0301-080 (SFD)-�:
LICENSED CONTRACTOR DECLARATION
I hereby affirm under'penalty of perjury that I am licensed under provisions of
F r Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
04; W Professionals Code, and my License is in full force and effect.
License#
r.. Lic..Class a Exp. Date
6b"�yV�d V03
W
Z r- . Date �' Signature of Contractor
JL) OWNER -BUILDER DECLARATION
U W � I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ d License Law for the following reason:
Z'- ( ) ' 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):
co() `I am exempt under Section B&P.C. for this reason
N Date Signature •of Owner
O.�
C� Q WORKER'S.COMPENSATION DECLARATION
n :—
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 STATTVVtILIND Policy No. 046M33-2003
(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,,p� visions of,Section 3700 of the Labor
Code, I shall fohhwith comply with.those provisions. 7
Date: ?^ + �_ 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. .
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 permitissued 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 propergy�for'inspection,purposes. <
SIg a u e (Owner/Agent) Date//.,
- BUILDING PERMIT PERMIT#
O3Q3I-• "
DATE VALUATION LOT TRACT
JOB SITE
ADDRESS 41?-35':.1pI CONQT Ca DUR
APN '64.4-210-067
OWNER
CONTRACTOR/DESIGNER/EN INEER
TD DEM�t'� DMYO23WOU
SPARKS 00118 ROC"'s,�:�SM
PC) BON: M 6
(70gj771,1941 C 3? ji 7`, 96
USE OF PERMIT
0rSAAY SdYVDWELNG
M?V - LO ��, .� � Pi;3f2. PERMIT bOES NOT I-RCY..t.1I3E B1,OP'IC.
Y1?+L?. , k�C501c, l�11 GFS, t5•RLn� «1. PtiF' 'c�sfaClt , $9S f'R3EMICTIOld TO
PLAN CHECK PEE =9T0 MiIXTLRLE ISSx�dariNC frV Sf«'Nh!E PLAN TYPE, •
C:lISTOM, i `ONSTRUMOW 10243.00 SF
PORCWPATIO 523,00 V
0ARAORMA11PORT 310100 SP
-..rTi �
VVIR AUX YZIC SUMMARY
C100T, RtdCTIONi 101-0004] OOO S46521.150
439 -aid;
PLAN L"HV;CX 3.194, 101-000439-318
161-OtlQ>x4alown $00,50
Xx,Ez:°f°R.I=, FEE 101. -000.4,4310-000 $7d�.�I
.ti.' RGINQ MO':JON I129 > R.F X10 101. -000-241 -(M
O A3WHOMR, 101.000-413-000 315A
FDEVELOPP, IMRA,CT F.28, $3a�RT, .010
-' O"C C:Cbk '3' "liS;°AIf? A," f J�.i+9 (If, -MCK
$5,252.05
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(Tj fv
•rvll.4f 15 1YR\,.:{+`-PAW D+.�.�4"
(f(1(�f�
t�`Ii •A'�!
kFaW zTen AM -now
$1. MIN
JuN- 2 c 2003
RECEIP '' DA `�°
- !'t'fFJs�IVCE
BY s� r i
fk�}z,/�,
DATEEFFIINALED
/t✓�. .•
INSPECTO
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tlrai1.�r�.x-.'.=.e�•c
N.
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
I
Set Backs
Underground Ducts
4orms & Footings
Z —
Ducts
_
'
z Slab Grade
(� 3
Return Air
Combustion Air
t
Roof Deck'
_
Exhaust Fans
O.K. to Wrap
_ 3
F.A.U.
Framing
—
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
4" Exterior Lath
Drywall - Int. Lath
"
1
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
f.yllaste Lines
- �%—
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
y."
Sewer Connection
Encapsulation
Gas Piping
Gas Test
_Appliances
12
Final
COMMENTS:
}
i X
Final'
I�
Utility Notice (Gas)
v U
ELECTRICAL APPROVALS
Temp. Power Pole
I
Underground Conduit
Rough Wiring
3
Low Voltage Wiring
K
Fixtures
Wain Service
Sub Panels
Exterior Receptacles
r
G.F.I.
7
Smoke Detectors
-
Temp. Use of Power
Final x
10 1-44_
Utility Notice (Perm)
Certificate .of Occypah,0_ Y
IWORKMAMD
oF�� ;�- : `., '' Buildin & Safet De artment.
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_y
Thin Certificate is issued pursuant, to the 'requirements of Section 109, of ;'the California,'Building
certifying that, at the ' time. r of issuance, .: th►s": structure was . ,�n, co►npliance .with the
provisions,�ofhhc Building" Code sand -`the various ordinances of the City` regulating 'building
truction'and/or use.
cons
; - BUILDING'ADDRESS: 49-352NIA CONISTADOR
' Use classification -SINGLE FAMILYMWELLING` Build ing.Permit No.: 0301-080
r' 7� a t r ;' 3 �S• a ?L 1 ~yi i'! 6". S.
_
Occupancy Gr6up:`R-3 T' r y Type of Construction'WN-r.. ' ` °Land Use Zone: -RL
kw
Owner of Building TD DESERT'DEVELOPMENT Address: -PO 60X,1716 . �r•
_ -yCity; ST, ZIP: LA QUINTA CA 92253' `
-.
By: 'GARY SHOWALTER
::2 -: �, � � .. �` Date: 10/28/2003=
:
Building,Offici
POST. IN A CONSPICUOUS PLACE
I
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