0203-043 (SFD)LICENSED CONTRACTOR DECLARATION
1 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'Signature of Contractor
OWNER -BUILDER DECD/ARATION
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.
('..) •.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 . 67AT9 FU?' D Policy No. 16,60PI'm
1•
(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 agrepAhat,�Yl should become
subject to the worker§"compensation pr v1 '6 of S cti5n 3700 of the Labor
Code I shall'forthwitj� )comply with thosepioiisio�
Date: f' r'�0 .) �PApplicant
Warning: Failure to secure Workersompensation 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 thb 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 -ion °hiss
application:
1. Each person upon whose behalf this application•is made & ea'ch 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 'and employees
2. Any permit issued as a result of this application becomes null and void If .L
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 cancellati.6h.
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 representative 6f this City to enter upon
the above-mentioned property for inspection purposes
,.Signature (Owner/Agent)
PERMIT #
BUILDING PERMIT:..::
DATE VALUATION LOT TRACT' "
JOB SITE Y
ADDRESS
APN
OWNER
CONTRACTOR / DESIGNER / EN &NEER
174 80 R, OTH 5'T.Oil 0+6
174SUE 171H ST. 106
CA 92790
111J97M4 CA. 92780
(j14)$08-4440 CIM -0. 4445
USE OFPERMIT '
r
Owl 9IV11l T WrwWe
e
SPI • ,LUT 12J P1.04 30A- PFRMIV f iORS 7401' INCLUDE, 01" ,K
WALLS, POOLOSPA 0W.WWWAY APPROACH
91 h 0 T COQ,,TR LyC.`7'IcaN 3A4,00 SY
P()R.C..�J1P1ATJO:
C#AltAWCARPORT 3cy,q �3
V211 1p1�1{+0.7y (X44RdMR7XA0{fin,1N
BRiMqq F,r
+70
nERMTFRE9LMNAyL
ryONSPTUM110N F%(}71,LO�,. t [p0+ n�{
t�b"\�L li ^f 1{7`L"Wil DAA' .Slid
PIAX CHECK FEE 1014)00.439-3
MECHANICAL 1+7I; X11^ QR�1�4� 1 �C1L�0 FiCt�.Cft�
ati(:E•1�°IC°r�I. Ir1.K111 1-000-420.,,100t?
PI,.'UM15PA(3 FrF1 101.000-419-000 119250
S1790140 MQT10k4 M, , PESO 103••000-241-000 $19.03 '
ORIADINO Wt 10 1,000-423 -000 $20,00
WIWE .OPAR IMPACT Pte!: SI't a':i:Do
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gyp �:1q��j��r�rgy•� �� •��y p5��q� ��}9 /� ^.�����y
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CITY®FLp®UINTA
'FINAia env L
RECEIPT E '--- " r BY
DATE FINALED
INSPECTOR
:. .
C""
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
— / - o
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Z 4 - oZ
Return Air
Steel
_ _ vy
Combustion Air
Roof Deck
-
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
$
Compressor
Insulation
1-
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls -
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
2—
Drywall
Drywall - Int. Lath
• oZi S
Final
Final
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
7— -8
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
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) oo ?j
COMMENTS:
Wo
Certificate of Occupan'.
c
City of La.Quin ta
c�'� Bu�l drug and Of
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 fof/owing:
BUILDING ADDRESS: 47-510 VIA- FLORENCE
.Use Classification:. SINGLE FAMILY DWELLING Bldg. Permit No.: 0203-043
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL
Owner of Building: CANADAY & COMPANY Address: 17480 E. 17"' ST. #106
City: TUSTIN, CA 92.780
By: - STEVE TRAXEL ,
Date 02-12-2003
Building Official
POST IN A CONSPICUOUS PLACE -