0301-079 (SFD)LICENSED CONTRACTOR DECLARATION
1 reby 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.
`Lice:ise # Lic. Class �-'''� Exp. Date
67407
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).
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:
Carrier rfla.'fZ Policy No.
(This'section need not be completed if the permit valuation is for $100.00 or less).
() 1 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'5ecome subject to the
'workers' compensation laws of California, and agree that if)l should become
"subject to the workers' compensation provisions of Section,3700.of•the`Labor
Code, I shall forthwith comply with t oserproyisions. l
Date:;r j !:" Applicant ` V11
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 fog 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 propAy for irispe ction pu p rses ..'.
Signature (Owner/Age'nt) ' - r t : Date''
BUILDING PERMIT PERM T#
�� ���
g (�y mry� LOT. TRACT
DATE VALUATION $=110610014 2081
JOB SITE
ADDRESS 49-1 ° V5.�NQMS`d.AD'i.�.Si
APN
OWNER
CONTRACTOR/DESIGNER/EN (NEER
metiSErfy Y,-OPMMI
SPARKS OWTiUCTI/N
SPO BOX 17161
79- 9:5 RANCH01A QWMAPFL
LAQi,T,€N A: CA 92.253
Xd%.quwrvr- : CIA 92253
F PERMIT
USE OAY9
A7I. oJrS"94V..1.4.+;LWViIywl.d$V.I.T
SM - LOT 24, PLEAS W..-FRRMIT DOES 140T 1-14CP:idl' Y BLOCK.
WALLS, ?Mt SPA OR DiRMWAY APPRO:&CH•, 7S% REl ilio TJON TO ( IAH
CHISCK ME' 3DUF. TO V f;iL't`M4I.SSU..+fi14CE OF FAME, PZ..AH TYPE:
(XI STOM CONSTRUCTION 313400 SF
PORMPA1 Iii NO, 00 -SP
2F
t OA3aaft.UMUM FES 101.,000-418.000 S1,2f1i400
KANCHECK MEI; W4.23
MSCR aNICAIL V EF. iF'kl-0w. .42.1,000 00,50-
iUCTRIC,Ell.: b+'lr , 3.01-000.4ZO.000
PI.I��tl�ls�"{�kti: 3.()i:,fit+Cl�7,9<��U ` •: �2f�.��. .
ORADTHO WE 101-000.423.000 USA
3JWEL iPER IMPACT FE -Y
t
R4C{T ISI i IJ I<I P C' - fMIE 270-000A4.5-000- 5205.E
_
i
41u�'a.'t";t�:(SC 109 M,
" i,` 5 "rU
iYRLP �':�.DM. Se f;
$0,00
`Q A� o .y.A� yy�y� 7 aye �t���p�
®.3.S.C6.7,d Cr; 1YY=1. 9US .MCr S9•O SY .�
�f ap
471s"SATJ
-2003 U
r CITE' OF LA QUINTA
,cst rR:
RECEIPT a'
DATE
BYO fAi h��
DATE FINA D
INSPECTO
w INSPECTION RECORD
Ir
1` OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
Z Set Backs
corms & Footings
ZB -3 S
lab Grade
— —3
SSteel
-�
Roof Deck
O.K. to Wrap
., 2
Framing-�
-�
Insulation:
Fireplace P.L.
Fireplace T.O.
Party Wall Insulation
Party Wall Firewall
_
_Exterior Lath
Drywall - Int. Lath
a`
Final
BLOCKWALL APPROVALS
Set Backs
Footings
Bond Beam
Final
PLUMBING APPROVALS
Waste Lines
Water Piping
Plumbing Top Out
Shower Pans
Sewer Lateral
I Final
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
OPERATION DATE INSPECTOR
MECHANICAL APPROVALS
Underground Ducts
Ducts
Return Air
Combustion Air
Exhaust Fans
F.A.U.
Compressor
Vents
Grills
Fans & Controls
Condensate Lines
Final
POOL S
Steel
Electric Bond
Main Drain
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Gas Piping
Gas Test
Electric Final
Heater Final
Plumbing Final
Equipment Enclosure
O.K. for Finish Plaster
Pool Cover
COMMENTS:
•. - , 1. r _ _ T - r .. !� •w S _ _ ,
-� ,- -Certificate of Otcqpancy-
oF9 . Y Bu�ld�ng .& -SafetyDepartment-
--
_
,This Certificate is issued' pursuant. to the requirements°of Section 109 of ithe -California Building
'certifying'• that, 'at the time •, of issuance,, 'this. -,structure was .in compliance -, with. the ` �.
ACode,
'and thenheCitY�Provisions oe '-various:orinacesore ulatin>g'.buildin g
,fxhBuildingCode
construction,and/or'=use. -• '-
{� ` ••' BUILDING ADDRESS: -49.328 VIA CONQUISTADOR
1
Use.classification: ASINGLE FAMILY DWELLING y : ' `�� - ``BuildingPermit No.: 0301-079
t 'Occupancy Croupy R3 of Construction, 'VN a �.,� La;ndYUse Zone: -RL,
_Type
Owner of Buildin TD DESERT DEVELOPMENT •Address:. PO BOX 1716 '.
_.
City, ST,.ZIP: LA,QUINTA CA"92253 '
By: -GARY- SHOWALTER -
- Date: ,10/27/2003 -'
Building. Offici , s
POST; INA CONSPICUOUS PLACE
•. - , 1. r _ _ T - r .. !� •w S _ _ ,