0002-022 (SFD)LICENSED CONTRACTOR DECLARATION'
I hereby affirm under penalty of perjury that I am licensed under proyisions,of
Chapter 9 (commencing with Section 7000) of Division 3 of4e Business and
Professionals Code, and my License.is'in full force and effect.
License #. Lic. Class Exp., Date
Date .F�i
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 *0'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 STATE MD Policy No. 046-0007333
(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 mer so:a,�s to become• subject to the
workers' compensation laws of.Cal omla, and agree that ifj .5 uId become
subject to the w9Pkers' compensation provisions of Secti6ri,3700 o the Labor
Code, I shall forthwith comply with those provisions.
Date—/ /T �n � Applicant .
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 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 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'f r•inspeetion purposes.
Signature (Owner/Agent), /--�~Date%�"'✓//' i�9
/7-,
BUILDING PERMIT PERMIT
o• il4jQDi-lPx�
DATE t VALUATION $260,917-" LOT `Q TRACT `1.4306
JOB,SITE 48 -437 -VISTA PM40MUNO
APN 649-100-006
ADDRESS
OWNER
CONTRACTOR/DESIGNER/ENGINEER
TD D6S CRT DrVT1.0PNIE'NT
SP kFL .S CONSTRU(TrION
PG a OX, 1 iib
T9-29 RANCHO LA QUflil A DR.
LA QUiNTA CA 92253
t,i\.'t, UINTA CA 922511'*a
s.t
i 110)-171-1.941 C13L#x_:1996 ft.-,
J
USE OF PERMIT
SINGLE FAMILY
w,rr
.DWELLING
� � # f •
SFD-POOO T 42 Pi.AN MI-'r�iiI64I'T DGES'NOT itvCLUDE BLOCK MSR
• °' ,€ -.ter .
cusTo9{ cows't'itUC'I';iriq 3,0'G.t3l? .3V
���.Cl�rih arT
GAR.ACd6/t"W0V.T 693.00 3F
ESTIMATED COST OF CON'S'I'RUMIR:i`;
260,9 7.20
I''irEi[4ri[fi t' ffdCii StllaltA3't�ftg
CONSTRUCTION FEE tO 1 -000-:418-000 Sat^_u3.+x3
f'.1 4JN CHF(`i> F E .10.1-000-439-3 18 R,?8
N,fECFL_4Ni^.Al, PEE ,C1-flCC-a2;.-CCIq �12�.Vi+
RLE-'CTRICAL FFA
PLUM13ING Fhb -101-000419-000
STRONG MOTION FM- - REStO 101-000-241-900 a45.t19.
GRADING FM- 101-0004213-000 $20.00
DEVELOPER liiPACT FEE S1,�fs7.�ifi
ART IN PUBLIC PLACES - RESID 701-000-255-000 $402,29
SUB -TOTAL CONSTRLICl ION AND R .A14 C:HECh.
S,G' p..18
LESS, ?Itis -PAID FEES
TOTAL PERAIlT FFM DCTE NO
�5,055�,lS
RECEIPT
DATE
B/Y�% �,j�'
%., ✓
DATE FINALED
INSPECTOR
,
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
a— OX,1,4
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
p� J
Compressor
Insulation
_
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
BLOCKWA
-POO
rAll
PPROVALS
Final -
AS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
I I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
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
«7
Appliances
Final
Final / Q
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)
COMMENTS:
s
--
CERIFICATE,-6f G L
.Occuanc�
p Y
O.F
+ t'f La Quanta f
w • ' . .'
Building and Safety -Department n
This Certificate issued pursuant to the••requirements of Section. 109'of the; Uniform ,Building Code,
certifying that, at•the*time-ofissuance, this structure was•in"Compfiance with the various ordinances
of the City regufatMig building' construction or use. - ,For the following: '
U,ILDING ADDRESS 48-437 VISTA PALOMINO"
Use Classification: SFD Bldg. Permit No.: 0002-022-- •;
Occupancy, Grouip': R-3 Type of Construction: Y VN Land Use Zone: ' RL-
"Owner
L'Owner of Building- ,,T:D., DESSERT DEVELOPMENT .-Address: P:O BOX 1,716
w City: L•AQUINTA,CA.92253'`
By:. 'GARY-HARTMAN