0301-095 (SFD)LICENSED CONTRACTOR DECLARATION
| h6rebya#irm under penalty o/perjury that l am licensed under provisio ns of
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Chapter o(commencing with Section 7oou) o/Division oufthe Business and
Professionals Code, and myLicense iuinfull force and effect.
uvenxo�� . uc.c/usv Exp. Date
1.674074 ' BJRC
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Date Signature of Contractor
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OWNER -BUILDER DECLARATION `
hereby affirm under penalty of perjury that |amexempt from the Contractor's
License Law for the following reason:
( ) |, as owner of the property, o, my employees with.wogoo as their on|o
compensation, will Uothe work' and the structure innot intended nroffered for.
sale (Goo.7o*4.Business &Pmfeooiona|oCvuo). .
( ) |, as owner, of the pmperty, am exclusively contracting with licensed
oummomrs to construct the project (Sec. 7044. Business a Professionals
Code).
()|om6xomp*under Section .omPC.for this reason
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Date ' . ' � ���Sinnam,o o, Owner
VVORmER'ScOMPENSAruJm DECLARATION
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hereby affirm..und6r
I have and will maintain a certificate of consent to self -insure for workers'
compensation, a� provided for by. Section: 3700 ' of . the, Labor C I ode, for the
performance of the -work for which this permit is issued.'
I have.6nd will maintain workers' compensation insurance, as required by
Se6tion 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:.
Qarri.er STATFU'VND Policy No. 046-7-338.=s
(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 Jaws of California, and,agree that if I should become
s . ubjec . t to the workers' compensation provigi'ons oPSection 3700 of the Labor
Code, I shall, forthwith comply with those, Orovisions.
Dateff' Applicant—
Warning: Failure to secure Workers' Compensation coverage is unlamul 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
I -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 hull and void if
'work is not commenced within 180 days from date of issuance of such -
permit, or dessation of work for 180 days will subject permit to cancel lation.,�:
|oertify that | have read this application and state that the above mfomvwoon.is
correct. | agree mcomply with all City, and State laws relating mthe building
construction, and hereby authorize
theabove-mentioned p y.fnc |on
BUILDING PERMIT
0303.-W. S
DATE VALUATION ,%2.824,105.00 LOT. TRACT 4928 31
40
JOB SITE
ADDRESS
APN
ffm
OWNER
CONTRACTOR DESIGNER / EN61NEER
LA QUM CA 92253
(760)771-1941 CBLA. 29,96
USE OF PERMIT
0YOTOM C*1141TRUff ION 3,348,00 SP
MOM=, D COST Or' COINSTRU0.20H
COMTRUCT100 FEE, 101400,418-00, P1280100
MOTAXICAL
PLUMINNORR $20,21215
PkAbINO 9M, WIN
MIAOT Mill
Ari 1X PUSU( *LAC In - RUM 270-000445,;000 $205.217
ON
Sufs-TOTAL C �MWQMOX AND PLAN CUE=
TA, -164,V)
[CliJA
1 '2 9 203 1-1)
OF L4 0014'fA
INSPECN RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
A Z, 9_,:�i
Ducts
Slab Grade
- -
Retum Air
Steel
Combustion Air
Roof Deck
_/ d
Exhaust Fans
O.K. to Wrap
- //- j ".
F.A.U.
Framing
- ��=
Compressor
Insulation
2 -
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wail Insulation
Condensate Lines
Party Wail Firewall
Exterior Lath
Drywall - Int. Lath
r�
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. 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
3
Encapsulation
Gas Piping
Gas Test
Appliances
Final
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.I.
Smoke Detectors
Temp. Use of Power
Final y
Utility Notice (Perm)_
COMMENTS:
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Certificate of Occupancy
T,4 -ht 4
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
p
rovisions of the Building Code and the various ordinances, of the City regulating building
construction and/or use.
BUILDING ADDRESS: 49-712 VIA CONISTADOR
Use classification: S.F.D.
Occupancy Group: R 3 Type of Construction: NV
Owner of Building: TD DESERT DEVELOPMENT
Building Official
IN A CONSPICUOUS P
Building Permit No.: 0301-095
Land Use Zone: RL
Address: PO BOX 1716
City, ST, ZIP: LA QUINTA CA 92253
By: G. SHOWALTER
Date: 03/23/04_