0301-100 (SFD)^`
LICENSED CONTRACTOR DECLARATION
affirm under penalty ofperjury that | am, licensed under- provisions u/
nmpto,9 (commencing with Section 7OOo)oVDivision the Business and
.P��ooionu|oCode, and myLicense i»infuU��oand oMe�.
uuonoo� ' / o/
1,—Exp: Date
' DMC
pate ' Contractor
` OVVNER'Bu|0DERDECLARAT%ON
|heeby 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 wages as their sole
compensation, will dothe work, and the structure isnot intended o,offered for
,sale (Sao.ro4*.Business mPmfeao|on6|oCudo).
( of mo.pmperty, am exclusively contracting with licensed
�
contractors to construct the project (Soo. 7044. Business & Professionals
Cod*)- ' '
()|am'oxomp^vnue,S6vion smpC.,fv,this reason
__�______
oateionomne o/ Owner
� -
WORKER'S - �
._. COIoPsNS*J|ONoECLARATON
hereby affirm under penalty of perjury one of the following declaration
i hitve and will maintain. a c6rtificate of, consent to self-insu4 for workers'
6im,pensation, 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
8�ktior� 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 VATRAYND Policy No. 046-13A,2003
(/n/o section need not be completed if the permit valuation is for $100.00 or less).
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 �f I should become
..
Wi�nihg: Failure to secure Workers' Compensation Coverage is unlawful and
�hall Subject an �mployer to criminal penalties and civil fines up to $100,000, in
addition '~ the cost of compensation, damages as provided for - Section __,
cxthe Labor Code, interest and fees.
IMPORTANT Application i's hereby made. mthe oireom,v/Building and Safety �
for a ponnV subject to, o �conditions and restrictions'mg ��x on his '
application.' ` ^ '
1'. Each person upon whose behalf this application -is & each person au
whose request and for whose benefit work /aperformed under o,pursuant m
any permit issued ao" result ovthis oppnoomnagrees to, &axan. indemnify
. & hold harmless the City of La.Ovinta. its officers, agents and employees.
'o..Anypermit issued aoaresult ofthis application becomes null and void i, '
work is not commenced within 180 days from date of issuance of such '
`pe,mi\;orcessation c«work for 18Odays wm au�eotp*,mit0000nnoUoUon.
|'oo��that | have mod8`ioappU��o"and o���
��meobovoinfonnaxionio
correct. I agree to comply with all Chy, and State laws relating mthe-building �
construction, and hereby authorize representatives of this City, -to ente'
on
'-meabove- monUonaUpmpe�^ 1
~' ' ^'���-' '
BUILDING PERMIT PERMIT#
DATE VALUATION Sri I; . MJ0 'LOT. -45 TRAC T 292183
JOB SITE
APN
P0 BOX 1 11:1 fl;
79-V5 RM-CHO LA, Q1MTADR,
1A QUIM. - CA., 0226-13
1A QUNTA CA 92,253
2996
USE OF PERMIT
rLy
WALLO, M, Q4 SPA OR DR IVEWAY APPROA011, 15% REDUCYAMTO
CUST&M CONSTRUCTION 4,20.00 OF
PbkCHIPATIO: 522.00 SF
0ARAWCARPORT 110.60 fir
FLXN CRECK'Vet 101-000-439-318 00, 'A_
NRCHANICIAL FEE 101, 1-000-421 -000 1.14 6 a$ 0
RLMTRICAL FEE 101,0)0-47.0-000 92A6.71
003
FIK.Am'-E DEPT-
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
— --
Ducts AC9
Slab Grade
�� –3
Return Air
Steel
_
Combustion Air
Roof Deck
— 3
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
9_1;�
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 6 � �y
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
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
Sewer Laterall
"
O.K. for Finish Plaster
Pool Cover
Sewer Connection
_
Z� -
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final _!
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring _L
Low Voltage Wiring
Fixtures
Main Service
Sub Panels _
Exterior Receptacles _
G.F.I.
Smoke Detectors EVE
Temp. Use of Power
Final
Utility Notice (Perm) j
COMMENTS:
�all nc_
Certificate of 0,cc u aLAMD
_
4.1
�t��- �
�G , 'Safe#
w5 � n • . � Buildin & arfinent��
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This Certificate -is, issuedpursuantpursuant- to'th_e requirements of, -Sc et�on 109 of the Californ'ia�"Budding
�Code,-- certif� in that .�af-.,the time �of issuance `this structure.•;wasx in �co►npliance with•'the
-. provisions :of 'the.<-.BuildingCode "_and ;the various 'ordinances." of7 they City regulating, 'building .
sN construction and/or.'use: :+ � � �;, �_� � '' �� � - ;k 5 -
,_ .� ;•;�;
BUILDING A DRESS: 49-808NIA CONQUISTADOR
lUse�classification' SFD �Building,Permit,No'.:*0301=100`
Oc`cupancy'Group: R-3 ._ - •- = �Type of .Construction: VN Land..-Use'Zone:�RL y
Owner of Buildm T.D. DESERT DEVELOPMENT Address: P.O. BOX 1716
g
-. ' E .7. City, ST, ZIP: LA QUINTA,.CA
• �
.By:
- •
�- f - GARY SHOWALTER - -
- Date:. APRIL 12,'2004
Building Officiaf � � ;.. •. ' . ";, .
POST IN A CONSPICUOUS PLACE