0301-063 (SFD)LICENSED CONTRACTO.R"DECLARATION
I hereby affirm under penalty of perjury thai ['am licensed under provisions of
jChapter 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
604074 137TH ' ,. `i'i�11C 3
Date a `fi �� Signature of Contractor
� f .' ,rJ - fit' 1 �.....,^.'"••••-".
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contract is
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):
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.
FV) 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:.
Cartier. 'w .A1` Policy No. .. qF€• 3##-�t��s
(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 if�l should become,
subjectto the workers' compensation provisions of Section 3700 of the Labor
Code, l shall forthwith comply with those provisions.
-Date j% / Applicant—
War
pplicant /- -^-
'sem .., a� .�.. •,,•s:
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 I have read this application and state that the above information is
il
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 inspecbonjpurposes.
,Signature (Owner/Agent) Dater
µ �ti
PERMIT #
BUILDING PERMIT
DATEVALUATION imf lr,,L
, o LOT 6 TRACT 21102M.3.
JOB
S ,945 VXA S.�l`� QQ Rr�"a'telD01Z
ADDRESS
APN
OWNER
CONTRACTOR/DESIGNER/ENGINEER
`ZD D.VSWr DR,141M.0P
SPARK COMMRUCTION
LA QUINTA
1:A t;3U1:t33`fA
USE OF PERMIT
irIGU RppI YyY ViNG
rr . �• .
SPE) - %,OT 81 F'T.:AN III I, My"RY.IT I".0F NOT I14CL.iF0Z bL?CK W:A;'.:1,.,
i 13UC.T1ON Mk it tWF1F1:K :t¢SI.T,AHCE. £2.11 S� :ftt � PLAN `P'yPE,
zit ixMHIPM10 $90.00 Sit
GA.1'�GU MKART 493.00 Sly
ESTIdE1E$ SC$r.OFC M'SYRUZ5ON
XI06.4"
�
PERMU gqiMMAy'V
CC)NMUC.1ION FRE 101.-000.418.00 l IEd"IN.
PLAN CHECK: FPP,' 101 -000 -4:351 -St$ $764,83
M17,CHANICA1,FEE IQ1-000-411-OW $149.50
F.'t EC TRICAL FEE, 101-000-420-000
'UdB£diAsR • 1 0 1 �00419-00 IT212rS
spCy1ry1hOTION ( p9 -ti4D 108 "0002-11 -000 $23.21
rp3�,gfAPt�y:N'��OFF:;isN■iBAtn! 16'Iv2% 0,w.2-7.000 8i19,CAI
@
Y. �EVEKi..�i./�DER F.n4F"ptfsr'd. NSaip, 1 $:koi3.w
ART IN PUM,1s PLAtu - RUM Z70 -000-445-0M)
O +.Cr -1`.J -&f L COME •Y�t�.1���[v A10 5'h.,<<-B.iM C.el.ei'W—M
ixu '1�' 1?�1T F -us
- 0.00
TOTAL MR110TIFUS DOF NOW
14,764.60
RECEIPTDATE
BY
DATE FINALED .
INSPECTO
1 .1
I
t 5.
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
.APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
y_ a 3 _
Ducts
Slab Grade
D
Return Air
< .
Steel
a
Combustion Air
Roof Deck
/— 3
Exhaust Fans
O.K. to Wrap
'7
F.A.U.
Framing
_ _
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
_
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final 2 _ g ., tt
BLOCKWALL APPROVALS
Final
Steel
POOLS - SPAS
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
_
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
/
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
3
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring ?�
Low Voltage Wiring
Fixtures
Main Service
Sub Panels _
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final CyAl
Utility Wice (Perm) z _
COMMENTS:
'.,fin 1r ' �Certifica
to of anc
.Occu
•�
-
Y - 1 ' �
� qty _"� ry
rn r "�
.' _,
.�' i1 .F� t -F. �
9 Buil r ing►$qf!y epartnient
of f�
`y • ,r l
t
This-Certificate'is,issued pursciant to -the, -`req uirements'of`Section 109'of�1he`Cali bmia Buildling
-Code,: certifying_ that, `'at -the, time 6f� ssuance, -'this ,-structure;-,wasin'.-compliance-'with.J a ?,
provisions -of the Budding Code'`and the various. ordinances of the City regulating building
x
-. :. - 4
-' construction �and/or.use:
Ak
M
ADDRESS* 0-583PVIN'CONQUISTADOR
-=BUILDING
62
-Use classification S.F.D. Buildind?drmit iVo '0301-063 =�
_Occupancy Group:_ RR 3,. �- "' Type of Construction: 'V -N ti 4,~�� `' Land Use:Zone: `R -L
Ownerof Building: TD DESERT DEVELOPMENT -Address.,PO, 60X.1716
City, ST, ZIPLA QUINTA"CA 92253
4
-By:, G.SHOWALTER
.r--• `�� 'J ,Date 02/09/04.
_ _
4... ' r :POSTIN A CONSPICUOUS PLACE �. _ r rr ;�,p. � i r•