0301-076 (SFD)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 # T�Licc. 7Class Exp. Date
Date �y' �" Signature of Contractor
s1�✓ l
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). / '
O I arr 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.
[have and will maintain workers' compensation insurance, as, required by
Section 3700 of the Labor Code, for the performance of theworkfor which this
permitais issued. My workers' compensation insurance carrier & policy no. are:.
Carrier 'L'7'>vq.TH S?L}1d.0 Policy No. ' 04e3M*2003
(This section need not be completed if the permit valuation is for $100.00 or less).
O 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,S'ectioh 3700 of the Labor
Code, I shall forthwith comply with those provisions. P'
Date: >-/ '`Ar :;t Applicant
Warning: Failure to secure Workers' Compensation coverage' -is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as`provided for in Section 3706
;of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to, the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application. , I
1. Each person upohwhose behalf this application is made &each person -at
whose request and for whose benefit work is performed under or pursuant io
any permit iss�,{ d as a result of this applicaton agrees to, &`shall'indemnify
& hold harmless the City of La Quinta, its officers, agents and employees
2. Any permit issued as a result of this application becomes null and void if.
work is not commenced within 180 days from' date of issuance,of such
permit, or cessation of, work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information, is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize 'representatives of this City to enter upon
the above-mentioned propertyfor,in spection purposes. f
Signature„(Owner/Agent)'-- ''' # - Dates%>$r� �.
BUILDING PERMIT PERMIT#
DATE VALUATION SMI. 0 LOT 211 TRACT V11283
JOB SITE
ADDRESSdtQ"1"tfl
APN
OWNER-
CONTRACTOR/DESIGNER/EN INEER
VO BOXlTM
1AQiJD;7"MD
LAQi;.iZ� A CA. 5*253
Ste{,?"I I�� CA 92253
,
aBIR 2996
USE OF PERMIT-
MOLF, F-M&LY, }J�J�'.�'LLD4CS,
V0 - d..,OT 21, PLAN 1>~4M I)MMIT DOES `NOT TMICL,11t' E 81,01rX.
WALLS POO 4 SPA OR D� IMI NWY APPROACH, Tiro jigbuo tt-aw'I;'O
PLAN CHTWK F-T.S: L?iWZ ` 0 BAtdi.:°.f'TPLZ ISS'LlARM x0N' Ste?' PI. A'H TYfPia
CUSTOM (110119TRUC ICY14
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0ARA EJi:ARPOI3"i 9?,®i3 of
EFTRANYIND COW 0, F VONSTRUCIMOR
X2, iCt�S tai '.
ME S°MSURY
i.ONSTRUCITMA Vt1;Z a01 -000.42w000. .... A2410M
PLAN CHECK FXX 101-0,00-43-2419. $264-33
MECtiARICALFE 1f�1•�t0����1.�0iiG S149:"
s :.
k�I�%i L�11�C3 i, a 1011.000-419.000 42 IR$
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ST.R:L}XC.t P OT110W VXZ - RESI i 101-000-W-000 1-000 S28 21
;
(MADYNO PRE 101-000-42" -000 WIN
,
f��'FtL1.0t�9P I-10PACT r � fS3.Qf�
,�,. •,
., k M PL`IkzW PLACESs -'LtESIE.270-000,443.00 9
03B -TOTAL OOMMUCTIONA`1�'.�9••�PL.A.y�T��•��yJ���Sp��.,��GGyy•����yy
-A,76i.50
;irti:esSS :C�£UI.Ip !RS.t/ .d'.l".M�7
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RECEIPT
DATE
BV
DATE FINALEDINSPECTOR
S
_ 0
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
IDATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
— -
Ducts
Slab Grade
/ 3
Return Air
Steel
Combustion Air
Roof Deck
.r/S-v -
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
C_
Compressor
Insulation-
/3 `','
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
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
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
2- / ii. -4 S
Encapsulation
Gas Piping
1-11
Gas Test
Appliances
l/.
Final
COMMENTS:
Final zz__
Utility Notice (Gas) %J
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit z'
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final /0-
p_"Utiliity
"UtilityNotice (Perm) - -
•
o �Certificate of Occupancy
o
_M: Oda AV
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: 49-271 VIA CONQUISTADOR
Use classification: SINGLE FAMILY DWELLING Building Permit No.: 0301-076
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL
fi
Owner of Building: T.D. DESERT DEVELOPMENT Address: P.O. BOX 1716
City, ST, ZIP: -LA QUINTA, CA 92253
........... By: GARY SHOWALTER
o Date: October 1, 2003
Building Official
POST IN A CONSPICUOUS PLACE