0112-070 (SFD)LICENSED CONTRACTOR DECLARATION
rI 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.Licen_se is in full force and effect.
License # Lic. Class Exp. Date
Date x. .r, 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).
( ) 1, as 'owner of the property, -am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
O 1 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:
CarrierOOl L�Zs`1�I RA.C31.K Policy No. ATONE.° ^701401
(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 of the Labor
Code, I shall fortrwith comply with those p ovlslons.
Date: 13 I 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 restrictons 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 inspect ion` purposes. r`
Signature (Owner/Agent).Datet F
BUILDING PERMIT / PERMIT# ;
DATE VALUATIONOW -0,10 TRACT
VALUATION LOT
c�i �rey app qn y {' y7ry9 q
FF
%:.J. .�+Fr��f•.: .F U.CogJ.YtrA.AV J4 9iJ3.8 �!'G
JOB SITE
ADDRESS Pa4ss vu iS
APN
604-212-006
OWNER
CONTRACTOR GINEER
yR)lM4 diLaq VVFLlM9r, I
W, CENT :It8RCOXN'D 8F.0GA�� J, Ci1
78-520 VM WrV,it LA.
78.520 WASMWA
LA Quw% CA 92.253
LA Qr,3MM CA 92253
(70)5645612 CPU,, 5,4V,
USE OF PERMIT
OL.E. FAMILY JARdI LIAW
3 - WT 5.8,, KAN 2A. P-MRIMIT 1 OAZ NOT INCLI1M;13LrJCZC'WA.1JA
F001401'11OR DRIVEWAY APPRO.P CK UK PLAN CRIWK. K -B
I'�titDUC`I'IOW FOR, MULTIPLE" I ;SCUNACl,Ct. OF SkME F"•I..AN TYPE
TRACT GUkt TRUO"TION 2170.06 SI'`
PORMVPATIO '72.00 SP
t'3 A.O.WAi'..I'ORT 433.40 SP
EI.ViTHA'17M COST OF CONS. RI F.•d MI
PRTWUPKE SiiMMAg2l Y
e°O:N3'1 RUC TTa 1 103 »000=41 ;,00: $2ti3.50
PLAN CHiE'CK M Illi 000 -43,04 1'8 5120.05
MECHANICAL FEE 101-000421-000 $99,30
+QIP I3 t3 r�t%, 101-000-419-000 816%73
STINYHO .N:ILi`I'ION FEE o II. ISAID 101-000-24.1-5 $16.37
4IRADINO PRE 101.000-423.000 S20,fI0
I)EVY-um"k lsd pAcT Fgx $I,9fl7.00
MB-4OTFit,.+G'Cy1� WIM71104FAM3 PIAN MC1b
I'C�"1.'�i.,YR`%ME`;I IMS DATE NOW
.iM
RECEIPT
DATE
E•
BY /
D�E F D w
U
INSPECTOR
y
91,
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
v Z
Underground Ducts
Forms & Footings
�_� ,s, _� _
Ducts
Slab Grade
i2S•-�Z
Return Air
Steel
/Y—oL
Combustion Air
Roof Deck
_
— Z —
Exhaust Fans
_
O.K. to Wrap
�2 — L
F.A.U.
—
Framing
—/ —
Compressor
_
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
_
i
Condensate Lines
Party Wall Firewall
Exterior Lath —2—
ZDrywall
Drywall - Int. Lath
2
Final
Final
(9 `G(� — p'�/ -
POOLS - SPAS _
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
I
Underground Plbg. Test
Final
I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
�� _��—��
Heater Final
Water Piping
_ _
Z .Z
Plumbing Final
Plumbing Top Out
zf Z—
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
_
5 �%
Encapsulation
Gas Piping
Gas Test
Appliances
_
Final
COMMENTS:
Final
Notice
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)
of Occu anc Cedificate.
City of La Quin ta'..
':-BU'ildiiig and Safety Department MOF -
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 regulating building construction or use. For the following:
BUILDING ADDRESS:' 78-45,5, VIA 'SEVILLA
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No. 00'112-070
"Occupancy Group: R-3 Type of Construction: V -N Land Use Zone: RM
Owner of Building: 'CENTURY AMERICAN Address: 78-520 VIA SEVILLA
.,DEVELOPMENT CORP.
`
City:'LA QUINTA.CA. 92253
By: GARY SHOWALTER
Date: 6\26\02
Building-
_Official
POST IN A CONSPICUOUS PLACE•
i
i
of Occu anc Cedificate.
City of La Quin ta'..
':-BU'ildiiig and Safety Department MOF -
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 regulating building construction or use. For the following:
BUILDING ADDRESS:' 78-45,5, VIA 'SEVILLA
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No. 00'112-070
"Occupancy Group: R-3 Type of Construction: V -N Land Use Zone: RM
Owner of Building: 'CENTURY AMERICAN Address: 78-520 VIA SEVILLA
.,DEVELOPMENT CORP.
`
City:'LA QUINTA.CA. 92253
By: GARY SHOWALTER
Date: 6\26\02
Building-
_Official
POST IN A CONSPICUOUS PLACE•
i