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0301-101 (SFD)y w' LICENSED CONTRACTOR DECLARATIONr I i-reby affirm under penalty of perjury that 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. License # Lic. Class Exp. Date 074074 7 1103 s• 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 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: ( ) . 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 ST' ,A'I`I F i4Cf Policy No. X46 } 3 • ! 3 (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,Sectloknk 3700 of the Labor Code, I shall forthwith comply with those provisions. i ,,,,Date:r; .f , }' �, Applicant— Warning: pplicant 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 hiss ,i 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 for,.& 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 representatives of this City to enter upon the above-mentioned propel y�for inspe lion purposes Signature (Owner/A ent) t. '+ i -,.`!Date,/ :X�7;n, BUILDING PERMIT PERMITk 110DATE VALUATION c9i txrj&W� LOT 44 TRACT 292193 JOB SITE'ADDRESS 49=i ' !. YTA Q�:0HQ' 1S,7r/.9DC� L APN OWNER CONTRACTOR DESIGNER IEN61NEER Al+03111!vrVVJfOP7NT Il±RYI..44 SyVddChOp .. _P0 BOX 17.16 7194A95 RANCUO.LA QiTnTrADk .�-A QUPr.rA CA. 92W LAQ CA 9225111 - 3 (700 7 J b"1 A' 1 VIJd.d9'S- ,!SY7'V USE OF PERMIT S01. LOT 416y }?f../ N :#M.I'P, I?UMI"P'3 OES NOT 11it;t..%iO ;ALO K WAW% Pct 419PA 014„PR1VVWAY'Ai PR0A.0 4 ; 73% �:DII.0 ION TO ! E .,B N CkIFCrX 'k eZ T --IUP. TO AlftFl.: rIPI�.g11Ssu.&.�dc OF RAMS PLKIN TY15E CUZoTOM CONSTRUCTION TION XMP.00 SY i%'t7kCeSs`t3?�!1S'IS3 "irO.Of) SY U.t?a't;..,r+b'C1VICCARPORT 3F EMU&7�ti;'LA CONrQF COIN?e5'rRUMION 2829106100 O° 4 3`t`.RUC 1`ION FEE 101-000-418-000 P,28111 00 PILAN CHECK R11111 :POES�!!' XKIAL h''i� l # 1f(3- t1,CSyta y 9 �.]e.-C1tit3 ©31 t4A:c5a F5.`.4r1Y+.. A'.R•`b.�:�t�¢�ilfo Y ilA��f�4d`fag4CJ"L'IAIi1 .8a�6.F.V�' -PIA).M 1110 I+ 1111-000.419.000 V012$ MLLOir�',ION PtS - .vESID -.101-000-241.-000 ��n'k�'yi'.I'31EvYYTa; `*6x. �bT'4tii8'Iw 1lYS'�VtJV' 6iT'"L�Vt7 V&W IBI''ti.I WP1'R IIAPArT Iii �i•?y405:ff0 ART IN, P11:t3"a;1C't PL.P. C -Es , Ilk -,81C 270.000r445.000 37031r �C�h�x41i.1 OC333� a2�S�''r.,00A1 9�,_.AMC"1;�t�t�"I� $4,764.SO D UL PIMMff FIf D UE D ow $4,7C4,X1 lT4,N JAN2 2003 , D CITY Or t~:A QUINU ' FINANCE"DEPT. 53t RECEIPT DATE BYj DATE��jjFINALED INSPECTOR if INSPECTIONRECORD e OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade -/ iS 3 Return Air Steel Combustion Air Roof Deck / _ Exhaust Fans O.K. to Wrap F.A.U. Framing //— _ � g Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans 8 Controls Party Wall Insulation _ Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath _ Final BLOCKWALL` A ROVALS Final =�y 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 7 Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans_� O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection e Encapsulation Gas Piping Gas Test Appliances Final COMMENTS: ' Final .Utility Notice (Gas) � y 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)_ _� ,` �fi f OcCUDanqyt� Cert c G` 9�5 _ ,Buildin & Safet 1De artment i V t of .g Y. ryp r , ti t , This Certificate is issued pursuant to ,the, requirements of 'Section.�109,,of the`California Building: ` Code, certifying. that, at the � tirne!'of jssuance, ''this . structure was .in' compliance with the r rwisions='of. the Building Code an 'd the` variousordinances~ of "the.. :City regulating -building construction an_ d%r use. I r `rC �. 'r_ � '' y�_'•�# 5_ , j •. 1�= ` S. __. �i. - :fix ,�_ -1_� .• _- .�,y1 y r-- -' ' BUIL-DING'ADDRESS: 49=856 VIA CONQUISTADOR' ., .. r t t f'Use classification: S.F D. Building 'Permit No " 0301=101 r Occupancy Group: iR-3". - ,. `,� `4Type of Construction.` V-N _J Land.Use=Zone R L Owner�of. " �. TD DESERT DEVELOPMENT. �T 4 Address:,P0•BOX 1716r j Building: - - City,.ST, ZIP:, LA QUINTACA. 9*2253 By: G SHOWALTER Date: -04/14/04 � Building Officia POST INA CONSPICUOUS PLACE