0101-318 (SFD)-U
H
( (1)V
W
'ODM
rCY
W
W
o Z
0_J b 0
H co
War1_
W
Z
co
110
0^
U CL
C Z
LID
r 0
xW�=
m<0
O
tl LO
Z_
cb=)r-0
J
F b
LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Ch?;;ter 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
Z2 14
Signature of Contrac!or
r'
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.
( ) 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.
hAdIRSH M& INC C001294102
(This section need riot 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,
]'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.
Date: =2 10-1 h I Applicant _.moo• d'
Warning Failure to secure Wor ers' Cmp tion co erage Isis 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
the aabbpve-mentioned property for inspection purposes.
Signature (Owner/Agenta,�,�/ IO
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 01.01 -MG TRACT
$324,726.00 311 29839-2
JOB SITE
APN
ADDRESS `
81,-22,0 4G0J.)R' VEWDRWE
752.394,070
OWNER
CONTRACTOR/[ / EN INEER
101 -WIZ OF S"A7 M).R.3.4A NO,
MRA OF CALMMA RX
3 CO3c.PU.Tt s' :KA&& SUITE 245
23 CORPS RATE P Ae A UY3:tM 245
M 01,1_TTEA CH CA 92660
NEWPOR'I`BRAC -H CA. 92660
(%49)719-49175 C-SLif 6364
USE OF PERMIT
M90LE FAMMY DW MING
#iiia -'PI W;9A WICASITA 'WT.31 PIMMIT I OES'DiOT 010J.109
DI.0Ct-'.'WALWF100UDR1Vi?`WAY APmIC3.F CIL 75% ma nm u; m -nom
CUSTOM CO3 YR11.3CITION 313161 of) 2,9'
PORCHIPA'TIO 813.00 SP
GARWEIC ARPORI 8.10.110 ST
M17MI= C09,r OF (1`0 Y3aSJCi.6d6e.61QN
324,72 -CW
�:�i�}5��1��G�`�0�1�Th� 11)�m��Ov�l�•'�� ��,�f����
x°11.ftit4 (~,HECK: YET $388.N
101-,000-421-000 S t 2OP
tt"RCTRIC:,P L Mr, 101 -OW- 420-ork $20:1.06
Pu111f1'sI' eVa 101-000-419.000 $199,75
3Tfrii�I1314I0'TIM4 i�.EZ - RES:11i 101-ODO-241-0 vt $3147
CRADING ts�'.ir' 101«100.423.000 $20.00
DLVE1.OPER, 7T19PACT $1,9noo
ARE' W PUBLIC P:LAC-400- RMIE701-000.255-000 $'3.01,9.2
n ;ice I't^17"l6.11 CCy1+l '$T i .3:0RAND PLAN C7rMIX
4ja4;S 13.1 O
�✓IMSIS PRR-PAM FRW
$0.00
=-.2 D� �►
CITY OF LA OUINTA
FINANCE DEPT
,���
RECEIPT
DATE�`r /t
BY j
Ri
DATEFINALED
INSPECTOR
Ad
t /
N
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION DATE INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
Underground Ducts
Ducts
Slab Grade
Return Air
Steel
Roof Deck9
_
Combustion Air
Exhaust Fans
O.K. to Wrap
`/- /
_ _
F.A.U.
Framing
/�
�(/
Compressor
Insulation
//��S d/
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
28��
•
Drywall - Int. Lath
!�
�r
Final
�e%Sl6y�,
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
/�—�/d/
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
��a,�!/
Encapsulation
Gas Piping
Gas Test
_
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)
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:
81-220 GOLF VIEW DRIVE
Use Classification:
SINGLE FAMILY DWELLING
Bldg. Permit No.:
0101-318
Occupancy Group:
R-3 Type of Construction:
VN Land Use Zone:
RL
Owner of Building: SHLR OF CALIFORNIA INC Address: 23 CORPORATE PLAZA STE 245
Building Official
City: NEWPORT BEACH, CA., 92660
By: BILL GORDON
Date: 2/25/02
POST IN A CONSPICUOUS PLACE