9708-033 (SFD)A r:
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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 # Lia C aAs� D
t a���
Date9 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 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
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:
Carder Policy No.
(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 ofl alifornia, and I Ahould become
ubject to the workers' compen tion provisions of a tion 37 of the Labor
ode, I f Jith comply wit r ions.
Date: 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 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 thorize representatives of this City to enter upon a
)Signature
he above mentioned prope y for p rpo t s. rq I8 7 (Owner/Agent) Date
BUILDING PERMIT PERMIT97OX-033 CONTROL#
5693
DATE VALUATION %1� LOT TRACTJOB
1��117
Silt
ADDRESS ,7K-950 QkLA,��I� ►JVF,
APN 609-480-020
OWNER
CONTRACTOR / DESIGNER / ENGINEER
:,,I..lf�.I�°r tx, : c,I.t,
I?8ANr, SIIARl,'.OMI 1?I.fNES P11C
P.O.13ox 3I au
P.O. BOX 5140
N13WPO U RUAC H CA 926621
NI'sWMt"i` IEACN CA 92692
(71.4)7:14-1517 CLIT111
USE OF PERMIT
S�.f1
LOT 1, TR .n773-3, PLPA ,16
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tl.STIa.N"Oi T."D(.1C)SOF C-GIpSRI111011 iN,
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c;clt�ft'd'ti�t rt'}cJfV Ph)�' $3,wlt.so
pi,tkj4 r -,f iq-
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P.1, r,.0 M K, At FE; fi $18;)_40
PI.t,.t:N#}fitNG CHI 101-000-4I9I $10.0111
S'1'Ed.ON+ a NV)TrON FEC -P.1VSK') 1(14 4*10,14I-C Y) %21.16
GRANN 1 1,,* 101.000 -423 -WO sa►.(A )
ON IZA; `t'#I;OaUke, ., i 1; �-t�v0-��i�+-�l� S4,1161.2'1
AKT fN i'1 tMAC* PLACIfiS - W -81C 711-(1Ci —255-000 S279 0.z
R1, CONKII�VC' ION A -NO PLAN (;fM-CY,
LESS PRIE-R.14D FRES
$0.00
I, f°1~,R86 +HS 011 K NIOW
SEP 18 1997 #'O A
S6,9;�!05
CI 5•,Y 01 L L;Oi.YONT
RECEIPT
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
ac_
4_To0—rm_s
Underground Qucts
&Footings
Ducts
Slab Grade
I
Return Air
Steel
f 7
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
Z
F.A.U.
Framing
Z
Compressor
Insulation
y 7 :
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
y
Drywall - Int. Lath
-YX4,97 ,
G
Final
Final re
BLOCKWALL A PROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
OX for Finish Plaster
Sewer Lateral
444 46�yPool
Cover
Sewer Connection
11,1111,71
Encapsulation
Gas Piping
Gas Test
Z
Appliances
Final
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)
COMMENTS:
i
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Certificate of'Occupancy
City of La Quinta
Building and Safety Department
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: 78-950 GALAXY DRIVE
Use Classification: SFD Bldg. Permit No.: 9708-033
Occupancy Group: R 3 Type of Construction: VN Land Use Zone: RL
Owner of Building: STARLIGHT DUNES LLC
Building Official
Address: P.O. BOX 5140
City: NEWPORT BEACH, CA 92662
By: STEVE TRAXEL
Date: 5-15-98
POST IN A CONSPICUOUS PLACE