0301-098 (SFD)LICENSED CONTRACTOR DECLARATION x ? BUILDING PERMIT
II he e6y affirm under penalty of'perjury that I am licensed under. provisions of i
y Chapter's (commencing with Section 7000) of.DIVISIon 3 of•the Business and DATE VALUATION LOT
Professionals Code, and my License is in full force and effect.' � ( � v2,,tt>a�i�l3i2.
License # Lic. Class Exp. Date
274JOB SITE
?f �� .B TTCr° e7131 /03 ADDRESS tag-Jni� �A �.0XQU���iA.��YR.
,� J ya r� 1
Dater, `{� Signature of Contractor-- -r') OWNER
OWNER -BUILDER DECLARATION
TD 1).W% M-71 iJ1r'�IU10—T&ON '
F0 BOX' 17.3 6
I hereby affirm under penalty of perjury that I am exempt from the Contractor's �, +12j.,
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 strurtt,re. is not intended or offered for
sale (Sec. 7044, Business & Professionals Code). USE OF PERMIT
( ) I, as owner, of the property, am exclusively contracting with licensed
3�TC3k"a%?"3J �3f:
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
I ;hereby' affirm under penalty of perjury one of the following declarations:
( ) -1 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
Sction 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:'
PERMIT #
43,
APN
CONTRACTOR/DESIGNER/EN
TRACT,
:SAAams t"'.fSAd:TRUCTIow
LA QUWTA C:.A. 922 S 3
Q00)e71-1941 C -M 1 29916
aYid a 1.&$1 <4,3�. P'1AftJ144
-136.' 1-MTUVJA1. &Jia a S401114%,LAP U
{� I•.,
7Sbad4,�ii
OR DRIVEWAY APPROAdH. T3% RIU)UCTION TO PLAN
Clip= ME T.)U > TO MULTIPLE ISSUAVCZ OP M—ME PLAN ` Y"Pt+
CUSTOM CONSTRUCTION Am r/ou
Carrier . S'i`Nf l? .FUND Policy No. €146.7)33.40.
COST OF C:tQXIMUM0,JR
•
xk q yg��9,:yS1E'9W.TSD
A �t4��3J��t�w tSVJuhi;K.2r
(This,section need not be completed it the permit valuation is for $100.00 or less).
COQ€ ? RUC'CTION ;?FE
101 «000-4.184.000
( ) 1•certify that in the performance of the work for which this permit is issued,
WEAN C:HP.0 FER
101-00*4.S9"328,
$204.23
1 shall not employ an person in an manner so as to become subject to the
- F
(i�..kl����i,�f���
101-000--01,-000
114%.50
workers' compensationaws of Clifornia, and•,agree That if l should become
workers'
to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with;tho'se,provisions.
3��3MOT140
�(i2 iBO^? 1s_00t)
;
r , �•, T�:'2�C)AaCI'>'fC3'i�i731
Date.. Applicant
Sii
1532Q(t-?.4 itJOz€i
71 '
;.
t°6"INO FEZ
Warning. Failure to secure Workers' Compensation coverage is unlawful and
i31Jl.Olaft IC�'I%
�t��
q0
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided fo�Jn Section 3706
ART f' 111 P 161,eIt`: N3'a�.fwR4 �- REM 270-0i10 �14�4ow.
S20,217
of, the Labor Code, interest and attorney's -fees.
4
IMPORTANT Application Is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on kis,-' .
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 applicator 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:..
2.106.00
I � z .
o .t
c, 3i4 -A x ,` 1ftC1!"l'7C�%Y 141TO PLA9Ct „ $4,764.50
I= PRE-PAJD FEED
Ayx� ry�yy��•p�q�rq+,I y� '
0 1 &1Fa d"•:•T+.Y61KAllA .C'3� 09 Ai U 1L NO YID $4,764--.9D
2003 it
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 loathe building st : �IpNWE eAc1�Y /
construction, and hereby authorize \ representatives of this Cdr to enter upon V/
�t
the above-mentioned property for inspection purposes
e \ r S RECEIPT DATE ;BY DATE FINAL D
.,rSignature_(.Owner1Agent)l' M -.; 3 r t ' ca'
� ar
ew s a� 3 +•:...
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INSPECTOR
1J
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
.vw ' BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
— —
Ducts
Slab Grade
g3 — /z -3
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K.toWrap
3
F.A.U.
Framing
//— y' — _v
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
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
Neater Final
Water Piping
Plumbing Top Out
_
_
3
Plumbing Final
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 _
Utility Notice (Perm)
COMMENTS:
�-. by �. - �
L- :Certificate:- of .Occ.:u t �-
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of 9ti �� , � ` . � 'Build, :& SOW D'epartrrment
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This Certificateris. issued pursuant 'tor. the requirements -of Secti6d 109''of the California Building '
f Code, . certifying;�_that,a't',:thetime, of- issuance, #his- 'structi►re`in 4 compliance with the
_ 1provisions. of, the Building Code "`and the various, ` ordinances '`of the ``City regulating, building .
construction and%r,use:-
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BUILDING ADDRESS:49:.784�VIA CONQUISTADOR '
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Use classification.-S:F.D: =� 'Building Permit No 0301-098
Occupancy Group::R-3 ; `. ,: -Type�of Construction .'V -N-
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Owner of Building'TD. DESERT'DEVELOPMENT -, Address PO BOX 1716' -
f. City,ST; ZIP -LA QUINTA CA"92253
_ By; G SHOWALTER
i ^ ..
_Date:- 05/14/04
j Building Offlcia
-POST INA CONSPICUOUS PLACE -t.