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LICENSED CONTRACTOR DECLARATION
til 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. Clld,�7
xp4e/
787$5Ci :L3
Date w Signature of Contrac d- ;"�
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.
PACIPIC 3?.AQLE. THS, 430102%3
(This section need not be completed if the permit valuation is for $100.00 or less).
( ) I certify that in the performance of the work for which this permit is issued,
I shall not employ any person in any manner so as to become su)�lect to the
workers' compensation laws of California,a re that if I sh9Llld eecome
p
subject to the workers' compensation pr9s'6ns g$/Section 37 0 0 .the Labor
Code, I shall forthwith comply withtho 6 p visi
Date: Applicant—� ✓ �-�
War ing: Failure to secure,,Workers' ompensation 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, indemnity;
& 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 staty that the above information is
correct. I agree to comply with all Cit)ff and StdtEate s relpt1 g'tO the building
construction, and hereby authorize depfese Atif this , ity to enter upon
the above-mentioned property for'r�i'' fiectio pur
Signature (Owner/Agent .'r '�
BUILDING PERMIT PERMITfi
DATE VALUATION LOT W09-0 "+,"P TRACT
*324 .776.10 7 O 708.1.7
JOB SITE
APN
ADDRESS_ -�8.1-..AQ J`lF Y79,3t T%F
018
OWNER
CONTRACTOR / DESIGNER / ENGINEER
SMA ur,,
81-9,R OF CAL,D-40R.N IA WC
16940 VOI KPOTa"N AVZ VIL, 200
23 CORPORME PLAZA 8TJA.CE 245
Si 'i71 CA, 92606
14EW PDXf BEACH CA 92660
(949)7191d89'75 MIX 6364
USE OF PERMIT
FD , .LOT 29, P1..A.N 9C. PZKMIT JX1V3'NOT :'114CLUDE HLOCK
0,tE1 1i t%:TW0N VOR, 1;41JAWCE OF StiMP PLAN TYPE
CUSTOM CONSTRUCTION 3,316.00 OF
PO R.C;Ti$1?ATIO 912.00 Sty
silotoo IF
WMAX.M COST O.FC'C?:1,T'E'S RUC•.'fiA PT
.124,726=
,i19:1WI0'3x`'Tli' 06'3"moi'
C"ONSTTxU ION RR@ 101-000-4-18-000 $1,427.00
P ,Qq CHECK Me 101.1000-429-318 $298.00
MECHANICAL IME 1.01.000.411.000 :124.:10
L, L ICRICf11,. F92, 101 -000-420-OOLI
PTIQ6tdtAD10 FEE 103.000-419-000 S139.7's
S T`RI~i14t31i110'1101d FSE . MND 101-000-24.1-000 $32.417
OP..A$9 10TH E 1.03.000.423.000
DIP, ZJ"=IMP.k1CTIY'EE
>4+Td V T,fa 3"ULiYr•.6C, PLSAORS - RESTE 270-000-145-000 i.K
I'VE.0—i r:3'A'Ld'T CTIC.0AY3D S?7LLN C'F.13A,CI�
SEP 11 2001 T'1�!L PE`w:L'kr, ts, VU .€s,.4�To>�f
CITY OF LA QUINTA
FINANCE DEPT.
RECEIPT
DATE
BY
DATE FINAL INSPECTOR
INSPECTION RECORD
'(OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
, ,MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
_
7 I
Ducts
Slab Grade
_
�� ��
Return Air
Steel
Combustion Air
-
Roof Deck/ll��b�
(o1Cl
Exhaust Fans
O.K.to Wrap _
i ,/
F.A.U.
Framing a
Compressor
-1-1311-1_&q
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall _
Exterior Lath Jl$l6/ �yt/
62
Drywall - Int. Lath
Finalf3jLG__
_
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
_ �%
/�y� A
Electric Final
Heater Final
Water Piping
% y
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection/C7
_
Pool Cover
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)
f1-7�
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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:. 81-240 GOLF VIEW DRIVE
Use Clastification: SINGLE FAMILY DWELLING
Occupancy Group: R-3 Type of Construction
Owner of Building: SRHI, LLC
Building Official
1U ►i
Bldg. Permit No.: 0109-057
Land Use Zone:. RL
Address: 16940 VON KARMAN AVE. STE 200
City: IRVINE, CA., 92606
By: RILL GORDON
Date: 3/18/02
POST IN A CONSPICUOUS PLACE