0112-081 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of. perjury that I am licensed under provisions of
H Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
N UJ Professionals Code, and my License is in full force and effect.
E
:)License # Lic. Class Exp. Date
Cy LO
o Lit 47866F9, B aIJ 110
OZ Date-� , .Signature of Contractor
J U �". OWNER -BUILDER DECLARATION
Hd I hereby affirm under penalty of perjury that I am_exempt from the Contractor's
a- 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, em exclusively contracting with licensed
contractors to construct the project (Sec, 7044, Business & Professionals
Code). `
Cl)
(') L am exempt under Section B&P.C. for this reason
N Date Signature •of Owner
ON
Ute'
Q WORKER'S COMPENSATION DECLARATION
p 2 Z I hereby affirm under. penalty of perjury one of the following declarations:
U') FZ O (.) 1 have and will maintain a certificate of consent to self -insure for workers'
X W LL compensation, as provided'for by Section 3700 of the Labor Code, ,for the
O J Q performance of the work for which this permit is issued.
m Q (� ( ) I have and will ..maintain workers' compensation insurance, as required by
Q U Q. Section,3700 of the Labor Code, for the performance of the work for which this
Il M •F— permit is.issued. My workers' compensation insurance carrier & policy no. are:
" Z Cartier Policy No.. -
Cb 5 0OLDION' E.A= ?14WC 54101.401
Qr (This section need not be completed if the permit valuation is for $100.00 or less).
J O I certify that in the performance of the.work for -which this permit is issued,
�tI shall not employ any person in any manner so as to become subject to the
. f workers' compensation laws of California, and agree that if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those evisions.,-„
Date: r Applicant
Y- n.. Mw.-w..�---•
—Warning: Failure to secure Workers' Compensation coverage.is unlawful and
shall subjectlan 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.
of
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 4,
& 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 1 -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 inspection purposes. t { s t s
Signature (Owner/Agent)r` +��""-^ "'" Date -)
BUILDING PERMIT PERMT#
DATE VALUATION LOT TRACT
t�'�'
? w 9 q 1
{4YA7d''K"dGirs-'A+u74P V+Y .. .14'sJ �O 2 u` 0 .
`e r.• �, /t..!s
JOB SITE `"� !
APN
}��
ADDRESS VIA U3!e Bd
604-213-101,
OWNER
CONTRACTOR / DESIGNER / ENGINEER
C01
4P, CEMURY .AIS021CAR`M_r` rMX',%P1Y11�Wr, CCY.
78-1520 VIA =Vy=LLA
76-5 20 VJA A
Tse i, T,T1vrA. 0,A 92253
LAC9'i:}' RTA CA 92253
(760)5V,-5612 CIM' 34S"
t'
USE OF PERMIT
. -. i..�'T' fiat, f?3.:� N 388. rPKRM1T .i'30.Z' t40T' INC'.d. OL, i�l.�C
WAAAA P0,04 f°tip, OR �:'3�I°J1:`,rVAYA'PPROAi'.K 75%,C9 AIN CHECK FRE .
J�.4?.�:9T�C.Y I K1.Ye �+ii�ilT3k'C.J "ff a�3A t:1 f J#� laAME P:.AA'M'T'YPIP.
TPACT MOSTRUCTION V"Ila.00 SF
,
MtIrfMA' M C09,r of cC)mmue Coto
10,485r5P
CIVNO `RUC": M FED 3 a14�5� -418-01DO S.95AIV
P'T.,&N ..H.'e K KVITR 1011-00"39-.1318 $199.06
MECUMCAL h'E9 IQ] -W.0-42'I -000 $35.30
ftF.rA i 0l i- .?'��-c'y36.'r7g9i
FM.T
xF- ��A�Vp`e,+y,�t,,0 r�,�,pypprZ
K i✓ nf.P FEE 101-000-41-00 r'i. $1 .t'4.50
SPT'WOO MOTION HIZ, - Et:E'= 10111000-24.1-X00 $18.95
i"°p�.�L"►➢NG Fir 10] -M-423 -000
'v 'EI•TO!"'9is'1Tv1Y'.rx CT ME
LC0)M1RU<',0A0H AND PLAV a, WAX
$1,537.63
T,�,���3 'daM 2'IATI.3 FMS
Ei.QQ
RECEIPT 0ATE��"'
BY
[
DATE FINALED )
INSPECTOR
!
D
1'.
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
--/ — Z /��
Underground Ducts
Forms & Footings
?j — j 9
Ducts
Slab Grade
Return Air
Steel
_
`j — e)— z
Combustion Air
_
Roof Deck 5 ._ p� _ _
Exhaust Fans
O.K. to Wrap
�--
F.A.U.
Framing
�y �� I
Compressor
Insulation
p2
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�_
0 57
POOLS - SPAS
BLOCKWAI
AI` PROVALS
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�'�
3 — / — 2
Heater Final
Water.Piping
_ _
Plumbing Final
Plumbing Top Out
6 4��
Equipment Enclosure
Shouter Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection—/j
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)
.0 7�
i
e of Occupanc Cert��ficatY04
City'of La Quinta x
Bulilding and Safety Department
This Certificate issued pursuant to -the requirements of Section 109 of the Uniform Building Code,
certifying that, at the time of issuance, this structure was in compliance with the various ordinances
of the. City regu/ating.bui/ding:construction or use. For the following:
BUILDING ADDRESS: .78-395 VIA SEVILLA.
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0112-081
Occupancy Group: R-3 - Type of Construction: VN Land Use Zone: RL
Owner of Building: CENTURY AMERICAN DEV., Address: 78-520 VIA SEVILLA
City: LA QUINTA, CA 92253
By: STEVE TRAXEL
! b! Date: 10-28-2002. `
.Building Official
r POST IN. A CONSPICUOUS PLACE