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Y 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
7Cci595 D 0.9 BIC 0913(.v2(
Date ��' �':- " 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.
I have and will maintain workers' compensation insurance, as required by
5edtion 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.
STATZ FUND 26011616-01
(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 sh II fo hwith comply with thos visions.
Date: (1..' Cif Applicant-
Warning:
pplicant
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 authorize representatives of this City to enter upon
the above-mentioned property forJnspection purposes.
Signature (Owner/Agent) � �- Date Xu
BUILDING PERMIT PERMIT#
_too TRACT
DATE VALUATION LOT 9W-1-1
77
JOB SITE
ADDRESS
APN
OWNER
CONTRACTOR/DESIGNER/EN INEER
WD D.EL'k:I.,OP1��Tfi, INC
DC -T iiT?VELOTURITr, DTC
78-600qyy����ttM�,yygqQUIWAY 9 ] 1
'7�8-600p�l19}t);,�ii�7'AT 11 l
,,ryry ryry'�+9� �y
I.A. Qi.BZI A CA 92253
//rr.. ��yyeeyy }
AdFY.tZUM,,& CA a92253
(760)771,.3345 CBV) 2180
USE OF PERMIT
abSr.��u'�trSr ,Pl�LYdXi:.l.Tl � fV.Ca1..t:.f.4.Li/\.l.
•
SSL k 8. T7py PLAN 1 PERMIT DOES NOT INC1.°109 BIZIC:A, WALL/
POOL ORAla1'ROACH DRIVEWAY- ;?S%P1.A14 CroHLCK,, F1:1. FTIDUCT109 ,
FOR.IaSiTAXG9 Olt SA.10 PL&N TY1'X
`RAC:T CONSTRUCTION 1,:03.90 OF
POR.t;1.171~ATIO 128.00 sp
C'i/1F3AMICAR1 ORO (SI) 3,043,64
OTMEXE C0911 OF, C<LJNSMClC.'•'!'1LON
109,248-90
�X�
.P.•dr'•4RAtiA�Ay.M��.Yr�i L71JAY'4S7B:fY8.6 Y.
CONSTRUCTION F,EE 101 -OW -418-000 '�ti?LOO
PdX0 C.'P4TriC1':1?i s, 101-000-439.318 7$140.50
AiF. HANI01 SL FRE 101.000.421-000 1"6190
}Ptr��:'1`FLiL'.:151.. 4� 1:: � C11-Qt�Ct-�.a�frt'•�1i,)ii � 1 �'?.4:1
PL1SMBiNC1 FF9 101 i-000.4150.000 %142.(Mt
3TR.OI+t000TIOW FES - R?_' 3= 101-0W-2:41-000 $10.82
t'31tADIWO FEE 101_00(M23_000 $20,00
3.DV9LOPE,R IMPACTFFZ $1,91i'.09
,ART IN OLIC PLAMI - RWIx ?01 at)00-25�-000 sae162
F, ,YM'DNi K A11 C}." S Mt
S3,1Jmr
D- - - LESS M -PAD MUS
30.00
DUE NOW
109"
JUN 1 3 2001
i
CITY OF LA O'UINTA
FINANCE OCRT
RE !�
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
_ _ _
7
Ducts
Slab Grade
_
Return Air
Steel
Roof Deck/Z��d
_
Combustion Air
Exhaust Fans
O.K. to Wrap
(,�=
F.A.U.
_•
Framing ��—_S�-Q�
Compressor
Insulation I—��� �/®
V/
Vents
Fireplace P.L.
(((
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
C
��—� g`!9/ �J'
POOLS='SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
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
t
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
—
Final.p�
Utility Notice (Perm)
—/• p
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: 79-770 DESERT WILLOW STREET
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.
Occupancy Group: R-3 Type of Construction: VN Land Use Zone
Owner of Building: DCD DEVELOPMENT, INC
Building Official
9907-200
CR
Address:
78-600 HIGHWAY 111
City:
LA QUINTA, CA 92253
By:
GARY SHOWALTER
Date:
DECEMBER 28, 2001
POST IN A CONSPICUOUS PLACE