0301-089 (SFD)•'• 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 Code, and my License is in full force and effect. {
License # c Lic. Class Exp. Date
Date /F ^'0 Signature of Contractor
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).
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct -the project (Sec. 7044, Business & Professionals
Code).. i ' ' -
() 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.
V) 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 3TAI`i; l<11'OD . Policy No. i4041338'1'n=
(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 irnany manner so as to become subject to the
workers' compensation laws of California;,and agree that if I should b1come
subject to the workers' compensation provisionrs, oYSeNon 37.06 of therLabor
Code, I shall forthwith comply with,those provisions.
Date: -�%� " Applicant a
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 forthlon his
application. r
1. Each personfupon whose behalf this application -is made & each person at
whose request and for whose benefit work is performed under or pdr'Suant to
any •permit issued as a result of this applicaton agrees to, & stiall, 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 bulldlrig
construction, and hereby authorize representatives of this:<City. to epter upon
the above-mentioned property'for inspecton purposejs.
BUILDING PERMIT PERMIT#
4 wxn-
DATE VALUATION LOT • TRACT
93 34
JOB SITE/
ADDRESS 49.,!Jl[% ��.tA CDrq(, )MT ;i? R'i
APN
64.9-2.10-067
-OWNER
CONTRACTOR / DESIGNER / EN (NEER
PO BOX. 17116
79-295 Rff,$3CA40;l AQu."ms'm",
i.At 3f;SMA CA 92253
LA iv:mCA CA. 92253
'
(70P)77 1 -1941 ML4 2996
USE OF PERMIT
MIN CHIP, MANLY DWIF UMG
SY'D , 101' X PLAN. K%R. P11lz.1 IT I)OF% NOT 1NC1,Ur39 .2LOCK
WAIAXN 1004 SPA Olt DLIV1 d4Y"PROACH.75%RMDtSGa1`ROW TO P ik
CHEM FRE 1jUX TO Td1i3T.'iISPLE USSS tANCF, OF SAW K.&N TYPE;
___7��.p�7y0 i°0M CONSTRUCTION 4,,24 0 ? .
{�'F.•±dr.C1"1f 1:3%��'4f� ��R'R.{V w.li7.
- t>;C.AGWIG`A€ POI -Cr 710,00 0
tr0411T1Z.U'C'1ION FEES 101 000418-000 $1,,nI,"sEa
1►+.i�pp'yyu Cx11iS�'. >: m,p 1011 _uJt/Jy 419-:�/1 8 s�g���{:'�
!tt:ppxyy.
MFP_HA4V1�.n ,ISF.R 101,0a'U'.FP-.n,}Pl-000 $136.60
&XGTV.1C,AL FELE 101-00 0-420-000 $146.7t
Pa#U1 411a10Fi9L WOO
MONO i M OTION VU; - RESI'!D -1-01-000-241-000
;�; 1 000-24 -000
q7
11R AAd,THO Rif, 101 -000-423-000 �14i 1�W
0XVyt,c�P171.{ 1 IMCIT 1PLI1;
ART !N PUBLI(,PLACES - WIr 270-000-445-000 SMA7
�,, �'{'�y`[�/''{'�'/�
` �{ ra: / p7 �l��%�•�'y'� �•����y PL
AA((y�( -TOTAL
ci` 3 TOTAL° OXIIT .U` /.4lSF+'1'f: X°111 [..� P.41d1'i,�•1w,S�F+ECK
S$,252,05
i ms ' IRT.-PAii9 MRS
D
:� p
TOT EMU MS DIM NOW
AN 2 q 2003
CdR?y (IF Lp@fCalpi�i�?yWrA
f �IV�KV'1^i ry .
RECEIPTDATE
` x
BY
DATE FINALED
4SPEC�TqR
j - ---Oft
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
, w _75
Ducts _, —
Slab Grade
_ — 3
ReturnAir -�
Steel
_ c> _3
Combustion Air
Roof Deck
—
Exhaust Fans
O.K. to Wrap
_
F.A.U.
Framing
Insulation
_ / -
Compressor
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
Final Y
—/2—
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
C ,Y
Heater Final
Water Piping
�'
Plumbing Final
Plumbing Top Out
v
Equipment Enclosure
Shower Pans
/ /
O.K. for Finish Plaster
Sewer Lateral
_
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS;
Final
Utility Notice
a���✓
(Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
l
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
r ..
j
Utility Notice (Perm)
fail
Mi
Ce lificate of -,Ocu ancy-
Ic-sp;
tA
yM060uhn�
of s Budding, &Safety Department
;�. { � •.� L. �.' `T" A .h, !� � "r C4f 'g ..I C� r�.f �'J-,� r C �,7 �..'J
This -Certificate is issued pursuant`to the requirements of Section, of;the'Califorhia Build1ng '
.. Rr }
1,C de,,� certifying ' that;" at the.., time of issuance, ;•this structure_ was in"� compliance -with 'they:
provisions _-of. they Building Code ,and' the :various ,ordinances of }the <City reg_ elating building'
construction and/or'use'
BUILDING. ADDRESS:- 49-568 VIA CONQUISTADOR
;'
,
Use classification: S.F.D. ' �� t' ' .Building Permit'No:€ 0301=089
r!♦ 1 '
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Occupancy.Gro' R-3 = ;Type ofrConstruction N -V Land Use Zone: -L
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Owner, of.Building;TD. DESERT DEVELOPMENT Address: -PO 60X,1716
- .
City,'. ST, ZIP: LA QUINTA CA. 92253
'� ''By:' G:' SHOWALTER`
�� , �; ti .- ;' •E. t• Date: 04/05004.
�""
=, .Bul ding OfficialMoll
" . 5 �t {j, .. POST INA
CONSPICUOUS PLACi'