0107-299 (SFD)LICENSED CONTRACTOR DECLARATION ,
r� .I I greby affirm under penalty of perjury that I am licensed under provisions of
l—
66apter.9`(commencing with Section 7000) of Division 3.of the Business and
WP(ofessionals,Code, and.rny License is in full force and effect.
O P M License # ` Lic. Class Exp. Date
7 i 82 3 4i• F7 V r3 3 UX 0 "...
Dater Signature of Contractor— �
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I ami 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 X
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:
' �s4"+I,•I :L;N` ,��C)1=l F)^JS, )Mi s$'M4•102
(This section need not be completed if the permit valuation is for $100.00 or less).
O 1'certify that in the,perforrnance 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 those�rovisions.
Date: J Applicant
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 owhis
application.
1. Each person upon whose behalf this application is made & each person at
whose reques'Vand 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 cess?tion of work for 180 days will subject permit to cancellation.
I certify that (..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 Idr inspection purposes `, '
Signature (Owner/Agenth �f Date"' J."
BUILDING PERMIT PERMIT# '
DATE f VALUATION LOT ��+�-�� TRACT
JOB SITE
APN
npp d, Cvp��gp�y y� �
ADDRESS -gyp 'epi VIA
�10-^wtJ�. v.Y[4'.l..1111S�d:Yi�.3k1A1, ..
tE` y �p3
6�W�"R".212-�i�u�
OWNER
CONTRACTOR/DESIGNER/EN (NEER
r-M,ff , t�a':A,WDSVW,,071�W:EN A' COX
P. R. t- F; OBBS Ccs' die Y �'�r"C
S5.48'7 SOS. liftXa
1430 :L° aflARM.W AVE,
LA Qr:TMA CA, 921253
ORANGE' CA M66
(714)633.1260 CBL' # 54V
USE OF PERMIT .
a1FD • PIAN' 3B,- PIE 2.M1T,;IlOIES "NOT INCIAIDE BLOCK: WA►i1l.O.OPL cm
TRACT CONSTRIXTION 1122.0 8F
Ye+,iIvC"Al 1'1.1•
2911MA= COW OF CONVIMUCT1011f
PF 1 f FEYK SUMMARY
COtdSTRUCT1011"Y" 101-000.438.000
PLAN :rEMM101-000-139-318
MWCAy7CA11 2n 6 \:f S °•9f�i+V k 6 A °141 V �3.>�!I
f.l?t "IfSfS:°At.If {I fttlf3_i2t? tttY?4�r1:t7
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1�1,um;�D4�C Ferl., 101.000-41san(yt O C74,3C
AICITICYN Pdi!°:• , RP.911) 1,01 -000 -241 -CX)/,)
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'sat �>fi'��mX
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I
RECEIPT
DATE' / r`
BY ..,,_✓
DATE FINALED
INSPECTOR
Jf
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
A
Underground Ducts
Forms & Footings
Slab Grade
%/U I
Ducts
Return Air
Steel
Combustion Air
Roof Deck =0f� (J(
Exhaust Fans
O.K. to Wrap
. Z
F.A.U.
Framing
_� B _p(
Compressor
Insulation
Fireplace P.L.
Vents
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
(-( 2
Final
Final
POOLS - SPAS
BLOCKWALL
APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
._� �•�-cs
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Water Piping
%
v Z3(
Heater Final
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
Z��/ s
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
-
Final - Z / = o—
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� %�-
a
. ,
ice'rtificate.bf Occupancy'011a-
-City of La"Quin'ta-
Building
and Safety Department OF
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/sting building construction or use. For thefol%wing:
BUILDING ADDRESS: 78-465 VIA SEVILLA
Use Classification:,.. SINGLE FAMILY bWELLING Bldg. Permit No.: 0107-299
Occupancy Group: 11=3 Type of Construction: VN Land Use Zone: RM
Owner of Building' .'CENTURY AMERICAN DEVELOPMENT Address: 55-487- SOUTHERN HILLS
CORP.
City: LA QUINTA, CA• 92253
By: GARY SHOWALTER r
Date: 03-12-02
Building Official '
` POST IN A CONSPICUOUS PLACE -