0301-057 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm'under penalty of perjury that I am licensed under provisions of
�;hapter 9 (commencing with Section 7000) of'Division 3 of the Business and
Professionals Code, and my License is in full force and effect. C.
License # Lic. Class Exp. Date
074T/4 3 1[ 7 t iO3
1,,,D9t'e ; -42-1
42 -, 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 theirsole
compensation, will do the work, and the structure isnotintended 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 bySection. 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 STA71 ES Policy No.
(Thissection 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 sofas to become subject to the
workers' compensation laws of California, and agree that if I should become
subject to;the workers' compensation provisions of Section 370.0 -of the Labor
Code, I'shall forthwith comply with those prov cions.
Date • ' ^ , Applicant
Warning: Failure to secure Workers' Compensation coverage L.unlawfuhand
shall subject an employer to criminal penalties and civil fines up to $100,000,1in
addition to the cost of compensation, damages as provided for in Section 37p6
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.
1, certify that I have read this application and state that the above information is
correct. l 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.
__ Sinnatiira_lr)wnar/Anant1– - -Z—r -_ori`---.Datei''C /-.a.
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BUILDING PERMIT
PERMIT #
0301-.057 IV
DATE VALUATION a�'�.;w LOT
TRACT .W 28JOB
T. %fit
SITEJ
ADDRESS �Q %:i��idlA.�,l�Bi�{Atdl,
APN���:EiJ
OWNER
CONTRACTOR/DESIGNER/EN (NEER
Ti.7DESERT MEWMOMMIT
SPARKS CM3 111 'RUCM INT
PQ B11OX 1? 1 e;
79,,295 RA*. i ap u: Qu%. rA.1�.
L.e?..Q,TD?, f A, CA, .922S",
S A tlU",CQP. 922,53
(160)771.1941 MU 2596
USE OF PERMIT
SWOL 1' itefi it �,' t 1l t
Sn'D n LCT 2,a,[..rQ N Aff`3R, PFJfl' F1 T DOES NOT INCLtll)E BLOCK WPUL . S,
POO,:t ;IPA'1t D1'�WKWAY Af?PRO.:CH
$3,534
OF
1'oOPCi3,P./t.'3'1O
523.00 sp
%It>iakl �9, .fid •ffi�i. 43�?�1`
110101 8
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RECEIPT DATE
BY DATE
INSPECTOR
COI•bSTRUCTTtM'1RE
101.OW-418.000
911M.30
NLkN CHECK* FEZ
ELECTIWA 1, rtE8.
101-00 42i OOO
W6.71
i'ia",BMUNG i'E.E . •
101,-000.4119^.000
$20.00
STRO11,40 M 01VON l?': Z - MID
101-00 0-241-000
$3,534
'3' IM P01AC NAMP - R&W 270-00040-000
RECEIPT DATE
BY DATE
INSPECTOR
INSPECTION"k8CORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
- BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
—,Z/--
Combustion Air r
Roof Deck
Exhaust Fans
O.K. to Wrap
—
F.A.U.
Framing
Compressor
Insulation
_ /� ..3
Vents
Grills
Fireplace P.L.
Fireplace T.O.
Fans & Controls
Party Wail 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
—3
Heater Final
Water Piping
Plumbing Top Out
, , J/�?
Plumbing Final
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 (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring '
Low Voltage Wiring
Foctures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
_
Utility Notice (Perm) �—
Certificate of Occupancy
Twf 4 xP a"
Building & Safety Department
This Certificate 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 compliance with the
provisions of . the Building Code and the various ordinances of the City regulating building
construction and/or use.
Use classification: S.F.D.
Occupancy Group: R 3
BUILDING ADDRESS: 49-727 VIA CONQUISTADOR
Type of Construction: N V
Building Permit No.: 0301-0057
Owner of Building: TD DESERT DEVELOPMENT ' Address: PO BOX 1716
Land Use Zone: R L
City, ST, ZIP: LA QUINTA CA 92253
By: G. SHOWALTER
Date: 03/26/04 Iep.40 SuiPI!ng