0301-068 (SFD)iWLICENSElicbNTRACTOR DECLARATION
I ere@y 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.
License #
Lic. Class Exp. Date
LID M.
9,74 4 Bfflc
Signature of Contractors
I ca
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors
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).
1, 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
LO
Date Signature of Owner
WORKER'S -COMPENSATION DECLARATION
Z i hereby affirm under penalty of perjury one of the following declarations:
0 l,hav6 and will maintain a 6ertificate of consent to self -insure for workers
IL
compensation,, as provided for by Section 3700 of the Labor Code, for the
erformance of 4 he work for which this permit is issued.
< p
I have and will maintain workers' compensation insurance, as required by
ction 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:"
Z. Carver, -WATiAMD. Policy No.. 046-734M-2003
Z)
< (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,tfTt1Kl should become
subject to the workers' compensation provisions ,of'Section *00 of the Labor
Code,* I shall forthwith comply with thos'e-provisions..
/2 1/Z Applicant
Warning: Failure to secure Workers' Compensation coverage is unlawfu/1 and
shall subject anemployer 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 attorneys fees.
IMPORTANT, Application is hereby'made to the Director of Building and Safety
for, a- pe'rmit fSubje6t to, the, conditions and 'restrictions set forth on his
applidation,11-
1. Each person upon whose behalf this application -is mmade& 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.
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-mentionbd property -for inspection purposes.
I—Signature-(Owner/Agent).
Datd X) fs
BUILDING PERMIT PERM T#
DATE VALUATION LOT TRACT
13 Bkt
JOB SITE
PN
ADDRESS 4946.3 VIA CO3NQLUSTt=R
649-210-067
OWNER
CONTRACTOR EN INFER
7DDH5WVf DE MHOMM].
CONMIRU0171014
PO D WK 17 16
'79-.2.95 .tA-N cH.0 L. Qmahrm,
LA Qtm. *A CA 92A"S
LA QUMA CA 92253
(760)1'73,--1,941 CBTAt 29496
USE OF PERMIT
SK) -LOT 11 PLAN M! -PEWIT DOES INCLIMS KLOCK INALL-S,
FSK)
I
OR DAIVEWAYAPI)ROACH. 7A. %, REDUCT101071 0 PLA14 CRECK
Fe, . Z IM10 MULTIPIX ISSUANCE Ofr SAIAE PLAN TYPE
CUSTOM CONTMUCTION VW&O'D SP
Pon"MATIO S141
0ARAGFICARPOR."r sp
EVM"TEZ COST OF CON's-YRUMON
282,106.00
C0N1TRUe,,','T1QNF9F, 101-000-43€i,000 2-1,28%00
'KAN CHWK, ME `1 al _000 -4"o -i I a
It RCHANICAL PER 101 -mo -421-000 SWIM
M.Wr k.. i c -A I, mi 101-000',,42G-000
STROM NOT104 FEE • RESID X01-000-241-000 Va, 21
ORAIDNO POK
r&rNrZLVVZR IMPACT PRE
ART IN PUSIAC PLACE10 Ufflr 270.000 -MS -000 $2,05.27
SET-4-aw.-PL C -614 -MUM ON ANDPLAW 0MOC,
T4,764.50
I
$0.00
Tara rmwr Fymr S vay. now
&4,.7&1,%)
RECEIPT
DATE
By
ti_ ,
J
DATE FINALED
11�_11A)_
INSPECTO
___
_ _
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
J
Underground Ducts
Forms & Footings
3
Ducts
Slab Grade
— Z —
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
—
Framing
Compressor
Insulation
- /— °5
Vents
Fireplace P.L.
Grillsfl
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final / — — 3
BLOCKWALL APPROVALS
steel
POOLS - SPAS
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
— _ 3
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
3 —
Encapsulation
Gas Piping
Gas Test
—
Appliances
Final
Final
Utility Notice (Gas) 1/7
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 — y
Utility Notice (Perm)
COMMENTS:
erriwncae o cpnaY i
•
iv0016'OtnTFD
9 Bu�ld�ng &- Safety7 D...epartment
OF._ � . .
This' Certificate=is issued pursuant'to the requirehients,of Section 109 df'thd,Cal►forn►a.BOding
-Code ` certifyin that, - at' the time} of :issuance, `this atruct ►re, was -=►n `corripl►ance ^with � the'
provisions- 6f. the =Building Code and the 'Various ordinancesof_ the ty regulating rbuilding
constr`uct►on and/or use.
J.
id t +•
�,49=463 VIA CONQUISTADOR
3BUILDING+ADDRESS:
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r i,. - '4, Stir r�. � .v y � � r � `�'• i ,�' ^+ l
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Use classification: SINGLE FAMILYDWELL' ING Building Permit'No •-
_'0301-068
Occaparcy Group R-3. , Y Type of Construction: V -N ) o' Land Use Zone: R -L
_ , .y
Addres'S:''PO BOX 1716
Owner.of:Building TD DESERT DEVELOPMENT -+
r ;. Fy s' ` •`10 = }+ ST;.,ZIP: LA.QUINTA'� CA`92253
+,.City; #
�.
By GARY SHOWALTER-
_,�.. >`• Dater -11/14/2003
Building Offici_
F' a� +
, f POST IN A CONSPICUOUS fLACE