0301-056 (SFD)r ` LICENSED CONTRACTOR DECLARATION„, -,'
I t;vreby affirm ;under penalty of perjuryahat 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.: 1.
License # Lic. Class Exp. Date
674074: IS 103
,Date /10 4*1' Signature of
OWNER -BUILDER DECLARATION c
I.hereby affirm under penalty of perjury that I am,exempt from the Contractor's
License Law for the following reason: i
( )I, as owner of the property, oi'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).. ?r • '
( ) 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
.1 hereby affirm . under penalty, of perjury :one of. the following declarations:
O 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 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 I3Ti1"1`1�F?3J.. Policy No. (�-^.•(r 74dw3
(This section need not be completed if the permit valuation is for $100.00 or less).
` O 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 I should become
Subject to the workers' compensation provisions of Section,3700 of the Labor
Code,, I, shall forthwith comply with'thosb provlslons.�<^"�
,,Date , Applicant
.Warning: Failure tosecure Workers' Compensation coverage is unlawful and
Shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's -fees
IMPORTANT: Application is hereby made to the Director of Building and Safety
for .a' permit subject to.. the conditions and restrictions set forth on,his
application.
1:'Each person upon whose behalf this application -is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold' harmless the City of La Quinta, its officers, agents and employees:
2. Any p6mit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned Drooertv•for insoectton purposes.
PERMITs # L .'BUILDING.PERMIT.'�
'
DATE VALUATION LOT 3 TRACT j
JOB SITE'
APN
ADDRESS
OWNER
CONTRACTOR /DESIGNER /ENN61NEER i
1-1) DWIXT.
SPARKS COP SRJ TO -
TODM III()
TaAQTJINTA CA . 92253
iAQ X,T-A
(160)771-19,41 MIX 2996
USE OF PERMIT
SQTG l FAMyG
.
SFD - JZT I PIAN MI..PEWMIT LIM'P$O b't3'C,t UMe 6.Wti:;tWAa.:t: 4
POOL SP.A. calx. DRIV, EWAY APPROACH
CUSTOM C'"MaTRUC°TICi 2 1141IM8.00 By
'E�t�i:£�Filr�,A,�'�C3 3at7.Gtt �;�'
�;:• �• _ `
0ARAMMA.RPORT 59.(iS�
Ufa Ti�?%'TI" CCPFX OF LON'OTR'!:J'C7EWN
282,106.0()
,ONO RUCTJON FLOE 101.-000418-000 SOSO."
PLAN CHECKFFEw000_429_318
MECHA141CAL FEE .. 101.0004421-000 $149.30.
f<,11'MCAL PFI D e', i ••a ltiQ X42 £afli' 1 ,.t2
Ys1,UMMING RIF, $202M ...
aft f M PUBLIC PT ACE. . W11W. ,l`7
nm ark -MIC.;
7 17
11 11V P�RFMI%1T> i el
.00
Y. '�'C}' All I'ET"I'1f FYIT5A, Dpi" INOW,
`r.4_,; %17
RECEIPT
DATE
BY {
DAT FINALED .--
INSPECTO
• r7 f /:a
INSPECTIO"- ECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
_ , c�
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
,��
F.A.U.
Framing
_,
�,z , 3 _
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
BLOCKWALL APPROVALS
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
7_ /
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
73 �S
Heater Final
Water Piping_
Plumbing Top Out
5-_/�__
Plumbing Final
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
/
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring 12 - �
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
_s
�- Certificate of Occupancy
o o
4F
OFT9 Building & Safety Departmentp
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. _
BUILDING ADDRESS49 757 VIA CONQUISTADOR
p
Use classification: S.F.D. Building Permit No'.:' 0301-156
Occupancy Group: R3 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
-�" Date: 03/30/04
Building Offi ' 1
POST IN A CONSPICUOUS PLACE s
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