0312-159 (MISC)7: -ca T - kr;
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
Professionals Code, and my License is in full force and effect
License# Lia Class Exp:,Date ,
S 34 0 < IiC � 0110::
Date 12 XV10") Signature of Contractor
/ r 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.
( ) 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:
Cartier ZURICH Aki1:111CAN Policy No. WC203392003
(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'th i if 1'should become
subject to the, workers' compensation pro isions�of.Section 3700 of the Labor
11 Code, I shalrforthwith comply with those_��oyis ons,'
Date: �� H Applicant -
i
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 f
the above-mentioned property,for inspection purposes.
Signature (Owner/Agent) Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 0312-1 `t TRACT
i ,.• iai � 4�;ti:'�k
JOB SITE - APN
ADDRESS k'i i i 11 J-7 i .!'.lJi• 7. 7t:E1 fjfk�
OWNER CONTRACTOR / DESIGNER / EN (NEER
PUFRIAP.'L A. PAkTNi:Tt;3, LLC L)AVIS Jd. h'O
17700 SW UPIPT Ft BOOMS _FERRY 10 :AY.0 WT RC :AD, [TM 105
POR 1.Ai4D OR ti`r27.4 WICIRITAS CA 9'?021
(760)634-2350 CBL', 420
USE OF PERMIT
tAr3C>i 1J_b 1J.1.1*0U i
SIOD - IA -Yr 30 PLAN 4P.R. %)PPL OAENTAL TO PERMIT 90311.056,
RFNE,1•:CrMO CORR1^.C'I M AIDDRRIV
311PPUEMI NTAL PERMIT FEE 101 -00n-423-0%) so
ri DEC 3 02;;03 Ir
CITY OF LA U, fA
SII-TOTALC0MWRUCli0N AND PLAN TA SU
GEM PRE-PAIT) ITEM.'. wt). cio
';1'(X1..,1"M MD MS .QUEM, NOW I A �n
R1
RECEIPT I DATE I BY I DATE `NAD_ / I 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 p q
Exhaust Fans
O.K. to Wrap cy
F.A.U.
Framing
Compressor
Insulation 6
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wali Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL P OVALS
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
Heater Final
Water Piping 4
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 L
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service 17-7
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
10/20/2004 12:29 7607771457 DAVISREED CONST
CI Oi A 0UINTA
co BUILDING & DEPARTMENT
lu UkU a (} 203 7012
_ INSPECTI EQUEST UNE
' ti1FY f- I.,q r,Ei,,6�,7A 7 7153
Owner LLU
Contractor DAVIS EED NSTR CTION
Permit Number 0312-159
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 80-907 VIA PUERT,A, AZUL
SFD - LOT 20 PLAN 4.AR. SUPPLEMENTAL TO
PERMIT #03.11.-056, REFLECTING CORRECTED
ADDRESS
TYPE OF INSPEC ON DATE INSP,
TEMPORARY POWER
r SETBACKS
CONC
DO NOT POUR CONCRETE UNTIVABJBVE SIGNED
NAIL / PRE -ROOF lZ 6
TO WRAP
ING COMBINATION
IGH ELECTRIC
COVER NO WO9"1XL.A6IOVFS1GNED
INTERIOR GYP BD. DRYWA
EXTERIOR LATH
GAS TEST
SEPTIC ABANDONMENT
SEWER CONNECTION
SEPTIC / GREASE INTERCEPTOR
MASONRY INSPECTIONS
POOL / SPA / WATER FEATURE INSPECTIONS
PRE-GUNITE/ SETBACKS
U/G PLUMBING
U/G GAS
U/G ELECTRICAL
PRE -PLASTER ALARMS / BARRIERS
FINAL INSPECTIONS
TEMP. USE OF PERMANENT POWER
ELECTRICAL
PLUMBING
MECHANICAL
PUBLIC WORKS DEPARTMENT
COMMUNITY DEVELOPMENT DEPT.
FINAL ! JOB COMPLETED I /d m D
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING
PAGE 01/01
� .0,
of OccupancyCertifcafe
9w�
OF Building 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: 80-907 VIA PUERTA AZUL
Use classification: SINGLE FAMILY DWELLING Building Permit No.: 0312-159
Occupancy Group: R-3 Type of Construction: V -N Land Use Zone: RM
Owner of Building: PUERTA AZUL PARTNERS, LLC Address: 17700S.W. UPPER BOONES FERRY
City, ST, ZIP: PORTLAND, OR. 97224
By: STEVE TRAXEL
Date: October 20, 2004
Building Official
POST IN A CONSPICUOUS PLACE