023 •. CALIF O.E.5. KEGI5TEKED EARTHQUAKE DAMAGE A55E550R #5A1373
f•
C;:
Certificate of Occupancy'''�
a
AN
Cit of La uinta J
Q
Buildingand Safety��, Department _ OF
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: 47-206 VIA ORVIETO
Use Classification: SFD Bldg.. Permit No.: 0010-090
Occupancy Group: R-3 Ty,pe of Construction: VN Land Use Zone: RL
Owner of Building: NORTHWEST- SOUTHWEST Address: 77-564A COUNTRY CLUB DRIVE
DEVELOPMENT s
;:. City: PALM DESSERT,CA 92211
By: GARY HARTMAN
Date:' 6-28-01
Building Official
POST IN A CONSPICUOUS PLACE