0311-055 (SFD)co
LO
N
O0)
U Q
CL -
Z
`rFZ0
X W
mQU
O0
cl: 0)
`t Z
wC)
J
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
Proitssionals Code, and my License is in full force and,effect.'
License # Lic. Class ,.+" . '.-y Exp.,bate
31
Date—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).
() 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.
Se(,) I have and will maintain workers' compensation insurance, as required by
ction 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 thework 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,4and agree•that':ifi1 should become
subject to the workers' compensation provisions of Section'37.00 of the Labor
Code, I shall forthwith comply with,those.pPov&tions, -- ,✓�
Date: ' , ti'�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 and or pursuariho
any permit issued as a result of this applicaton agrees to, &h shaalL_indemnify
& hold harmless the City of La Quinta, its officers, agentsland employees.
2. Any permit issued as a result of this application becomes n ll a void i��jj
work is not commenced within 180 days from date of s luance�Of�s c�S••' 4
permit, or cessation of work for 180,days will subject permCt to cancellation.
�.�,P 1
I certify that I have read this. application and state that the ab � ve informat&oh)is
correct. I agree to comply°with all City; -and State�'aws:relating to_the_building:
construction, and hereby authorise representai ues ofthis City to enter upon
the above-mentioned Drooertv'far•insoectici purod` es!*
I Signature
Date
LA
�E
BUILDING PERMIT PERM&T#
DATE VALUATION LOT TRACT
fI � �•�
G'
JOB SITE
ADDRESS iOt VV
APN
M56Y �,'SA WAA X.iT AR -k)T.
[iN_'t t1 -t fi:3
OWNER
CONTRACTOR/DESIGNER/EN &NEER
PCiEM., ZIYL IPARINFR% 11.43
12,11 RIJ REND
FIRRY
OR 972TA
iE C.Nrt`t'M CA e 920 d
USE OF PERMIT
MWIl :t? 17it`t: fTT .'Y' Y ': F?r J:imr+
`
SAI? v LAYf 1.9111LAlf ;;r is PERMIT 30-1ci 140T INCab..UIX SLOCK wip'I,l s,
ih.04 SPA Oft rtKrV!,WAY APPROA.CK 75%REL`UC'NOW TO 1 YAIf 011-w K.
I.,E D~ IZ TO Mi.Y117;"'U 15SUAIXE OF° y",E PLAN TY.tl
TItACi: C'.';N!tY R UCT1. ON so
PORCIIVRA.1110 SP
OA.IwVA 11'1(::&{i.rC-l.Rf3 2.2110 SF
April) illoy 3 OF ^ )1i�TM UCIV>;' 1
94.427.70
; �qt �•�; �F.ErEw
TR 9 10
C ON 3 TR UC rIG1i11,fr 103.ODO-418.000 M?'. O
A JAW C.`kilid;;tfF"'+ri' 1011•C300- :39-31F $131.£3
At4I�,�"I;.l�N1C111,�a�x:1; iUl•(M?c}.�.1��„U ft •, �. . � ���.ir3
t7i.i+CTQi�2fkyC/.9�E.t.Sy�i' i{01•Lya}C�IAC-�1a`-Ol):Z �iI�NIS.Oi
:•�IdIIM:�J1fYV i71:A`. �(ia'(xi'�.,��n�i)�{� .u+Fi7�'.�'
:l l';t C:hT(3 A9:�'II 3a3 PrZ. t: Fr' 311E) 101.000 -i=i I.00fJ g fl{
ORA.DW01� M 2 C 3-(°S11fi :3•bt7i) f .sM)
i #s�"li .da{ CCiMI3 IiTI!:'i'{ONIWDPUNrXWX
n,51f%5a
2003 :rOTAT1 PKInu .,,.W01 -sr" I10W
QUINTA
DEPT.
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck Z7
Exhaust Fans
OX to Wrap
F.A.U.
Framing
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
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
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
Appliances
Final
COMMENTS:
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)
-�. Certificate of Occupancyo
G� OF g Y p Building & Safety Department
This Certificate is issued pursuant to the requirements of Section 109 of the California Building
Code, certifying that, at the time of issuance, this structure was in compliance with the
provisions of the Building Code and the various ordinances of the City regulating building
construction and/or use.
BUILDING ADDRESS: 80-901 VIA PUERTA AZUL
Use classification: SINGLE FAMILY DWELLING Building Permit No.: 0312-158
Occupancy Group: R3 Type of Construction: VN Land Use Zone: RL
Owner of Building: PUERTA AZUL PARTNERS Address: 17700 SW UPPER BONNES FERRY
City, ST, ZIP: PORTLAND, OR 97224
Ale. By: GARY HARTMAN
Date: SEPTEMBER 9, 2004
Building Official
POST IN A CONSPICUOUS PLACE