0112-068 (SFD),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 # Lic. Class, Exp. Date.
'478689, B
Dater c; YdSignature 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:
( ) 1, 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 & Prof essionals-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 Labof 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:
Policy No; !
Carrier Q3 +E.'i3 ! t Clyuay X C $41P14191
(This section need not be completed if the permit valuation is for $100.00 or less).
( ) .l 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 of the Labor
Code, I shall, forthwith comply with thosepr visions.
Date: .- -E-•`e I Applicant—
Warning:
✓"""" . '�
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code; interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit 'subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta; its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, Or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with.all City, and State laws relating to the building
construction,. and hereby authorize. representatives of this City to enter. upon
the above-mentioned property for inspection purposes
Signature (Owner/Agent) _ tl.-'°Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT �.t TRACT
24 22912.1
JOB SITE
APN ,
ADDRESS 7847
60t -,n 1,1?-W.�i
OWNER
CONTRACTOR / DESIGNER / EN (NEER
CEVIVORY AN' i1(9_4.)e8' ]DLV ��.:."CAPMTN`1'", coi
u-. Cfwu,1,,3! .i 'AkI 9&te t t:•iA �a ' +3'T`; �3 �
7 8,,;52 O ' IA .d > VeUA
78-520 VM 00MLLA.
L& Qp1m.1,A, CA 92253
LA. I Uri TA CA 92253
(160564-561% CZLI$ 5487
USE OF PERMIT
2-AVELL M,
151P1.1 � I.GD`P" 24, PI 04'I.E. P1CRMfli t7C7ES YdDT INCI,X I)t 9DOCK W.tiLA4
i,om, opA, oit Y I rowA'Y'..4pI'1;ohoi. ?s09,mi c. I•Y'ECK FEE ,
Tt"%tXT C'MIT33UCTION ;;t4M,00 OF
PORMPNI70 .63.00 ZIP
0A RA00CARi<+Ci0 OF
C°oN aRUCT-40N, FRE 301e000418.000 $954.50
PLkI4 CHECK FLEZ 101-000.4' 9-318 $19F.06
MPCifAN:It(-A:t,t".09 S.10
V1:l..VfR1CAJ ,11 101 -OW -420-000 12
MLUMMING "ILI 101.000-419-000
:3'P'RONn MOTICN. FEE • R S41xa 101 -00D -W-000
Cb12ADD10d` E 101.000-42'51..000
0X VCLOP ZR FM}tiAZT FUER: �@;9H►"1.Ot3
ff 'B.T4Y.•CAL CIONSTRUM'ON fes3 PLAN E: DWK
0,537.63
FSM F.1REI A FEW�►i.ca�
RECEIPT
DATE
BY
D ALED
INSPECTOR
T
P.
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
f , /O —v2 _�
/_�—BZ
Underground Ducts
Ducts
Slab Grade
_ O _ !9�
1._
_
Return Air
Steel
/o=v y
Combustion Air
Roof Deck
- .2
Exhaust Fans
O.K. Wrap
��% p
_—
F.A.U.
—
Framing
Compressor
Insulation
Vents
Fireplace P.L.
L
Grills
_
Fireplace T.O.,
Fans & Controls
Party Wall Insulation p v
�� p� . A
Condensate Lines
Party Wall Firewall
Exterior lath
Drywall -Int. Lath
_
�_ �_ - Z.•
W—E
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
Gas Test
_
Waste Lines ��
— ,g -6v
Electric Final
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
11
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
— J L
Encapsulation
Gas Piping
�O -
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)
Z
Certificate of Occupancy
0
city of La Quinta. OFti°
Building and Safety Department',
_
This Certificate -issued pursuant to the requirements of Section 109 of the Uniform Building Code, Use
Classification: certifying that, at the time of issuance,, this structure was in compliance with the -various
ordinances of the City regulating building construction or use. For the Mllowing:
BUILDING ADDRESS: 78-420 VIA SEVEILLA
SINGLE FAMILY DWELLING Bldg. Permit No.: 0112-068
Occupancy Group: -R-3 Type -"of Construction: V -N Land Use Zone: R -L
Owner of Building: CENTURY AMERICAN DEV. Address: 78-520 VIA'SEVEILLA
City: LA QUINTA CA. 92253
By: GARY SHOWALTER
Building Offical Date: 07-17-02
POST IN CONSPICUOUS PLACE