0301-075 (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# 11 ea Lic. Class Exp. Date
0d04ti' .13111C 7/31./03
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Date �'� s,J 3 Signature of Contractor
J
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. 70441. Business & Professionals
Code).
() I am exempt under Section B&P.C. for this reason
Date Signature. of Owner `
WORKER'S COMPENSATION DECLARATION
Ihereby 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
Se'ltion 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:.
Cartier . STAT}Y',T'I_t'ND Policy No. 046M38-2003
(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 shall forthwith comply with those provisions.N^�,.- '1
Date: Applicant 'f )
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 hist
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 harmleem
ss'the City of La Quinta, its officers, agents and ployees.
2. Any permit issued as a result of this application becomes nu&� nd 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 authorise representatives of this City to enter upon
the above-mentioned property for inspection purposes. ; y,
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Signature (Owner/Agent). _ Date
PERMIT /t
BUILDING PERMIT
I- a ._.
DATE VALUATION $ 1,18S.30 LOT 20 TRACT 29283,
�• _'� cry .. � �,�
'OB SITE
DDRE S 49-2. VIA. CO.4'SQ6.I.ESTAi IDD,
ADDRESS
APN (459-210-W
OWNER
CONTRAC73R/DESIGNER /EN 1NEER
1IN't rL�Vf_0P1q%
72tT(S COIy513Warl w y
Fd) # 0Y. 171679-
29 'RMCI�(J A L>UWAI) i,
L& QUVNU,� CA 922.13
)AQUINwA ck 92m
�1G�CJ'7'7i;•,39�I1 ... �1� ��?.9t�
—
USE OF PERMIT
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SLIMLE FAM11,Y ?3MIELUNG
Sn) . WT 2(1, PIAN. Ykl'sit.. flMMI`P D0WNCIT .INCI,.i I)F, B1.0"C.D.°',
WAL1A 'POflYL�, PA OR DRDIR•WA.Y APPROAC H. 75% PYMUC TIOW TO
PLAN C1110' x Fpw DLIE pro mtiuInz IS uANO;H OR, "')Mord `2;n%
CUMM CONSTRUCTION 4124310D SF
POACkliY>ATIO n .00 sy
0AMl`1.135#'G'ARP00 51?
VNITUATM COOT OF CIONSMUCTION
1,308"M
PLAN CHECK ME -00,0w439-1318 �3Qfi �3
MECHANICAL Lf ZZ, 101,!,000-421-000
ZL ECTRICAL T'f ak. $246.71
PIAIMR.MG 1t'I'; . 1 Ul dil�it}R4 ] � QO $iii4,(i
STRONG IMC)TIO IVE a REM 101.000-241-000
ORAD#x•40 MR F15100
J: EVEWPLDt.1AIPACT PE! i - �Tyei0 .V3FJ
,SRT IN IPUBLSC, PIfACYS - €tk8K VC -000-445-000 $378. ?
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n• MAL 11"WGI MI;E
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JAN 2- 2003?';i
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CITY �►F L4 r� a`;i,A
FINANCE rFpT _ ?�• c1 L
RECEIPT
DATE
BY
DA FINpLED
INSPECTOR
/. _ li
.. INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck —// _
Exhaust Fans
O.K. to Wrap S— _
F.A.U.
Framing _ G _ —
Compressor
Insulation s _
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls ILI
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath -
Drywall - Int. Lath
Final Ip: y_
Final ` / =3
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 J
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 ZS
Utility Notice (Gas) 'r
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) ..
,- Ce'rIdun-mcate -of Orcunancy...
RATW
OF Building & fety*Sa Department ti =
This Certificate is issued�pursuant to=the requirements of Section 109. of the Califor`nia.Building
Code, certfyfiig :that,._ at- the Y ime `of issuance, this structure was "in _ co►npliance with . the
.
1. _ ..
' provisions of Code and t e" various ordinancesti of -`the City regulating building
;the"Building`
construction and/or":use.
. - .,. r. �'" r .. _' A• ., �•-b 'fir. .,. fn � . F# � � rr -
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A ! `j`' r `;BUILDINGADDRESSA9-295 =
.VIA,CONQUISTADOR
T Use. Classification: S.F.D. � �� �'� r : Bulldmg Permit No.: 030.1'-075 ,
Occiapancy,Group: R-3 r,s - Type of Construction.•V-N . ' r< Land UseZ_one: R L
•,Owner of. Building: TD DESERT -DEVELOPMENT ' -: �, Add ress'PO`BOX=1716.
_
City,.ST;:ZIP.:LAQUINTA': CA 92253 f �,
By GARY SHOWALTER - f
Date: 10-14-03
Building Official -.' • .�
_
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POST IN A CONSPICUOUS PLACE W