0307-341 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
I— Chapter 9 (commencing with Section 7000) of Division 3 ofythe_Business and
WProfessionals Code, and my License is in full force,and'efject.
O ch License # Lic. Class"'A Ex��eDate f
LLJ
4'
i
C)
Z Die -,^'' r , Signature of Contracf6`�
CID
ip OWNER -BUILDER DECLARATION
W W I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ co License Law for the following reason:
Z_ ( ) 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, .
CY)() I am exempt under Section B&P.C. for this reason
C%; 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
, ption 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 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 that -if I should become
subject to the workers' compensation provisions of Section•°3700!;bf�the Labor
.. ,,,.., . , .., • _yam Y,,..••:
Code, I shall forthwith comply Withthose p ovlslons.,,e �- . ,,e'
Date:
1, - Applicant
r , y
Warning: Failure to secure WorkersCompensation 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 emplo"y"ees.
2. Any permit issued as a result of this application becomes null andrv`oid if
work is not commenced within 180 days from date of issuance I 8 such N(
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 inforation iISCIT
correct. I agree to comply'with all City, and State laws relating to the building F
construction, and hereby authorize represVtatives.-of this,City to enter upon
the above mentioli`ed property for inspection+purposes., -
Signature (Owner/Agent)!`-�c%i.�'� Datg��rs
fes,. , ..
BUILDING PERMIT PERMIT"
DATE VALUATION LOT tijt'j. TRACT
JOB SITE
. yADDRESS
APN
t3fl-950 Y) A 1'"t�.n bi•rA 147,'1.11.
7r� 24041
OWNER
CONTRACTOR /DESIGNER / EN INEER
PTA2- XA. Z1YL.IJ•4.'jiMZ8, LLC
DA'4if1; REED
17700 MN U1'lrM ;LTOIDNE3 FIMR-.Y
169 SAX014Y.'-t OAD, ME 105
PoR,nAND OR) 9", 222
1zl�l;�TIUA:S CA 9207A
�1fcs)�; i�►� •3�+J MALO 420
USE OF PERMIT
:�it���? 1�'A1vJfL,i° L•'6�1J'�L�',R7C1
'LIST 4 PLA14 3A. PERM IT DOES''I O -T INCLitZIR F-1,,i;:U WAU !,
P00iq SPA OR
TR.t°XT =4TRUCTICAN 11371,00 SP
3164V Sir
tIYCp1EpiCklry�.JPATK,i
�•JLfitt.tiY�J��eT�?p4•nli F�1.� �Y�•
..R"�'7�[l.VfR�'1':�;,� ��f�' X11' G•�".f?1�".�.1?1.IC'I�a�1':r
'�4�i:�7.7�
��y� �/�%��j��+f( 7�y F
C<<1VO'i'ttilt::T?C21'1 ME, 10] _000,416.00) $617i10
1• LA 14 c'HW.K. k"U, f a 1-000 R' 39-3 : R $326.3;4
Ott CHANAti:AL, ME 1.01-000-421.00V) S961(r1,
0,12CTRiCALL Fitt 101.1000A9: kC1.00^0 V16-0?
P1.UMB1140 FEF 101 000-1,19.000 It139.5(�
STRf:N(I MOTION K -f% • REED I WA000'A1-OXI!
nil =N0 PT2 101 -.000-4217 -0oo
b - x uY]IN,.+:.`0=11RU3'°s1C M, .AKD iiLIAN :3M -111h
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V 2 4 2003 TUM, EVIRMUTrJo:81A.,M.NOW
I OF LA QUINTA
NANCE DEPT.
VA 4AS
RECEIPT
DATE
BY
D TE FJ14AL
INSPF„CTpti
6C/O!L
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
27 p
Exhaust Fans
O.K. to Wrap
s' Z
F.A.U.
Framing7
/�
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
BLOCKWALL APPROVALS
Steel
POOLS - SPAS
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
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
OX for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
UZ
Encapsulation
Gas Piping
Gas Test
-
7,
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)
COMMENTS:
-
Certificate of Occupancy
U 4v ��GlGv
. -
jco�oRn7ID 4��
C� 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: 80-950 VIA PUERTA AZUL
Use classification: SINGLE FAMILY DWELLING Building Permit No.: 0307-341
Occupancy Group: R-3 Type of Construction: V -N Land Use Zone: R -M
Owner of Building: PUERTA AZUL PARTNERS, LLC Address: 17700 SW UPPER BOONES FERRY
City, ST, ZIP: PORTLAND, OR. 97224
By: GARY HARTMAN
Date: OCTOBER 6, 2004
Building Official
POST IN A CONSPICUOUS PLACE