0301-097 (SFD)LICENSED CONTRACTOR xDECLARATION
I hei by affirm under penalty of perjury that I am licensed under provisions of
Chapter Lg (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 Exp. Date
614074. E � SIC , w , ?A 1103
Date - 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).
( ) I, as owner of the property, am exclusively contracting with licensed
contractors`to construct the project (Sec. 7044; Business & Professionals
Code)\
O I am.e'xempt under Section B&P.C. for this reason
Date t Signature of Owner
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one ofAhe 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 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 STATE FUND Policy No. 04"438_20flm
(This section need, not be completed if the permit valuation` is for $100.00 or less):
.( ) I certify that in theperformance 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 Secfion,k00 of the Labor
Code, I shall forthwith comply with,those)provisions.,
Date -
- 7Applicant i Y *•>
:` . .,
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"rr6presentatives of this City to enter upon'
the above-mentioned property for. inspection purposes
PERMIT #
BUILDING PERMIT_;
DATE VALUATIONI LOT�y TRACT 29283
JOB SITE
ADDRESS 49-70 VIA.CONPMUADOR ]APN
649.210—o�j
OWNER
CONTRACTOR/DESIGNER/EN (NEER
Po BOX 3716
LA Q'IS4MA CA 92253
LA. QIPINTA CA, 92253
l;Pvj7'l1 1.r�I C`L7# 2996
USE OF PERMIT
SPD - LOT 42, P1,AN E07. ,.PLI'tBRn 1�C1ES2�It� T INCLUDEBLOCK
'I
W.A118, POOL14 SPA -gilt, DliiVWAY „A,PPPuOACH. ?5 REDUCTION O PfJAH
C;3fl.CIv F. DUZ TO 4 uVrIPLE M(:f t NCE or SAME PL,ft,> IrYPB
!`bL1I(C:iIt4?k 'iC� 529.00 SY '
dJ��JIYi41[S �u.X4.�.!'�^!'.ti I iM�Li - �.F.�',i-eI'6•1d�'� a'{�Y 1�W �% ,��l+�.k2fa�i%
PI.AANC°I-Isr''IX., PT40 t4 a -D00 -4_9—!.,1f3
I`ilZCl STIT,gL 101-000-421-000 $1 it6 5
JUICTI` CALIP2E
PL;f,IMUNO FFM 101-000-419.000 SAUDI
STROND �MDTJDN FEE 101-060-241-000 $35J4
1>i);Js PZF 1.lil�C>N3�i3,40 '�SS,QB
IMnfs.CT 1'4211 $2,40-sm
AIT IAl'xtUBLAC' u'LAC~'L°o$ - RESIr 2.70.000.•445-flli0 S37 A7
Ll'-f.'l'�••,8to7'��l',!s{.r l:iV.itF 4�d.t5.4.��1�.��yd"4S'471..r ��.}s«""�ill l.rt.L"a.7.N.rli. �
VT:.7,,d..i d.::4�.;3
IJAN 2 9
CITY OF Lk QUIN' -A
EINAfICE Or PT.
RECEIPT
DATE
BY
DATE FINALED
INSPECT`
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
G
Ducts
Slab Grade
—/� -j
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
»
F.A.U.
Framing
/ _
Compressor
Insulation
_ 7_
Vents
_
Fireplace P.L.
ZGrills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
=�
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
N— /
Final
�/S
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 Lines4,1/
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
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
27 — 72,2 -
Fixtures
Main Service
Sub Panels
_
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
Final
—71
Utility Notice (Perm)
EBINJ
..++lrirt •.. �* i +i+�++r�^+ram:.--.,-..�. � -- „ � _ . _ - .. .� .rf �, -.
�.+ .. - s ,` - . 'ice - .• ` •... ! � . `�') � .� r
0000,
�-- - Certific�iteof Occupanc
F
r.T. Iscoryo
"I -1
Sudding &Safety_ Department
49- - OF -
i
This, Certificate is. issued pursuant to the requirements of Section n 109'ofthe ;California `Building
Code, certifying that, ;at ,the', timb - of issuance, this, structure was,,.in 'compliance with' tlie_
,
provisions of .,,the-, Building,'Code andthe=-.various ordinances%of. fhe City regulating building,
onstruction'and/or use.
c 'L
t
BUILDING ADDRESS: 49-760'VIA CONISTADOR,
-Use classification: S.F.D. '� - r; - V s'.3 r -� Building'Permit No:'0301-097
Occupancy Group:,, R-3 _ '1: ;Type of Construction: V -N - - Land U' 6 Zone:,aR IL ,
Owner of..Building STD DESERT DEVELOPMENT Address: PO BOX 1716
�_-.,,City,:ST,,ZIP: LAQUINTAzCA'�92253 ,
' ..' .� :. . - •.J `.; {, By: G SHOWALTER
• ,;
Date:' 04/21/04 "
Building Official-,
^ POST IN A CONSPICUOUS PLACE-'
..++lrirt •.. �* i +i+�++r�^+ram:.--.,-..�. � -- „ � _ . _ - .. .� .rf �, -.
�.+ .. - s ,` - . 'ice - .• ` •... ! � . `�') � .� r