0301-081 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby ae` rm'under penalty of perjury that I am licensed under provisions of
�, CHapter 9 (commencing with Section 7000) of Division 3 of the Business and
W Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
O LL1! X5740? Of _�
Z r- Date', ' Signature of Contractor Y
P. o 1 OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that 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).
(.) .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:
( )..Lhave and will maintain a certificate of consent to selMnsure 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 TATF. PU]Nf) Policy No. 046:.1.318,2003
(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 tshould become
subject to the workers' compensation"provisions of -Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.-•-�`�-
,-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 Cdde, 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 pursuantto
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,
uch. 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�p
correct. I agree to comply with all City, and State laws relating to the bUildingr-
construction, and hereby authorize representatives of this.City to enter.upon
the above-mentioned property for. inspection purposes.f .
—Signature (Owner/Agent),
BUILDING PERMIT PERMIT#
0101_091
DATE VALUATION LOT TRACT
26
JOB SITE ADDRESS '% :%.Y�b *iii is A i
APN .649-210 *7
OWNER
CONTRACTOR/DESIGNER/EN (NEER
1) �33�ES#;'R DIME:t,OIN6 A, T
SPARKS C;ON91RUC°iION
.t31���.y%`p���rryy?..i`gqYi
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�ryf qqPPM��! ��jj
LA q1J-. NIST CA 92213
rigqtfs.�.�}t, ??
J.� A QT.In rA CA 92r?:3
(760yn 1-I smfI Gee ? ft 299.915
USE OF PERMIT
AlR !'
30). iA) T lk PY.2PAIR.
�F�H'i. Ad�C'l%wilk%Jrl�p:#VS�/,fJlLP;Ot�R
TYpU-8, FOC,%" "{A OR In.11!3dklYAt�5lpL�R�OO
1JAX CHECK IPE't'' Ol.lP'TO %tiT7IMPLt ISSUMCIX, OF aAMN RLXW TYPE
CUSTOM CONSTRUCTION 3�340AXISF
PCii�C`if7ATt SII.UU SF
S'�yr-Mb,k�l SJ:3T,rTi.ih. tt fA 101-0,W-439-318 tZWtas
ME 101-000-421,000 Vii.;SR,1A
Ft. :ni'ktCa:. F 101-000420-000
PIV�rX�el.��,B�If��pG
C /�yu p Sy; g101.1tp�tS0.419-/0040
SJ`Yris.�il71.f.:V lTffdia ON , ZZ �'./:.U�a�IO 1.01-W��0-241-000 G.6Y7.Gi
GV ON
GRADW ME 109.000-423.40041
t DFiPFA.O wE1t ;IMPAC71 ]FRE
kRT 1N PI.D;f'lUC" 1'LACM - RIMIE VO -000-4454100
4
'ISUB-'PMAiL C"t0MGCrlP14 ANM 4}1 <Ai CBECK
$4,1164,50
$0.00
4a"iav� st3
JhiV 2 2003
CiT1( OF LA Q 11r^!1A • r lw,..
.
FIN�1'E ^PST
_ _~DATE
RECEIPT
X7/��� iw ' R"
BY 6 r �/
DATE FINNAALED
INSPECTOR ,
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
_$et Backs
Underground Ducts
'Forms & Footings
p —
Ducts
Slab Grade
�p 3
Return Air
Steel
213 - Q --
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
.�_a
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Lj
// ✓�
Drywall - Int. Lath
-
Final
Final
G=
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
ZO.K.
for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
_
12 -:2 jjj?-
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice
�'
(Gas)
CP�/
ELECTRICAL APPROVALS
Temp. Power Pole
.Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
:Exterior Receptacles
GT. 1.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
- - 4
Cert�ficat6_ofoccupanoy �.
...
G` OF T1 9� F :� -. Building &Safe t Departihen"t
w
. y
This Certificate' is issued p_ ursuafit 46 the requirements of -Section 109 of the California -Building •
_ Code;, certifying that, -a t the; time of issuance;' this `structure. was, -in compliance with;: the '
_ � provisions of •• the .Building , .Code and the '.various 1ordinancis ,- of •the � City regulatiing 'building .
construction and/or use
... ice. �." BUILDING ADDRESS: 4043 15 VIA CONQUISTADOR �
- . MY •sv - ji "-:.4 - _ ili - ' ,� v1.. _. _ - i �•. � - .�. f
r � �
Use classification , -SINGLE FAMILY DWELLING r y .� �~ Building Permit Nos 0301-081 • -
<• -,,,,,Land Use"Zo'neRL
+-' Occupancy Group: R-3 Type of'Construction -V-N �� , Y
55
w _'Owner of Building: TD DESERT. DEVELOPMENT. '' Address:. PO BOX`1716
y �Y _ _ .� 7 «. 1 ,. ', - .-. • .. Cit � .ST' ZIP: -LA -- �. , . . ;,- . , � •
- Y� QUINTA CA 92253
�.
L
By: GARY SHOWALTER
-
Ale Date: 10/30/2003 -
Building Official/.-
f = - POST IN A CONSPICUOUS PLACE -