0301-086 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of. perjury that I am licensed under provisions of
fs;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 -
,rDate Signature of Contractor
�y
OWNER-BUILDERDECLARATION
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).
( )- 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
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.
S c(�) L have and will maintain workers' compensation insurance, as required by
tion 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 STAT z'FOWD Policy No.
t
(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--b\ecome subject to the
workers' compensation laws of California, and -agree thdt if I should become
subject to the wprkers' compensation pro visions of Section 3700 of the Labor
Code, I shall forthwith comply with those'provisions. f .... .
t 1'
Date: •�` ''} Applicant ..�-rZ
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $10000, in
addition to the cost of compensation; damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.-,
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to. the conditions and restrictions set forth on' his
application.
1. Each person upon whose behalf this application1s made & each person at
whose request and forwhose benefit work is performed under or pursuant to
any permit issued'as a result of this applicaton agrees to, & shall, indemnify,
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
! work is: 'not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have'read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above mentioned prope"ity forinspec it on purposes. T
—Si nature`(Owner/Agent)'"'"" Date"0 ` `
BUILDING PERMIT' ° • PERMIT"
.
DATE VALUAT�IIIOoNd�ayys� qq 11� ��qq LOT . 1 TRACT �y xypp��i
i W y^�_d �'� "{.� N. �LIViY.Y.�'si)S;1 - ►�7. - �:P �r�3y►
JOB SITE
ADDRESS �%�B, is{� CQ�T.i�Ck
APN 9- 107
OWNER
CONTRACTOR DESIGNER /EN I�NEEE�rRi�y�Y
.. 'l;td �✓L:.�a.�;,.74.J:.WL!•�L'�✓VY��1d7+►�i�
Jijd�ll:�:El.�7 aa�:R70 J,�A1.7'�.'dA1J,+.V •
'C+BOX, 17 16
19-295 RAu`�•1 F10L'a QWWA DR
LAQ-11I TA CA 92253
LA Q't$�P+t�'.1A CA 92251-
92251USE
USEOF PERMIT
SVD LOT .71. #t LAN 11x1, b+'E•RVIIT I,),C1ES Yt1O!' MC1.1FDS SSI: ICK WA:l,Ls,
POCII , "SRA Olt OiiN};'iW & APPROACH. 7 ; � .RMUC l`ION TO PLAN C1M-CK
FEE b`UZ TO Ml',11'll•'Li!:ISSUANCE CI SAME PLAN T11"PE
Ci1S°i"O,M CONSTRUCTION 430-00 sp
.pokrutifpAsi0 tSE 0109 Firz
OAFI.ACiWC.± RPORT 6!.4tl9 SF
1
RITZ ATM cos!r OF C:OMS7wic7I"lon
282.106.00
C•ONSTRUC 1019FliE 101-000-418-000 sli280.00
13
PLAN CHECK PEP, 101-000-439-319 � $2641-13
P�:'i< 1011-��/J�0O.42.1 0S1050
Nrn�Ipp
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daeO..FAi.I.'RICAZs N'1 bM.d "L/"Jli"atri�0^lFlRa� .. i/Ni°7.V
• st C;iS�li31NO R`.6!�? $ (31X �t2Ut?ti� $ 9�Jati ��O�,�S
S'1'RONO MOV014 FFY,o n3lb '10,14-000441-000 sa.8.'1
ORAri io Fzr,.tea �.f)t g 2? �flir!O 1 .0
,VEM1 M IMPACT 3t'ZE �ik,4t?�.f10
ART IN PU13LIC= a'1.1i CEg - Wit 270.000445.000 12011V
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affil-TOt AL COrrMLIMON ARYDIyryP,�SeAbT C'�;T�Au'ji�'C�
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TO'f'A?ALIPAUUMT1.F', Ek,S DUE AXTOW
$4,704,50
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,JAN 2,(((i���
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REC IPT�I Or f► f to)
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Bit � dfs � ' DATE FINALED
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INSPECT
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INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
- -5
Ducts
Slab Grade
y . s -
Return Air
Steel
-, j
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
_ z,
F.A.U.
Framing
Compressor
Insulation
_
Vents
Fireplace P.L.
Fireplace T.O.
Grills
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall -Int. Lath
_
Fina- �/
l
BLOCKWALL APPROVALS
Final
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
- - 3
Heater Final
Water Piping
/-
Plumbing Final
Plumbing Top Out
�J�/_
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
_ _
_ _ _
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
r
Final
Utility Notice (Gas) / r�
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 _
Utility Notice (Perm) �/
41
/^ _
�4 �-a- etof anc o Occu.
Qum;C..
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Building°f& Safety Departrr�en_t
-
Th�s�Certficate is issued pursuantto.the requirements' -of Section; 109 .of the. California Building; -
' Code, certifying 'that,,,,At,- the .time'', of- issuance;�I this structure Boa's<� i&'compliance with
provisions of : •the Building. Code ,and the 'various., ordinances of the City regulatind - building' 3
construction, and/or°use.
ADDRESS: -,49-496-VIA'CONISTA®OR
;BU.ILDING:,. ..
• h � ��
n
1 lJse_class'ification: S.F.D.-"', A _ � a �� Building Permit,No.: 0301-086 '
�
Occupancy Group:F R-3 r `'� } Type of Constri�ction:r V-NLand Use Zone: R -L'
Vp
pr
Owner of Building::,TD:DESERT DEVELOPMENT ,' Address; P.O.BOX 17.1.6 ;t-
;: Cify, -ST, ZIP: LA QUINTA CA. 92253-.
By: G. SHOWALTER
4
:Date: 01/15/04,,
s Building Offic - ,
�y a
POST IN A CONSPICUOUS PLACE ;