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0301-060 (SFD)LICENSED CONTRACTOR DECLARATION KINereby affirm under penalty of perjury that I am licensed under provisions of AChapter 9 (commencing with Section 7000) of Division 3 of the Business and yProT sionals Code, and my License is in full force and effect.. .License # Lic. Class Exp. Date • 664074 i3MC �, ` � 7rd1/03 Date `�` y '`� Signature of Contractor OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury -that I am exempt from the Contra_ctor'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). 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 fors 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':.vmm Foill,? Policy No. (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 iff l should become subject. to the workers' compensation'pro isions of 'Section of the Labor Code ,•l Shall f 'rthwith comply with those Avis ons. ,.Date. Applicant G Warning:• Failure to secure Workers' Compensation coverage is unlawfful 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 80 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 autr6he- representatives of this City to enter upon rthe above-mentioned property for inspection -purposes. ,..,.Signature (Owner/Agent) Datf. e'y� T� BUILDING PERMIT PERMT# DATE VALUATIONm�+0� LOT. TRACTJOB SITE ADDRESS `49-.� `VTA �C;4�i�Q�':1'€.`41:. 0 ' APN OWNER CONTRACpTOR/DESIGNER CONTRACTOR ��y.�yy �}�} gyp`' �y� �� �gN .61i DES) .� 1 �R'J© I7�i+�.F'�CVxLt+.l.Y:1 q/yFE1N61N/EWE7R1�y ,t" ILKS Vin!�lYy3FiGi�.s.IXON .. I.AQiYTWA. CA 92,233 1AQEM4TA C. 92253- (160)? 71'1941 MIX Zr () USE OF PERMIT nwu Iw&�1 'U4 mlmo P0014 SPA O11 DRVWXYAPPROAC,&1, °5-1/b PLAN C31.F:CK Ari: REtYIUCT3011 FFTL MULTIPU." IV31J.F►;Adt;90N SAME rjP:A11 TYPE CV21TOM CON RUCT10A .04% 0 0 IF P4 `xt S6it.rJf, ►r. . nGJ��13¢17?tde9n. r; m ' ciA:4'+.��Nt.�s'M,%�t.4' .),psi i�93A S R DMI13) CONT OF C4* p.NMUMON 2'�s'rMW M Ge )Y h"r','tICITION PFIF 101-000-418.000 PIMA r-tm mr-m'A: , 1q.g.::400--4 9-.118 2M.23 V1.1C�V�.W1C°AWME 101000.4tl,000 $149,50 �+Pwief�lC'I(°A..i FRE STP,0 MO' ICYH a� vUl • ? -E-SID 101.400-241 00 -241 -£lam y(yY%g1�Ayi��gINGgIr'(*sl�1A }�. I J.ILOPd:a,i'4. ART 11+1 PUBLIC PLA 0, SIL 2 0,00-4-4S-0Crf)' $20SIT7 M.T07AL COM IMUCHOW MID PLAN �.;"�':Cf?'.�X i FRE, PAJD MIMI) RECEIPT DATE BY DATE FINALED JINSPECTO INSPECTION RECORD OPERATION q DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms &Footings Ducts Slab Grade $—>y Return Air Steel - _ Combustion Air Roof Deck Exhaust Fans O.K to Wrap F.A.U. _ Framing Compressor _ Insulation - Vents _ Fireplace P.L. _ Grills Fireplace T.O. _ _ Fans & Controls Party Wali Insulation _ _ Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath Final Final 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 ` —/ _ 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 Appliances / Final Final Utility Notice (Gas) 7 ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring=5 Low Voltage Wiring Fixtures Main Service Sub Panels _ Exterior Receptacles —� G.F.I. Smoke Detectors Temp. Use of Power Final .� Utility Notice (Perm) /- _ COMMENTS: � Cer-tificate'df Occupanq-y 0RAMr t_ B it in Saf :D' _ , m n r u g & ety epart 0f9 �d - ,e "..• This Certificate isaissued pursuant to."the requirements of Section 409,of the, California Building. f , Code, certifying `that,4 the. � time ­ of •issuance; this ; structure was - in` `compliance with the" . ,at, provisions;of the Building Coale- and the ,various. ordinances ofr*the. City..regulating building'` T ` :construction and/or -:'use. j - f ; r BUILDINGADDRESS:'49-655 VIA WNQUISTADQR �.,. k Use classification.`SFD r : f:f,_,°f" '- "" ;_ F Building Permit,No.: 0301-060 Occupancy Groiap: R-3 t Type,of Construction: VN" "' ` Land'Use Zone: RL Owner of Building: T.D. DESERT DEVELOPMENT Address: P.O. BOX 1716 F - T City; ST; ZIP: LA QUINTA, CA J, By: GARY SHOWALTER " Date: FEBRUARY 25,'2004 - `Building'Official ' 1_v POST IN A CONSPICUOUS PLACE. -`