0312-160 (MISC),e LICENSED CONTRACTOR DECLARATION
' I'hereby affirm under penalty of perjury that I am licensed under provisions of
ChaptF_:9 (commencing with Section 7000) of Division 3 of the Business and
Professionals Code, and my License is in full force and effect., ,r
License # Lic. Class r'% Exp: Date
84. 0
iDate h4 "' 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.
( ) 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:
Cancer ZURICII AMERICAN Policy No. WC24llBYM3
(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-7that if I should become
subject to the workers' compensation provisions sIof Section 3700 of the Labor
Code, I shall forthwith comply with those provi5ions.
Date: P n n i 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 for inspecjiori purpose`s.
Signature (Owner/Agent) 7 Date U,
BUILDING PERMIT PERMIT#0312
1 60
DATE VALUATION LOT TRACT
JOB SITE
APN
ADDRESS t3iT-913 VIA P'D7,.WrA AZUI,
762-24G 003
OWNER
CONTRACTOR/DESIGNER/EN INEER
I-11T.)?K'1'.AAZUf1 PARTNF.R8, I.,LC
DAVIS RYM)
17100 SW UP..Rtgt BOO, JNFS FETLRY-
169 94XONY ROAD, SPE- 103
PORTLAND OR �r1224
ENCINTrAs CA 92024.
('760)634-2350 CAL# 420
USE OF PERMIT
1�s�:u ns�rOtTs
stFr) • I,U'C alpl,AN thy.. SU1:'1�t..Lr&Il*.]J't'AL TCa PfSF:fd1T !11131 f-Og:
RI?t�GIjC'riNc# c�c'+RItEG'i't�.t) �1Dntz��
EI3UtlA'tED COST OF C014MUM014
OAA
Y�:FtM1'i' i+'[ti'k b'iJMJNiJ�iilt'
SUPPLY-WATAL• PERMIT Flit 101 000-423-005 $4, A0
p Q D
DEC 3 0 2003
CITY OF LA QUiNTA
FINANCE DEPT.
191.Ti3-'r0TAL CONSTP 1.1 CTION Alit) PLAN Cl-TTTW
$4.10
IMS PklZ-.PATD FUS
$0.00
TOTAL PFItMT'f FEES DUY. NOW
$44%)
RECEIPT
DATE
BY-
DAT�I LED
INSPF�T9Fj.
/� v
(p (O
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
O.K. to Wrap
F.A.U.
Framing
7% /
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
Gas Piping
PLUMBING APPROVALS
112
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
71A V
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)
l
INSULATION CERTIFICATE'
This is to certify that insulation has been installed in conformance with the current energy
regulation, California Administrative Code, Title 24, State of California, in the building at
80-913 VIA PUERTA AZUL LOT 21, PHASE 1, LA QUINTA CA
CEILINGS:
TYPE: BLOW MAUNFACTURER: Certainteed THICKNESS: R-38
WALLS:
TYPE: BATTS MANUFACTURER: Certainteed THICKNESS: R-19
GENERAL CONTRACTOR: DAVIS- REED CONSTRUCTION LICENSE #
BY:
TITLE:
PARAGON SCHMID BUILDING PRODUCTS A MASCO Company LICENSE # 22 517
BY: &444129 TITLE: ACCOUNT REPRESENTIVE: DATE:
ti '
- Certificate of Occupancy.
0
OF -9 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: 80-913 VIA PUERTA AZUL
Use classification: SINGLE FAMILY DWELLING Building Permit No.: 0312-160
Occupancy Group: R3 Type of Construction: VN Land Use Zone: RL
Owner of Building: PUERTA AZUL PARTNERS, LLC Address: 17700 SW UPPER BOONES FERRY
City, ST, ZIP: PORTLAND, OR 97224
By: GARY HARTMAN
Date: SEPTEMBER, 13., 2004
Building Official
POST IN A CONSPICUOUS PLACE