0301-078 (SFD)�. LICENSED CONTRACTOR DECLARATION
'I hergby affirm under penalty of perjury that 1am 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
4074, B 4' -..'" ' � 3'1103
Date , _ "� e+ Signature of Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjurythat I am exempt from the Contractor's
License Law for the following reason:
( )' 1, 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,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
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:.
Canier1 PaIT :i I> Policy No. &733 8 tt�
(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 tobecome 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-provlsioils. f, -�-•�
e rL ;; :L _ .Applicant ✓' ) l
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $1 WOW, 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 1
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 pursuaht 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 j
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.
a
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
1. 7/ spy^ �+:' ,
Si nature (Owner/A ent) ""� � •Date
- • BUILDING PERMIT. ''PERMIT#
DATE j VALUATION LOT �RTRACT.
JOB SITE
ADDRESS �A . {� V . �r s + E
APN
94-10-067
OWNER
CONTRACTOR/DESIGNER/EN INEER
IT) i; RSMIi'!'�INLWPI"r
����GG��t�2xlr°1101a 7
10130X' 1'116
1A. Q,01IT'TA' ', CA K253
LA Ql.�N A VIA 9=411
0771-1911 r1 2996
USE OF PERMIT
k"D . LOT 39 -Pi: AN PI M PI?'MIT' :DORKS Wt?'f 11v�:f UDZ HIA3C : W0.1 f,,;a,
tna 014 '.PA OR ii4�NIMI Ta?.'6 APPROACH. 75°Fa;J,k'!)1JC°T:IE R TO PT AN CSF EI: 'i;
9.1' W T b f�ittr<�.`II?L,d;' tSSiJARC`E OF SME i�LA14 TYPE
i iJ TC? c`�P1S t �;T.iC3N 4,24..00 Sr
�C#ItOd��.i�;lr� • �t�.�Zf ��
QA.11X&J RPOWP VAN 101?
•
ES"E`�IFS�9 MD COST Off" Sf`ONSIR 7C'TfO R
3.51, ao
PLA 14 CHWK E 141-000-439#:318 kqua.,?3
MECHANICAL ME 101-000-421 - 09 $,136.50
Z?,1�TPJC':,A2.. f" Tt: 1fD1-CJ4�S-fir +.J"-1:Oi1 $240.71
A
PLUMBING rUl. 1 ti1•tllI0�41 �?=040 ��I13,s0
STR4P140MOt`It*NP w 517? 101-000~241-0 $33.14
(YRADDIG F98 101=f90C A-23.000 sis.69
DZVE;OP I!4 PAC -T tyEL 2,SU�+.SKJ
�z i PYWAC! PXACE . IMAIAr 210.00. - 5.000 >�TIM `'-
.7c Ila
7..�« PPMr'P'4gpIfs s
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ntNF 7�, MART
- J` �%nRT.�QRR:.L l 113 �J ON FiP
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SAN 2 � 200
1�°�'A�'c�•�
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CITY Sir s 6 �!i.i447AFINANCE
t.
PEPT.
AS
RECEIPT
DATE f x i` t
BYE. tiw
DATE FINALE
INSPEC
9...9 :, .. � ✓,raJ.». �'. ++.+tr+d"o:�: _ �" . •ik.s� ' ;� I a ...,e.xx
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & FootingsDucts
H
Slab Grade
j
Return Air
Steel
3 -
Combustion Air
Roof Deck
Exhaust Fans
O.K.to Wrap
.5
F.A.U.
Framing
c3
Compressor
Insulation
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
BLOCKWALL APPROVALS
POOLS - SPAS
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
Encapsulation •-
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring -513
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
Gu
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/IN��
a� a'`c
,- Certificate of Occupancy
_
Ivoocoanm
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: 49-304 VIA -CONQUISTADOR
Use classification` SFD Building Permit No.: 0301-078
Occupancy Group: R 3 Type of Construction: V N Land Use Zone: R L
Owner of Building: TD DESERT DEVELOPMENT Address: PO BOX 1716
City, ST, ZIP: LA QOINTA CA 92253
By: G SHOWALTER
&4--t Date: 03/19/04
Building Official
POST IN A CONSPICUOUS PLACE
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