0301-094 (SFD)LICENSED CONTRACTOR DECLARATION
I`h by 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 # Lic. Class Ex . Date
.674074
Date'''/' X'" 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).
( )., 1, 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:
( ). 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 rriaintain'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 MATE 1PLYN w? ' Policy No. 04&7.13M003,
(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 1, should become
subject to the. workers' compensation provisions -of Section 3700 of the Labor
Code I.�a� te�orth.xwith comply with thosk.
provisions.
Date - ro
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. o
1. Each person upon whose behalf this application -is made &.each person at ti
whose request and f*or 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 uponi
the above-mentioned prop ertyrfor es inspection purposes
a f
f f.' b
Si nature (Owner/A ent) 2�
BUILDING PERMIT PERMTk
DATE VALUATION, y�+ LOT ,fig, TRACT a,02811
JOB SITE
ADDRESS 40- M. VIA CDfiQ ad(�Yria�����
APN
OWNER
CONTRACTOR/DESIGNER/EN (NEER
,D) DU- MIT 1 EVEW marf
u i CCj1` STRTiMIald
110 BOX 17.16
79-195 RAI-TC110 LAM`1'.,'� M.
LA OiAtTf A CA 922S3
LA QU'NT A CA 92253
(760)171-1941 C.'D16 2996
USE OF PERMIT
MOLE 3.-A MYDWRLIXG
&M a LOT 39, P A2+3 >; M Pl!;,R V-1T'!')0&S NOT INCLUDE, HL,OCK
WALIA POP4 SPA 09 f9I3KWAYAPPROACH, %*o kt.�''f31:JC ' ON TO
PLAN C;2 YCK MIF, L'tLlZ'#'O.MUL'I IM.11, IS IUANC9 OF ViME PLAN `{'A" PV,'
Cuvom CoNsTwoc tuw V49,09 UP
I?OR011PATWO' SNO.00 Sir
GARAMUCARPORT SF
f 1" S17MO O C 0117 or, C, ONCI ►.' UMMY1
2-32,196.00
VK; Mtr M SMUM l Y —
C014STRUCTION FBE 101-000419-00 $Ia280.00
PLAW CHECK M 1 $264.23
ktL'lat;;'•HAINICAL ME „ 1.0140Q-421-000
=C TIFUC:AL. M 2 � - 2[a- a3 ` $215AX
STRONG MO"FION VZE a L+'ESID i 03 -000-241 01DO
ORADIRO PER irluo
�"f��r FLOPk:Iti' IMPMVP 3.'JGZ itsI03:U0
ART M PUBLIC !PIMP.! - RKRL 270-000445-000 � $203411.0
I
ar• l 'Oice+-'.!"mi L 0Q),if'mC�'.�.K3w ANTD 111 nwf Cap=
-4, MA. 50
1;a;4) .MPAD) !,,r`1
$0.00
rmAL Mawr XMIKS DIT111 NOW
IJAN 2 q 2003 111) k
CITY OF Lk 00W -
RECEIPT FON+�6�NE F
DATE. r� I ' BY
DATE FINALED
INSPECT0
IAA
a
INSPECTION RECORD
i OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Sef,Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Xmr' -3
Return Air
Steel
/ ..
Combustion Air
Roof Deck
- j -
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing7s
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 •
Final
—?—
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
17 j
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
.14
Final
X:
COMMENTS:
A
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.t.
Smoke Detectors
Temp. Use of Power
or
Final-
Utility Notice (Perm)
,
r �L+�r�� �' -."�-':��f•g�;,=,� �'"''f``^��� `� :sw..� �:,:.: _ �u .""'..- ,.r•'�a'Y.[tw Y.*�,c. �_j •�.� t: .t�..tv s'•s° ,.:;ilA+_"cid. y� fir' a-a--�t;..,o- !•_ �^-�c�. •r.�.j�r-.._ _ _•.�_1.� __.. �► ,,.�3„� ;tyy,� - 4.,
ertiTica-te b Occup ancy-,,,
0p�
....
OF. 9 --Budin_g &Safety. PeOa'rtment.
.
This Certificate is sissued,pursuant to therequirements . of `Section `109of the Cali_ fornia'; Building
Code., 'certifying that, At7,OMe tiine sof issuance',: this `structure was in` compliance; :with -the,
..
provisions of the: Budding -Code and ;the various ordinances of- the •;City ^regulating, building
4<-
construction and/or. use
,-;
BUILDING -ADDRESS:'3-49-688 VIA -CONQUISTADOR
-`
wA
Use Classification: SFD Building`Recmit No.. , 0301'-094
' �- • ti _. .. .1 '" r - ti /, .. it , S` .. w� ..r .. _ .'_ ►.
`U M
~' Occupancy Group: R-3`Type of Construction V N ', Land Use Zone: "R L`
Owner,of Building TD DESERT DEVELOPMENT - , ` , Address:`-PO.BOX 1716 1,
. ,'"
City, :,ST, -ZIP: LA QUINTA CA 92253
y - - ,By -G: SHOWAL'TER._
"�--11 1 2.4;• Date:02/27/04
Building Official A 40 x,
POST IN A CONSPICUOUS PEACE .� ..