0301-070 (SFD)LICENSED CONTRACTOR DECLARATION
I he {eby affirm under penalty of perjury that I am licensed under provisions of
"'Chap*r 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
x'14 ,4: STC: a�31 !3
spate t�? :1 Signature of Contractor^ H i
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).
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 .'y'- 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.
�(k/) 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 .!1'A7ElE1�1D Policy No. , fl4ti-°:13-d(iEl3
(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 ifjl should become
subject to the workers' compensation proyisions•of Section,3700 of the Labor
Code, lrshall forthwith comply with those provisions.
Date:' Applicant—
Warning:
pplicant 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 for 180 days will subject permit to cancellation.
I.certify that l 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 proerty,,fo inspection purposes.
r
—Signature .(Owner/Agent)��-•�`�-- Date-� r'
_ i `� �`•
BUILDING PERMIT - PERMIT# - :.
(M-1-0701
DATE VALUATION Qwry�� q LOT t TRACT �^
JOB SITE .
ADDRESS t9 -•4,,'.S VIA C (,)NQV47,A])(YR
APN
6419 223V -M
OWNER
CONTRACTOR DESIGNER (NEER
PO BOY"' 17 16
7.M95 TRA14CM LA Q�WYA DA.
L.4'g QtTbrl'A. CA 9221
I'A q corm CA 92253
299.5
USE OF PERMIT
3FD • LOT 15 1" AN 411 Pi? RM T DOESNOT bf Ce; UJDP At.C1CK: i'k";&%,. %
P004 TO PTA!t 0HECK
k e Dux m mi)uEPu 1w3AmE O.t? Sp;lt.it PLA1 'P`irnw.
Ct3MM CONSTRUCTION 3,30.09 OF
P0.P ii P,,ATIC+ 590.00 SF
06-00
'�I79yirry, f�Lv'F�3 q�,'�� }�,qq p�(�}��q p�C,t� y.} �(y
4 ONSTl4'� C O"A F)EKE .101-000-'T�16-000 S18r280.t/.57
PIAM CHECK PEE l0 -Mllm-4319318
Iv°sln.Ci°faMICAT.'FEE 101.OQO-421.000 $149,S®
mcG'f,XICA. Ei'S:.9 101 -000-4-20-000 5,04
Pa.UMI INO HE • 101-000-419-000 5602,25
0 TiO1+F0 MOTION 1EFs .. U.511 10 i-00VZ41.000 $28121
ORAD190 FEE 101.-000-4 3-00£I t:0.09
PJIWk"LOPYR IMPACT FZ a2a'fQ`%�
ARS' I14 PUBLIC PLf> dES R IE 270-M-445-000 $20127
" • •• '�'t ��-�Y'?'.fiA:'i. �f3td�'i13.iT+~�1'T�J1�' :k��il"� �''t' 017
;£4.y )�:5f�
I,,EW ?X.&PAW �iBJM
W,fr'•1�
RECEIPT
DATE
BY At
DATE FINALED
INSPECT
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
3.., _ 3
Ducts
Slab Grade
=-3
Return Air
Steel
] - i , 3 S
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
` 2
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
�G
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 /%��
Water Piping
Plumbing Top Out
_ _
Heater Final
Plumbing Final
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral_
Pool Cover
Sewer Connection
ti - 3
Encapsulation
Gas Piping
Gas Test
,
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
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
iY
Final
Utility Notice (Perm)
�. to +-'-+m :.r,. a w',g 'tra.f'•.^',f�!-R+?'�: _ wS(�t`a
C. ficate of
c� OFT9� 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: 49-415 via conquistador'
Use classification:'sirigle family dwelling - 3 •, i i Building Permit No.: 0301-070.
y
Occupancy Group: R3 Type of Construction: VN , s Land Use Zone: RL
Owner of Building: TD DESERT DEVELOPMENT Address: PO BOX 1716
- City, ST, ZIP: LA.QUINTA CA 92253
By: GARY SHOWALTER
Date: 10-23-03
BUI ding Official
POST IN A CONSPICUOUS PLACE