0112-071 (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
47 fi a� T3 1/02
Date 1 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).
O I am,exempt under Section B&P.C. for this reason
Date Signature of Ov..,ner
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:
CarrierC'lC;tl,.�MN EOl.r'R.. Policy No.We W01401
(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 cl.gree that if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall fort with comply with tbor?provisions.
Date: ""' t Applicant—
Warning:
pplicant 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 fpyinspection purposes
Signature (Owner/Agent)
BUILDING PERMIT PERMIT.#
DATE - VALUATION ' LOT 0112-071 TRACT
19 23971-1
JOB SITE
APN
ADDRESS 7&445 Tt/XJI!. S,�.�6T.LLLA
OWNER
CONTRACTOR / DESIGNER / EN (NEER
c Aw°fs"g.y mow mtlfaawmc , Ca.
'cT'". a "' TLTR,Y A?'RICA DEVE.t}NOUNT, C"01
P.
78-520 VA DEMIL-A
7 0-5 2* VIA -MMIA
Lt`s Q1lUM CA 92253
1A OUMA ("A 922.53
CiC7)W. -56512. Com'.* 5481
USE
�OyF�PPEER,�MIITv ��p �f py�gy�y� T yyy
CFEfeI'S.f-a4:�d"i�i� fl ,RJD'VL�7.aLc1. O
SFTJ .. LXYF 0, P1,.AN 3%i�'i.. PERMIT Jia s IVOT 1140 AUDE. BLOCK
`
.
WALLA P004 SR& OR DR V'3LWAYAPPROACH. 7S"k LI%X C11 Fee FE
It:EQi,3fv' 110111 FOR MULTIPLE 1ssu.Awc?, OF SAME,PIOAV 'i°'YPF1
TRACT CONSTRUCTION
PORCIVRATIO ' 63.0 SP
iE 31',CtF�NAPPO 'T 682.00 V
p35 ryyg,� q� �y�, ��p �+ + P1y�y �p1�•d.�oG7/'�fat�
L'OSJ. W? CW.i.`io�.Y•�'[C.0.+6.�.L. O
q�j,, �[�
18914110.5150
}�dpaClmy�..�VJ4i1.rED
CONSTRUCTION PU 101-000,416-000 $I3°54, 50
PLAN CHECK K FTIH, 101-000-4391-318 $108.06
WKIEIANICA L FEE, 101w=-421-000 -421-000 005,.50
F. IXZrrit(`A1, ME, 1,01-000-4 20-000 1117D, : 2
PLJMM01is.I l2�1 •i3C3D 19a0�3Ca �'E. f�+,X11
STP OH(lt MOTTOW PER o =1r) 101-000-2141-000 $18.95
C KANNG W1: 101 -0 -423w000 $20,40
OE►`NIA)PER IMPACT FEY $I,907.fib
30WAY.")'1'AL CC3a't<'fMUC;"I.°1:t?1v AND PLAWZHECK
$3,,51-7.63
LUL 'F'R&PAID FE 0.3
1, om
RECEIPT DATE BY t DATE FIN ED INSPECTOR
i
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
Set Backs
Forms & Footings
Slab Grade
APPROVALS
I `/- UL
% /y -mZ
MECHANICAL APPROVALS
Underground Ducts _
Ducts
etum Air
Steel
Roof Deck
;l, / _ v =
Combustion Air
Exhaust Fans
O.K. to Wrap
Framing
Insulation
Fireplace P.L./—
Z
-_T - z
-AP ^ 2
F.A.U.
Compressor
Vents
Grills
Fireplace T.O.
J
Fans & Controls
Party Wall Insulation;�;Z77__,n /(9&�_� j n�
Condensate Lines
Party Wall Firewall
Exterior Lath
„c
y - /? -z-
Drywall - Int. Lath
Drywall
Final
(3,�oz
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
Electric Final
Waste Lines
_
7� - �/
Heater Final
Water Piping
_
- I - L
Plumbing Final
Plumbing Top Out
_
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
e
Pool Cover
Sewer Connection
> / =y S
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final /
Utility Notice (Gas) C//T
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voftage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
_
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
CeCertificatea'te of Occu anc �-
• Citof Lya--Qu+anta
Building. and Safety Department,. -,�MoF->ti
r
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.comp/iance with the .various ordinances
ofthe City regu/ating,bui/ding construction -or. use. `'For the fo/%wing:
BUILDING ADDRESS: 78-445 VIA,SEVILLE.
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 01.12-071
Occupancy Group: R-3 Type of-Construction: VN LandUse Zone: RM
Owner of Building: CENTURY AMERICAN Address: 78-520 VIA SEVILLA
DEVELOPMENT,CORP.
City: . LA AQUINTA i
By: GARY SHOWALTETR `
'l 6 Date: 06-26-02
Building Official