0101-322 (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
7878.156 B. I
ate —_7 An Signature of Contractor
OWNER -BUILDER DECLARATION C/
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, �...s Signature of Owner «,a.
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:
Carrier Policy No.
MARSH VIM MIC C"001AZA10i
(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.
D t'e *- eL ,., . Applicant „� r
77-77-67—
f N• t'i ¢ /'•" .r: I / Mao
Warning: Failure to secure Wo lee�Com ens fion e6t ge"is unlav ul^an
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application. f"
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation..
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
jthp,above-mentioned property for inspection purposes.
Signature (Owner/Agent)�'����
Date �� I
BUILDING PERMIT PERMIT#
DATE VALUATION LOT(��(�'d�7 TRACT
37, 88384
JOB SITE
ADDRESS
'
APN
614k) C*1' F 'WSCW DMIK
76.2-2.801-020
OWNER _ -- _ _
CONTRACTOR / DESIGNER / EN &NEER
9� .Jf OF C'A1..d ,ORIliA WC
81111$ OF CAi HiD. ,NIA1 Cs
23 CORPOR NVEPUGhiii 11 245
HEMP001 B4:f ACH CA 92660
N"1;VP07-Zr BEACit CA 42660
(949)719.4975 CBI* 63(A.
USE OF PERMIT
STWOT:k' 1 1� £�1F71"6 3Y r
3lvV£A23tR..W1 110A tT67PE'MIT VOLS NOT 'INCLU nF
ptyXWpgNAY00LyXrfSWAf dSPEhAtKJeFRGN 0-11Y-cr. 91
' 1"
WIDUCTIO11 FOR MLf1AIPL1p ISSUA: CIT OF VJ48, PLA14 TYPE.
PE.
ICUSTOM CON#'1'RUC:'HP, W U16100 8V
Pe'71�.G"kliPA T IO 812100 SF
lxxlaa.;lts'I OT 1i F -C STRAMARY I I
CON3`1`1tUc 1'1011 YEE 101-000-4.1 B -OW $1,4.17..3111
PLAN C HFICK "19 101..000 439-318
F' '11Ce131C +11 li11�pgR�4 1a�ii1C 31240
S�l::b''A; a'1i.,C6',,d3,1,, J'A'.1�: 9 �3-U1:tFi-dt��3••flE� ��03.�16
;P1.UMB11' O VAR 101 --000y419-M $199.75
v 1'X%ONO 105VT H PER a R'EMP 101-000.24 3 -OL)AD sni7
11A1.31wO mem 101 _000-433-010 519.E
0XVr1.0P.tf3. J,MJAPAC".r FER $1,moo
RT i*R PUBLIC 111.ACT11- l MIC 701.000.2551-000 831.1,sa
4'41., l ONUiRUCTI N .AWD IPY- s CMC K
LEM P1t3-PAIt)1:'.1.r
$4,513.10
1£%too
Ertl �1 "1 Li'4 rfxsDUE NOW
z 1u� tD
j JUL 2 2001 11
CITY OF LA QUINT
RECIELE,
BY /
DATE INALED
Irt�s CTOR
aa-
'CSS
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
a.
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings!�
Underground Ducts
Ducts
Slab Grade
Steel
_
O�� _
Retum Air
Combustion Air
Roof Deck9
O.K. to Wrap
Framing
_ _ _
_
!
Exhaust Fans
F.A.U.
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
Final
S(3(va DuGj�(lodr—
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
Gas Piping
PLUMBING APPROVALS
Gas Test
Waste Lines
_//����
"!�'�'fx/�—
Electric Final
Heater Final
Water: Piping
I
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
_ _
�
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
r
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)
r
-
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: 81-180
GOLF VIEW DRIVE
Use Classification:
SINGLE FAMILY DWELLING
Bldg. Permit No.: 0101-322 ,
Occupancy Group:
R-3 Type of Construction:
VN
Land Use Zone: RL
Owner of Building:
SHLR OF CALIFORNIA CIN Address:
23 CORPORATE PLAZA STE 245
City:
NEWPORT BEACH, CA., 92660
-ram
By:
BILL GORDON
Date:
5/13/02
Building Official
POST IN A CONSPICUOUS PLACE