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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 a ec .
License # bb.[[ fyLic. Class . Date
1 1r{ 6
Date d'. p�Signature of Contract,. ✓! y /////%
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 andwill 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.
(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 manneo as o become su�fec o the
workers' compensation laws of California d ag a that if I sVGld ecome
subject to the workers' compensation pro ylon of Sectio oSTAO oPthe Labor._
Code, I shall forthwith comply withthJaov` ons.
DateOfu — 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 C'ty d ate laws el tlrng to the building
construction, and hereby authorize resp tatives oCity to enter upon
the above-mentioned property fo i s ec+6n p rRd S.
Signature (Owner/Agent Date
BUILDING PERMIT PERMITk
DATE VALUATION LOT TRACT
L12.7"26M V?3R.1.2
JOB SITE
ADDRESS _qq
APN
A'iOi(Alar 1ny.W My
j+y'� (�(■ /�r�(�
�S•Yl' J1T'4YF.is7V
OWNER _
CONTRACTOR / DESIGNER / EN (NEER
SRIXT, 14C
SMER OF CALD)0"%i" J:k D3C
109401s ON XJMUM AVF. = 200
23 CORPORAZPLAZAA MJX'l.l 245
"LRYMIX CA 92606
NFWPORT BE M CA 92460
(949X,3)9«4975 w':8IA 63&1
USE OF PERMIT
3')+M - LOT41, PLAN f3F1R, PEWIT fe=31JOT YPIC1.f3'I3,[ BLOCK
"WllLI % P.0, 0EAPA OFA RNFWAV.sty,PPROACH,
REL?sJluTt4A POR, iSSI.7ANCE C'aF&kM1? i?LXW'PYPE
t:WTOM i7ONM.0 TION X316.0) VF
POI2p"'Aw IC+ 812.0 Si?
WMAMWARl ORT P0100 OF
.:y3yr1Igl.i..lC.pa'+i.P3.A.�a.f..+' sy.otr � OFcvAY1.TN"B.� UCYl!.�.�N
3.L4, d,d:i7.l 9
yyy;y��+gg1 g p, ,,�pp11 n�//3y
O c'm'17"?�.E)'f"•x'.164 Par 101-�t3;'?0-4 ] 8-(X)Q 51,437,070
PLAU U C:I FP -,K %tri 101 -C*0-43.9-3 18 tm.ao
MWNIANTCAL PER 101-000-421-000 $124.00
—ELI T—RI a`+'L;I>
PLIJ.teE'kIINO FFE $il,►PM
STWN0 MOTION FVF -, R9310 101400. —.`2.42-000 W.47
CIRADINO W10 101.OW-423-000 $20..€0
DEVELOPEO IMr`.AC',I rL11, $r107.00
.SRT 114 P1:ISt,rIC' PLACES -1REW 270-00OA45.000 $311,8"
mlm_ rcyrAL COW031 ? t7Cr'IWO AND PLAW CIMM.
$4,113.10
Law PRE -PAM PM- 1
Ott
e AXEM'Fn13.DUF I'
Jff0
SEP 112001
R CEIPT FINANC ?FI�VN
BY : E ::ZATE
AILED'
INSPEC
INSPECTION RECORD
OPERATION
j
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs _ _
Forms & Footings ( _ �� _
Slab Grade �Q �
Underground Ducts
Ducts
Return Air
Steel
Roof Deck
_
Combustion Air
Exhaust Fans
O.K. to Wrap
/ if (qV
F.A.U.
Framing
Insulation
/�/d _O Z
/ljl�lfd fi �/
Compressor
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
�7 /
_
Final
BLOCKWALL APPROVALS
Final
O`
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
I
Gas Piping
PLUMBING APPROVALS
Waste Lines ��/ f3��
Water Piping `
Gas Test
Electric Final
Heater Final
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
_
`Q��/j}�
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)
Certificate of Occupancy0 o
OF Building & Safety Department
This Certificate is issued pursuant to the requirements of Section 109 of the California Building
Code, certifying that, at the time of issuance, this structure was in compliance with the
provisions of the Building Code and the various ordinances of the City regulating building
construction and/or use.
BUILDING ADDRESS: 81-285 GOLF VIEW DRIVE
Use classification: SINGLE FAMILY DWELLING Building Permit No.: 0109-062
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL
Owner of Building: SRHI, LLC Address: 16940 VON KARMAN AVE STE 200
City, ST, ZIP: IRVINE, CA 92606
By: BILL GORDON
Date: 3/27/02
Building Official
POST IN A CONSPICUOUS PLACE