0301-066 (SFD)U .
LICENSED CONTRACTOR DECLARATION
I hereby -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 Cobe,'•and my License is in full force and effect.
License # Lic. Class Exp. Date
6741D74 $ I" C ` 1 7M, 11103
Date / ? �'' Signature.of Contracto'� r� 5
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).
( ).e I, as owner of the, property, am exclusively contracting with licensed
contractors to construct the project (Seca 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:
O 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 STA TE FU D - Policy No. 11404333�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 f\should become
subject to the workers' compensation provisions of Section 3700 of the Labor."
Code, I shall forthwith comply with those provisions...».
Date'.' S•r,€: �; Applicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties. and civil fines up to $100,000, in
'addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit, subject to. the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application -is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta; its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit; or cessation of work for 180 days will subject permit to cancellation.
I certify that.l have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for°inspection purposes. r,
"`Cinmatri'rn!(lwnor/Gnontl- ""1`a:°�`t���ra��-�-�. Date
BUILDING PERMIT PERMIT#
DATE VALUATION'S LOT # TRACT
'3
w
JOB SITE
ADDRESS 4 �;'tl'
x511 IA .1NQV=}, D
APN 649w110-06
OWNER
CONTRACTOR/DESIGNER/ENGINEER
PiaDOX 1716
'79495 RA14CHDL&Q'CiKEADF.
C.A. 922J1 .
LA QU�1v` lk CA, 92.253
6( )77'1.194'1 CSI.91 2996
USE OF PERMIT
3C7sJAMMY
.MMLING'
SPI) .. d, )T 0, 1 L01 ''XI; I~PRMI`I` ).?DES NOT INC )DY, 81.00K..
r�
WAI,I,�, P+� 014 r$IA OR t)Ri l &W.' .Y S,PPI:O,A�.CH. 15% I��F. AN C 14Fc.4. ''E* ' .
RFAIUIC 1014 11011 MULTIPIX ISSUANCE Ok':l,d AIV Pl-.AN'1`5E' E,
t;`USTOM C T9TR 1CTI.0'N 21�349,00 OF
(f7l1(1liw'ii'�;ItI >$'J.OU 8% .
- aY,Tw,2! �V6Y�4 4!d�..�.TVdi�pR &4�„,S.tia�.B�AY
�[���A'e."17s0�iq
? ;Wyyp7� yv Yq•��q, (+�ry.• �:y, q�ayeyiyi.d.Ql.'YA.C1,1,
6:b,B"..D.CA:t.�A 37 A4/!Fs a4 AY�FV2�Si $.
CO STRUCM011I Fir,.,� 101 <:00041 9-000 n,230..00
PT.iEtN CFiI•r'M %'3vN 10 1-001D-41 9 -I18
M$C?r3ANIC":IlEt 101-000 4.21-000 $Ift5y
F,LVWT1RXAL Ml' 101.1000420-000 $213AW
I1? . 91Aid FFR 101-000-419-000 5202125
S'I`Ii:ONO k6OTION 1.01 •.000-24;1-000 $23.31
1ol-0004,23-000 $111,000
nxy'�,y
}0l(i�.��p9..Oitp80
(}•W7t
2�3:'K 1t✓a.R.'�7dd•LS. FLYd�.[:i1i.j� Eti�.�i .��WV:7. iP1F
ART IId PUBLIC KIACYS R-Mi't I' 15 MV -44:5-000 $206.27
L 10 1"IM-1 A M
;$0100
TMAJ." NOW;71nAMW
..
RECEIPT
DATE
f
BY
DATE FINALED
INSP CTQR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
— —
Ducts
Slab Grade
Return Air
Steel
— —J?
Combustion Air
Roof Deck
115.�
Exhaust Fans
O.K. to Wrap
_
F.A.U.
Framing
Compressor
Insulation
- 3
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
c'
Drywall - Int. Lath
c
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final I
I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
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— — 3
Encapsulation
Gas Piping
Gas Test—.
3
Appliances
Final
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
Final
Utility Notice (Perm) / s J
COMMENTS:
Certificate Of Occupancy'
uiE 'rc�
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: 49-511 VIA CONQUISTADOR
Owner of Building: TD DESERT DEVELOPMENT Address: PO BOX 1716
City, ST, ZIP:, LA QUINTA CA 92253
By: -G. SHOWALTER
Date: 03/26/04
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