0112-074 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Cla3pter 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 2, 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: =y
( ) I, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure is nof.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:
() 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
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. "
001a)14 Fuss; 14W .54701401
(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, Ipshall forthwith comply with those)provisions.
Date: - • .'^� - i.. �9 Applicant—
Warning:
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.
r .
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 orpursuant 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.
Signature (Owner/Agent) . 1"Date ~fir
.BUILDING PERMIT PERMIT# ;
LOT 01a•+ 474
DATE VALUATION$1464971,50
TRACT
Q� yq (��/r)'
49
23971
JOB SITE
ADDRESS
APN
44-= CO R0i1;i'DO
OWNER
CONTRACTOR / DESIGNER / EN INFER
C I7.TRY'AME' fiC'',a%N']Yh,-T-I,OPML-14T,CC9iMC.'1WTURY./.LWWCoAae333
i.,4%ak#i ,MP.•
78-520 VIA ITWt.; lta1
i8-520VIAM T: A
:i.ak ti l2+1'J`h L".:1 . 92253
c?. C )�1Q 1.a
CA, 9225 3
(760)564-561Z
C PL# 548 7
USE OFPERMIT
fflX Y1z/: W3DWE1.DTIG
_.
'`SYD - LOT 49., PF.AN 114. 9 EIRMIT:nG&.y 14cyr INC:1..UDE 21,OCK
WALLA P004 SPA, OR ORRMAYAPPROACH.
TRAM CONSTRILICp7RYN 2461.00 3F
PORCH/PATIO 76.00 SF
M
4." ASTRUC.' IOP :fes 10:1-000. 1 8-000 $804.00
PLAN CHECK FEE 101-000.439-318 w9,°m
A✓zECRA IiOA,FRE . 101-000.421x•000 970.0
=-CTRIC:AL F;1vg 101-000-4.20.000 $151.3:
t*0;E�i1�113f1 t?IL? 2F;1 i�aC►-?,rJ-t3i1C93t5t,4�J
b�?'[2aNa MUTIL. 111; • 1',l :11 ! 091 00 -241 �U11E1 $14.70
'GRADING nX 101-01.00.423.000 $20.00
D V IU,O1•'ER.. IMPACT F'L $1,907.00
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sem.
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47
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`
OFlLAQUINT-A _
IR NOW
RECEIPT
BY
DAT INALED
INSPECTO
JDATE
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
-
Ducts
Slab Grade
Return Air
Steel
, Z>
Combustion Air
Roof Deck
- -Z
Exhaust Fans
O.K. to Wrap
Framing
e
F.A.U.
Compressor
_
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
_
Party Wall Insulation
Condensate Lines
el
Party Wall Firewall
Exterior Lath
- 02 -
ZDrywall
Drywall - Int. Lath
Final
I
Final O2
BLOCKWALL APPROVALS
steel
POOLS - SPAS
Set Backs
Electric Bond
Footings
—� -- _
Main Drain
Bond Beam
- -
Approval to Cover
-�
Equipment Location
Underground Electric
Underground Plbg. Test
Final
-- Z -p
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
- - 2
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
i
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Gas Piping
Gas Test
Appliances
_
-av_ _
Encapsulation
Final
Final
Utility Notice (Gas) - -U
ELECTRICAL APPROVALS
Temp. Power Pote
Underground Conduit
Rough Wiring - 2
Low Voltage Wiring
Fixtures
Main Service
Sub Panels _
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
_ .of OddupancyCertifdate,a
4
..7
.� .- ..,.... ,
City. ofla..Q`uin to
• . ' i • .. � , •� .�� ~ 'rte y
"n and Sa"fetyDepartM'ent . Bufld� g_
This Certificateissued pursuant to the requirements of Section 109 of the Uniform Bui/ding , Code,
'certifying that, at the time of issuance, thin structure was in compliance with
the various ordinances
•F .y of the City regulating building construction.or use: For the. fol%wing: -
R ♦ _ ..
4 :BUILDING ADDRESS: - 44-530:V1A CORONADO
r
s= _.Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0112-074 a `r
Occupancy Group: R3_ • Type of Construction: VN Land Use Zone: RL
Owner of .Building: CENTURY. AMERICAN Address: 78.520 VIA SEVILLA -
DEVELOPMENT -
City: LA QUINTA CA. 92253
- - By: GARY SHOWALTER'.
71 bpi f Date: 08/22/02 -
4
Building Official