0101-343 (SFD)M".
LICENSED CONTRACTOR DECLARATION ,
I h4eby 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
Rmfessionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
478689P 0wo I &C
Date.1 t Signature of Contract r.
OWNER-BUILDER DECLARATION
• r
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason: a
( ) 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).
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.
( )-1'have -and will maintain workers' compensation insurance, as required by
S ce tion 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.
0014YEIN QAC L -K NviC U701401
(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: "? / Applicants
^u
Warning: Failure to secure Workers' Compensation coverage As unlawful and
shall subject an employer to criminal penalties and civil fines up.to.-$100,000, in
-addition to the cost of compensation, damages as provided for'In Section 3706
of the Labor Code, interest and attorney's fees. `'� '�•
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on. his .
application.
'1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to%�-
any permit issued as a result of this applicaton agrees to, & shall, indemnify'
& hold harmless the City of La Quinta, its officers, agents andemployees.
2. Any permit issued as a result of this application becomes null,and void if
work is not commenced within 180 days from date of issuance:'of:such
permit, or cessation of work for 180 days will subject permit tgtcancellation.
L�
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent)„ ""JM""^^""" ""`" "a Dated
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 033013 —3dd3 TRACT
46- 23971A
JOB SITE
ADDRESS
APN
44-440 VIA CORONADO
OWNER
CONTRACTOR/DESIGNER/EN (NEER
CFHJ t1 Y Axx4AXlUC. DEVE.OMA�1ENT, CO%M
a!, I
C�'e�i�'�1.1.M AMMUCAdDEW.W.P.:U NT,axi
55-487 SOWHEF17 MLLS
55-487 3011 tT 1ORA ILM-LeS
LA QUNrA ' :'A 92253
LA. Q1:TN'T'AC A 922S3
(760),564-563.2 CRU, 5497
36O 3$ 0 i
USE OF PERMIT
t
RPI .1.OT 46 PLAN t RP • 4%t PAMIT DC3'ALS 141171' INCL UZ& BLOCK
WA>. r.'.+fPWAPA ORAPPROACH DRIVWAY,75% PLAN CHECK FEF
TPaC T CONSTRUCTION Z461,00 SF
I:C+RCHIP.A1!C3 " " 454.00 SF
(A- RAGvC.1aR..}'on (Ay) 1:4323,40
ESTIMA :CD C;051 011' C:ONY'rRi7MOPF:t,,
'�, o
CE2kiri7'k3UC`."ll'10H FRL 3 031.000-^'s•1 0-000
PIAN 0RECK PEZ 101-000.439<318 5170.36
MECHANICAL EUE 101-000-421-000
01-000-421-000 l0160
aU.FC.vtiiMAL L?Z 101-.000-4•2/'000 %132.22
_
i't l I�3Ci 1 1; 00.4.19.0003
101-000-419-000
3 T?2OU:i0 M0j'T6A'' FZ RM2I,) 101-000-241-000 Si.l.3. f1
o"' m Dwo FRE""z", "; . 1031.000.423-0 0
Iitwi4•E,I..d3.PHR &PAXT:FF!:FtP
Fj[j� ,
d 14-t�C3:P,d!`�.i�C�.�;N.4 AMTS PT,,.i1�3 C"r XM
$3,314.00
M-0 3 PRL-PAMFSED
S0,00 .
•Y,�k*eY.lkt 9.9.1Y.48R d'.3::?`+rJ119T9'i t]=0.✓N"F
"JNM4:1!0
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
D�
Underground Ducts
Forms & Footings
`��
Ducts
Slab Grade
2
Return Air
Steel
Combustion Air
Roof Deck
3�g�"=
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
InsulationLf
f
Compressor
Vents
Fireplace P.L.
tt /
Grills
Fireplace T.O.
Fans & Controls
Party Wall insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
�_13
Drywall - Int. Lath
y�2�
atL-To tlasr,,Lar�E
C-1 •1_►_3
cs�n�
FinalT�I���
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
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines��
�F-�lSic
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
Jl�
��djr�
O.K. for Finish Piaster
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
FoQures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
cT
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
Certificate of Occupancy-.,.,.-.
uiry
of L.a wuir ra
Building and Safety De'parftneht
This Certificate issued pursuant to the requirements of Section 109 of -the Uniform Building Code,
certifying that, 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:
BUILDING ADDRESS:, 44-440 VIA CORONADO,
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0101-343
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
By:. STEVE TRAXEL
y
Date: , 8/29/01
Building Official
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