0101-334 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby 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
Date '� = r Signature of Contractor—- 13A "'
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).
( ) 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.
(wf 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 Policy No.
(This section need not be completed if the permit valuation is for $100.00 or less).
. ( ) 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 those provisions.
Date: : a 14 c�.1 Applicant 4 -AR -!A& cx... s.�..
Warning: Failure to secure Workers' Compensation coverageJs;�unlawful and
shall subject an employer to criminal penalties and civil fines 6p-,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' hiW
application.
1. Each person upon whose behalf this application is made & each sn�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 representatives of this City to enter upon
the above-mentioned property for inspection purposes.
li .� , r
Signature (Owner/Agent)- Date ' �✓ I" ` d r
BUILDING PERMIT PERM T#
DATE VALUATION LOT OJOI-334 TRACT
JOB SITE
APN
ADDRESS 4-325 VU,ryOq )NpDO
! eqp p
OWNER
CONTRACTOR/DESIGNER/EN (NEER
6
tw3 MMY A►'�4"' Z',€CAA DB;V l'..0Y'.�'��At 1,C0
W. M- %t URY AMM Ci.',T DY_,M?L0P1:9r; otol
55.4-�l.'
55.4 7 St3MMAN IMIZ
1A QXJIW.-,A C.A .92-253
1A QLTi14 s.0. CA 922,53
6i0).i64ys60, I CB1.4 5487
USE OF PERMIT
15MMY, FA',2t&MY J 1VV Ci
:SID � I..0T 37 JIaLAN 3CR • Pg,RMiT IDOES NVr 1)4= 020 B1.C3CK
WAWPt3Cpf4MA OP. lVilROACH DIUV'i:WAY. 7 %)<'LAN CHECK l±+'f: R
RMUCi'IORNA MULT1P1Y_ «3S1,1AHC%OFSAMPPLAN'D"[ Z
TRACT G't.)MTRUCTIUM 3214.130 sig
ixORCHiPA,TIO l 63.f3if Y
Eb"UMNEW COST Ole CtiN04 IRITCMo '
CONu".i UC9 ION 1°RZ 101-000-41 8-030 SW1G7. 0
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P Ta€14 CHECK PTE 101-000-41.39-3 t e �1^13.tiF
a�JI1,A1�t;,tle,:L11 3 �3� dOQCt-�i 23 -Oi3U - �Sf�.S'�i
1A,K1; r 9 *,A!,, PER, 3 f.)I ^OQd;^�t20 •Qft2 �1:�..i 2
k'LUMIRTHO .t?FX.-', G; 101.000.419.000 211�M
STRO�eOMOIIIIP f{'L+>.1 Isn) 101 -Oft -241-000
0MAD-11 o 1?n ° { , i.<Sl •Q�JO•�6 FOftiO ,?�.
)PER IMP.A T FEELA
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y�
; 'fT.B rpa, tsol m— �7G�?V. A� PYAN C'"Ftt'`�
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RECEIPT
DATE`i s
BY
DATE FINALED
INSPECTOR
ri.
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
C'"
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Roof Deck _ Z �`�
O.K. to Wrap 3p�O��
Combustion Air
Exhaust Fans
F.A.U.
Framing
_
Compressor
Insulation
Vents
Fireplace P.L.
-D�
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall -Int. Lath
Fuw_ la it\V►�N5
�c �'j//b
Final
Final
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 I
I I jGas
Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
C�
Heater Final
Water Piping
2
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
21•ZQJ �Q�'�
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
pp
Appliances
Final
.COMMENTS:
Final
Utility Notice / S
(Gas)
`OOOJ
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
-
Rough Wiring
Law Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
—/
Final
Utility Notice (Perm)
+q., —
-
--Certificate.. of-occu,npacYy .
...City of La Quinta
fw w�
Buildinand Safety De artmentp F
This Certificate issued pursuant to the requirements of- Section 109 -of the Uniform Bui/ding Code,
certifyingthat, at the time -of issuance,, this structure was in compliance with the various ordinances
of the City regulating building construction .or use: For the following:
. r
BUILDING ADDRESS: 44-325 VIA CORONADO
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0101-334
l
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL
Owner of. Building: CENTURY AMERICAN DEV. CORP > Address 55-487 SOUTHERN HILLS
City: LA QUINTA, CA., 92253
13y: STEVE TRAXEL `
"7d
Date: 8/29/01
Building Official
POSTIN A CONSPICUOUS PLACE i