0107-298 (SFD)LICENSED CONTRACTOR DECLARATION
'Thereby 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 .
'7182'14 E3
Date 0, b 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 I am exempt under Section B&P.C. for this reason
Date Signature of Owner t
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: !.
Carrier Policy No.
00'b.D10.4 �.�bC 3:' .1? � 1 fro- '�tJ�4•t!"e
(This section need not be completed if the permit valuation is for $100.00."oraess);
O 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 to1he
workers' compensation laws of California, and agree that if I sh4iYbecome
subject to the workers' compensation provisions of Section .3700:of'the Labor
Code.,-h'shall forthwith} comply with thos!:provisions.., provisions., Date a -t
Applicant—
Warning:
. -
Failure to secure Workers' Compensation coverage is unlawfuf.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 Rohe 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 applicatoh'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 toicancellation.
I certify that I have read this application and state that the above information is
correct. l 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 prope5y.fgr inspection,purposes.
Signature (Owner/Agent)"" Date
r. , Z"
BUILDING PERMIT PERMITk r
/
DATE j j VALUATION LOT �'J—,, TRACT ,
JOB SITE
APN
ADDRESSy
' "i¢s.'•4��!��e.c,r�.u�'nr+r�,'�/�t�i ` ("
1�fP�Q".2.�.�i'•i�Od�
OWNER
CONTRACTOR / DESIGNER / EN INEER
Ly��oy 1�]�.y 1,�.. d,�, �;,.�� /. ny,y �E� ,n, ��7,��y
., L`4•�IArvJ'S�6 l4G.i•7:"✓F l ,�t'rf•� Tt�i..` V}t sGJ Lvavr1V •1.�. 4
I� Y.� ty ^�'S��y 9��T p�,7�yy�q�+
�.ti'°. .G`•. �i..-. ..c3�'.Jlew 6.��',kK1R'A1F 7, ,FI;Vc
CA 91253
ORANGE CA 92866
(714) 33-7 260 CS3:A i487
USE OF PERMIT
SM ,.l'IAX 9AIP-i PUK9. IT 009.`-`NDT INb°: UDE BLDCK"'WAl..t. 001, OR
Dti.1' .Z.%VAY APPROACH
TRACT COMM YR,ftVow 3, 28.E 3r
PORC731PATIO: ` :" 63.00 3F
C?�1,�.titit:A�Fi�i°!' $ OF
��y�;VA' ' 3 COVI' M did<NFrH17M101K
M,465.
i psy�y��+�av�;�t�; �p�-y7�� ,p•
,Yy.i�,.•Y5..4tlA.A .II 9Y AC1�bb,,6",,4 CE:SYAiWJ��G'I�
: Jf{� '�a�.!u'•f'ASr''� 101, -000-418-000 4 64.SD
101-000-439-318
M.IM14A46 L..'bFi+E 101.000421.000 $85,50
T01AYMMO. 49C 101-000-419-000 WWW
Tr ONO NOTA H FEMT r�.a". V 1,01•-000-241-000 $18:95
1i i1�Ci 1 101i,000-423-000 2 .f3i1
SURIJ '1 CJ.)9 I ,T furT`fqll fiH13 }? LAR C' '•�f?.G"'.'4,`a
$3,331.63r
} :_.-.• '- _ .._,.. ,.�. _ j " 4 i 1,EWS M - -PAID IMMS
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RECEIPT
DATES AJ
BY)
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs _
Forms & Footings 3� /
Underground Ducts
Ducts
_
Slab Grade
_
(
Return Air
�>
Steel
Combustion Air
Roof Deck l�—U=(J (
_
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing (3 -O
%
Compressor
Insulation
�1 Q (
Vents
Fireplace P.L.
_
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
_ _
/�
Condensate Lines
Party Wall Firewall
Exterior Lathr
3
9
Drywall - Int. Lath
Final„�
% 3 -D 2 J
Final
17-31 -6)
1
POOLS - SPAS
BLOCKWALL APPROVALS
"Y
Set Backs
Et3a 2snd
Footings
iiain
Bond Beam
I - /� �L ;;ti=, "lppioval to Cover
;:;;ES.`. -'`equipment Location
Underground Electric
Underground Plbg. Test
Final
;” :'"I,,., �: �K•'
Gas Piping
PLUMBING .A,4 C$,441 LS
Gas Test
Electric Final
Waste Lines
�
S�
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
-
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateralp/
Sewer Connection
�J L3
�I
s`
(/
Pool Cover
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)
;z - �m
S
fica'
to oOccupanqy_ •.- .- �
City of La -Quin ta 7)
B uilding and Safe�y-Department �F 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 compfiance, with the `various ordinances
of the City regulating building construction. or use.' For the •fol%wing:
BUILDING ADDRESS: 78-475 VIA SEVILLA
Use Classification: SINGEL•FAMILY DWELLING Bldg. Permit No.: 0107-298
Occupancy Group:, R-3 Type of Construction: V.N Land. Use Zone:. RL
Owner of Building: CENTURY AMERICAN DEV. CORP. Address:, 55-487 SOUTHERN HILLS
• City:. LA QUINTA CA.92253
By:. GARY SHOWALTER
-1'° Date: 07/31 /02
;'"l. r
Building Official
POST IN A CONSPICUOUS PLACE '