0301-092 (SFD).)fid '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
P,i6fessionals Code, and my License is in full force and effect. .
License # r Lic. Class Exp. Date .
ate Signature of Contractor? t✓�
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt froml he Contractor's
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 &.P.rofessionals Code).
".( ) I, 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:
( .) 1. 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' compensationinsurance, 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 • ► TATR FUND Policy No. 046-7438.200,
(This section need not be completed if the permit valuation is for $100.00 or less).
( ),1. 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 agrt If I should become
subject to the workers' compensation, provisions
of Section' 3700 of the Labor
Code, I shall forthwith comply with:those�provisions. o .
D ate: ^f; Applicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as -provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a� permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null,and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.'•
I certify that I have read this application and state that the above information is
• correct. I agree to comply with,all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property.for inspection purposes. 1,
.-
Signature (Owner/Agent)' ' i Date �..
BUILDING PERMIT PFRMITN
DATE VALUATION en LOT TRACT
has i43S.d3
JOBSITE
ADDRESS 49 RED VIA, C"-6�,� QUES..WADOR
OWNEE�yR{
CONTCRRAYC{�T�OyRp/�D$ESIGN�ER/1EnjN�jINFER
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MARKS Oi,SRwf.� CITO6�C
PO Box 17 ifs
LA QT3WTA CA 92253
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USE OF PERMIT
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PLM CHECK Fra; �4�14000-4,139.318
MECHANICAJ, PEP lb3«tJrltl- ZTG�t)1� 3140,5
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ARTIN PUbLIC.. PLAC. �` - RESIT+ X?0.0100 �I455 00.0 $.G0127 '
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10� 11 IRA UTM IMM
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S4,164M
JAN 2:Q 2003
as
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RECEIPT
DAT BY.�
DAT INAL D
INSPECTOR
• INSPECTION RECORD
C OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
- -
Ducts
Slab Grade
- - -
Return Air
Steel
/y - 5
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
- 3
Compressor
Insulation
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall -Int. Lath
7
Final
Final t�,3/
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
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lit 57
y- Z _
Heater Final
Water Piping
'
Plumbing Final
Plumbing Top Out
"Z7
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
- 3 - , j
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas) - A __
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) /
. --?. bs�.^^-ir^ ..'-.'rr'4J, "•',4 +7C`.^'^-�-,5.�.�• _' s^tsC–•a'. ��^..?���LX.–^'-"� '—z�=c^s �!.?^ria c:raC. �'ra,.nfo.c°,+�=?w?C'
-
�..� . .. ... - ..� ._�IYi`�'�'I,•'.�' '� - �'•'xa .. rt-^=.lT A...S,d:', •31.. 1r�
��- Certificate of Occppancy.'.
.-
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V _ Com-" .. ,j _ • ` r � -` , - ��,r�l��� � .. ! , ; ,. -
.OF'9Y y :Bu, ilding& Safe`ty PpPartihent • �
4
3
This,Cerfificate`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.. c-ompliance with ahe
:.
" ,provisions of the Building (Code- and °the -various. ordinances .of the `Cityregulating building
construction: and/or, use.,y
' �81UILDING ADDRESS: 49-640 VIA CONQUISTADOR-
•
Use classification :SFD ' ={ " ` -`. - ' 4 Building=Permit No : 0301=092
:
`Occupancy Group R-3 �.,' '� Type'of Construction:. V -N Land Use'Zone: R L
Owner of Building: TD DESERT DEVELOPMENT '• :: " Address: PO BOX 1716
_
'City;�ST;:ZIP: LA QUINTA CA 92253.
- By• G.SHOWALTER 4 rh
! '� Date: 02/26/04
. ,• ,, , , .
Building Official
,y
- ' •. - < - '• < POST IN A CONSPICUOUS PLACE - .1 ' t..•" '
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