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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
Pre Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
76859; D C8 = 091,30/2C
Date _ ^ f Signature of Contractor
OWNER-3UILDER 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
S ction 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.
TAT FUND I.sa bll-#fit
(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 forthwith comply with those revisions.
Date'. Applicant ff
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 for inspection purposes.
14
Signature (Owner/Agent) — Date 6,-113,163
BUILDING PERMIT PERMIT#
DATE VALUATION LOT '�..�,��, TRACT
90"7401
�
�1i0�t.i. 76
JOB SITE ° /
APN
ADDRESS
OWNER
CONTRACTOR / DESIGNER / EN (NEER
DCD DF.V91X)P1a%HT, LNC
JDC .10EVFWP%tRIT, DIC
8.6001110 WAY 111
'78.600 RIG AY l } l
LA Ca3iJ04TT°A CA 92253
LA QLTIM-A, CA 92253
C Lff 21 so
USE OFPERMIT
60101A .RAiffiX Dwcy q G
:M • LOT 76 PLAAN JR JA.FIRMI T TJOE.S WT 114C,'1.,Y.JDE BLOCK WA.
MOM ORAPPROACH Oi1NMAY
TRACT A.C'e G' NSTV4UC:'° ION 1, x03.01) 3F
FCIPIC lf'PNrIO 128.00 Sig
E IrMA'11W COST OY CONM TCROW
3.08,348,90
P +TZWf.:V!1W' S'CtAMA
CONSTRUCTION 17F2 101-000418-009 3671.00
PIAN CHE-CM 00B 101-000-4$9-316 x.362.00
MEC&U51 ICA , FEF, 101-0001,421-000 $661"
'I?i.00TRICAL r1f19 101-000-4.20-000 $130.43
P%ILtMETWO FRY. 101.000.419.000 $142,00
�aF LG210 WRITION ME- RISIAD 101-000^2412-000 $10,82
O &D1913 pit 101-M-0-423.000 620,00
i' ZV'Z1:!af*P:1'+. 1%6PA `ih FEE $1,097.00
AM ig PUBLIC- PLACES - RE,Si1'/iJt0,000•M.,000 VA62
S* 0TAJ ITON AND PLAK MMOM
$3,520.31
USS 'M�EE".1"•AID FM
$0.00
JUN 13 A T�'1� E:� i�� .NOW
CITY OF LA OUINTA
FINANCE DEPT
S"20437
RECEIPT
DATE/
A" .r•
/ r1r
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
�l
Underground Ducts
Forms & Footings
_ _
% d (
Ducts
Slab Grade
Return Air
Steel
Roof Deck /of
Combustion Air
Exhaust Fans '
O.K. to Wrap
Framing
( ljL
F.A.U.
Compressor
Insulation
F
Vents
Fireplace P.L.
((((
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
_
Drywall - Int. Lath
_Q_j��(f
Final
Final
/,2
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
I
Gas Piping
PLUMBING APPROVALS
Gas Test
Waste Lines
� ��
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
_ �p/�
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
_s
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)
�=A ..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: 79-780 DESERT WILLOW STREET
Use Classification: SINGLE FAMILY DWELLING
Occupancy Group: R-3 Type of Construction:
Owner of Building: DCD DEVELOPMENT, INC
aZ"L
Building Official
Bldg.- Permit No.: 9907-201
Land Use Zone: CR
Address:
78-600 HIGHWAY 111
City:
LA QUINTA, CA 92253
By:
GARY SHOWALTER
Date:
DECEMBER 28, 2001
POST IN A CONSPICUOUS PLACE