0307-339 (SFD)(!1
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LICENSED CONTRACTOR DECLARATION
Niereby 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
ffect.--- ---License # Lic. Class " r Exp. Date
81349DI 'rs
Dated6 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:
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 Californias~and agree ,that if I should'become
subject to the workers' compensation provisions'of,Sectip,P�-3700.of the Labor
Code, I shall forthwith comply with those•provisions �'r`f' r
Date: -> yApplicant / r',f'
Warning: Failure to secure Wo
iikers' 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, & shalt iYndemnify
& hold harmless the City of La Quinta, its officers, agents and employees" `
2. Any permit issued as a result of this application becomes null Gandvoid if `d
work is not commenced within 180 days from date of issuance of sugh®Y
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 inf o rmationnsfy, ,
correct. I agree to comply with all City, and State laws relating to tl�e bulldm6FI;g
construction; and hereby author (V of this City to ent-r-upon
the above-mentioned'proper y f6r;inspection''purposes.
ignature(Owner%Agent) >' ' Date(
.�• .fi of
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BUILDING PERMIT PERMIT#
DATE VALUATION LOT (� .39 TRACT
: !I ,. I 07SM) 2 ii3lla 5
JOB SITE ` ' !
APN
ADDRESS
ZR:'t' 462 '7 .P•iif?:R'T . 7,01,
762-240-=
OWNER
CONTRACTOR/DESIGNER/EN (NEER
0"s1` EyPF-R B04,XQi� l�f.:�.I Y
169�yi^`l••�y5rrO1,NY•RO 0, n"..r:;1,
�s�Y.+
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USE OF PERMIT
c s+` f^ •r 7 c[71 7 n
iaS�Vk�i..,f',` ,c''.c;'krY'f. .a .rx A� V1.GS.�`.�.aING
ffFD , LOT 7 PLAN 2A.. PERMIT lyt7'.M NOT &NCLt 09 IILCXX WALL4 '
P001, SM l'R.i1RIVEWAY APPROACH
TRACT CONSIRUCVON J,541'.0 V
PORC I if:PA. T 10 451.8(1 SF
(WAAMCAA':F`ORT 239,00 SF
E,1V IW.-.€X,D COST <" FCE3f�S^1XE1?¢MORT
b ��,11i7.�Jtt
PXItMiT' Jwl.�`rCTP a7Sil V,
CONSTRKJCTI014 MUM J 03.000.41(4.00101 $6111U
MAN CIMCK J"fyt lot -•000.439-318 534V
MWHAN111,'Al WX 101.000.421.001 P2.50
RLJ'C'JR!CtJ, N'it.1r 101 Do00-420-000 X115.32
1'f�J.J1.+JJ%iNt3 �.F,F: �'!� �Qgii- Y25�UgLt X145,3!5
STnONO ilw OTJCiN MEZ > MID 101-000-M1 Q(}r .1915i
MAD114113 FU I101 -000-425.00K- S11101i
2 4 2003 Pa.r .f,PF�.r�ul<YKES:��u;H MAN
)F LA QUI.NTA
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RECEIPT
DATEBY
F AL
INF
.i
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
Exhaust Fans
O.K. to Wrap
7A
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wali Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
L a
Final
Final
BLOCKWALL APPROVALS
steel
POOLS - SPAS
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. 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
/— Di
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
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:
;
cc �Certificate of Occupancy
4
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C� OF'I1Building & 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: 80-962 VIA PUERTA AZUL
Use classification: SINGLE FAMILY DWELLING Building Permit No.: 0307-339
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
Al By: GARY HARTMAN
Date: OCTOBER 5, 2004
Building Official
POST IN A CONSPICUOUS PLACE
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