0301-083 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm _under penalty of perjury that I am licensed under provisions of
.,hapter 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
,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 Policy No. d1t1•?:i aQt!3
(This sectioh need not be completed if the permit valuation is for $100.00 or less).
O 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 become subject to the
-workers' compensation laws of California, and agree that if I should become
subject to the workers' compensation provisions of Sectio 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 Code,°interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permitsubject to' the conditions and restrictions set forth on his
application. ,' t
1. Each person upon whose behalf this application1s 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 for 180 days will subject permit to cancellation.,
I certify that I have read this application and state that the above information is j
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorizerepresentativesof this City to enter upon
the above-mentloned property,for ininspectioK p'rposes•N
� Fr'
Slgnature`(Owner/Agent)- �-i --Date a` -- �•t
BUILDING PERMIT PERMIT #
DATE VALUATION rce std LOT TRACT
- �r��i.�.� �CTt7..SV b�U �irYF�.•4;4
JOB SITE
ADDRESS ` 9-4?,4 Vu CL�NC�1=TA.
APN ray i. — •T
N
'
OWNER
CONTRACTOR / DESIGNER / EN (NEER
7D DM. U`T 13�i�'.L�i: PMlrNT
€ Plam - t.:`OA€l .UMTON
PCS BOX 1716
794.95 I+,MIM10 LA QURTTA DR,
Ltbf URq.,YA CA 922$3
LA. QUIM ACA 92253
(760)777.1941 C EU 2996.
USE OF PERMIT
SM,- ,- Leri air, PL AW M 3R. PUMIT DOP-3 NOT n4CLLtLit.? BLOCK
WA1414 P004 ;SPA 0A DR:fVMVAY APPROACH. 'fi3AWEL)I3'CTION To
PLAN CHF-CY FEE DUE TO MU1,,TIPL? ISSV.l NCF, OF SAW PLAN mYPV.
�ldm o,4iLfl �NAVf:J B-dLLtS✓tio/iF �W if.'(,i,WY WI`
C&IM.�y.TI�Oyy{°�jyQC .- SP
jP
4'.5195\$T,��1iJ•Cl%A,F.M;IY.1 4td, V1+61 f/
PERM, rm
CO�IvftUCTJON Fn 101 .000 A. IS -000 A11523150
PLA34 CHM4 Mit 3 01.000.43.9-318 " OOVIJ I
1yl�C�i.AN%CAi�.%,t';�;I£: a�]•�}(f0�4�I•OP)s3 �I�lb,�1?
=CTMICAL TFEF 101•'Q00,4204iflr3
PL13RA:�:t IOVE.M 101-000,419-000 SWIM
ST) OND :'4,IOTION FEE o RESID . 191-000-:x,41-000
46TWO va, 101.000,42.3.00-0 t15A
DEVELOPER JMPAMM
ART LH PUilUC PLACES • RE81Y. c 4-000.4 r-000
,,.T)1'3-T'cy.I �1 I t"i tl(""3f.7� ? i` i1� S�Li�q`���y,`��1*E=
$'�,2q�r}2�.C1�/��
. �v�r9
rw
JAN 2 703, x s�
CITY OF L,Q, 00"WYA
RECEIPT'.
DATE /1 �` BY. , t
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
- 3 -
Ducts
Slab Grade
y - - 3
Return Air b
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
G _z5 _ 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
Exterior Lath
Drywall - Int. Lath
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
Waste Lines - E
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
=�y-�
Encapsulation
Gas Piping
Gas Test
Appliances r
_
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS .
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring v
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
a
r '
15
-� - f �Oc a
� Q�c- .' O C U n Cert�ficate p , y -
L04
5 - ; S fet =De artme
ildin & a p. .. nt:.
Bu g Y.
. -; • �, s r} ` " f the" California ,Building
a ..
W This :Certificate .is` issued pursuant to the requirements of Section 1.09= 0 ,
liance with; the
,-. _ �•'�,
Code, :certifying :that, 'at'the time, of •issuance, . is `structure was :,-in `comp
rovisions of the
Building,,. Code' and ' the various'- ordinances' :of the, City,
regulating' building
- 4 �ponstruction and/or{use h `�' :,� ��• � �t ti`s rK��-.+ Yr•� � �" � .r. T r� � � ��:
C
C �', ••J r 7 x to - - — �� - i+ t - ` 'Y• "` v
' ,;a +,r r+ • r ;'• ~. to "` r� .a, t , �.�" C , ` i, `-� _ �"' i ..«� � �%�. • _ ' . .'
FYr� 1 ADDRESS: 49-424VIA :CONQUISTADOR'
` + :BUILDING"
-it >Y ?. � 7 � ` , 3 .+! t � :+ ` � . ^",_ '. •'" � • r . F � �` s. A J � . '� ' a i 'r c'. l' r : �
ay` �, /-��, !Rf. i f L yt�,�Lt �» �..fa;,r} `�,w ✓. Ri �� t ^i^ ,y
WELLING
,4 Building Permit�No 0301=083a
SINGLETAMILY DW
classification: , - x r
•• !.� - �f' i. ♦ } -,:._. 'try /• r , ..�
a
Y. O' .L„+ tri, . , ..�,��f' _. •cam,: } x ` T Yp; r }n••.�'r. V -N `� , rte>;. ;YY '�- . Land,Us� e.
�Z, on7±e.:�`R'i
C
re,ofCruetio'ost
ccupancy Group:R 3 r . .
,
a
+a .
}
t
�.Address• PO BOX
Owner of Budding. TD DESERT DEVELOPMENT _,,.. • -
- A TA CA
+., 92253 r
4 .r - J.
`:� City, ST -.ZIP:, --LA
`
-GARY. SH
OWAL-TER
� - � ''I{ i. .^ •, ,�• -- � .. ! lei' �_J 4 .BY; � _ 's � x• � - •
- Date: 11 /07/2003:
• ; - R �Buildi'g Offic'
t w Y.
_POST 1N A CONSPIC
UOUS'PLACE_ � `' -
t•:
” `.