0107-294 (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
7782M l
Date ,f /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). f I
() 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:
O I have and will maintairna 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 -t he 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. '
�tr.1.�0�'�Y &�i�i.(r6�??•ifl':'S�, 1`3'4�'4';�`Ytt.k�-�
(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 forthwith comply with A those revisions.'
Date: ' 7• :r, PS (Applicant � � .,M. • --� .� _
-
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). S t.--�=— ��^ Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOTS—.�.� TRACT
,7/)/73 IV I
JOB SITE/ f �� � .
APN
ADDRESS
-460 VIA S1?`�iI9'alw.d<A
ro' 4_121.3._007
OWNER
CONTRACTOR / DESIGNER / ENGINEER
U'.-WWRYA .t"�.ICA'D1y:WfAM!f C01
:I:f.. X0,- HOB B8C014PAN,'YWC
5.5-447 SU'OUMNIMM
MO E, CrIlAYMM .AVE.
LA QVIWTA CA 92253
0k'ANCIF Cyst 92.866
(714)633-7760 C'SLO 5487
USE OF PERMIT "
ST,f�tiP 213-- PE�:R�111T 00M*.NVI' lNIC ,.i IXE, BI.�2CK. �V.l�.i..t.l�"OOL OR
�3nc-lyix'.yRA,M
ACH
PORCHIPAY10 72, IV Sy
10.2 R OWx+13;8" Ofl T 6:13.0(1 kir
�/���p���1r7gF����n); a„�♦dt�tta���
{�y y, n
�q�y �,p�yy p * 6���• S1633,11
C 3f5M I UCTION k�ER 1 0 { ^�VJ'�!1P-4 t 8, 000 5163. JW
P11,11 'N i(;.>rEMCK FEE 101-001439-318 $190.0
MXCILA'kY1CAL FEE 1011-000-421-.000 $98,10
1,01-00"2 0-000 9143.04
PLUPADT34,10 ME *1 W -00041 9_00 .0 $16011yi
STP, % a MOVOW !', • RPUP.D1..• i)1-060 -2a 3.000 $16.37
GRADINO FOY 101-01130-423-000 00.00
Di VXL0PF,?, IMPACT ME. }�1,90`l.f1t3
r4 r
f� (n. 100 AND MAN (3�f ?X,4 ;�
I
t J U L 3 0 2001 .
E .f 119A 14T•.K8 Duv. nowe'398.2
Cf1"!�'�Qli;f=r1�
art.
RECEIPT
DATE1 �/
BY
D F ALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms& Footings
_
Underground Ducts
Ducts
/
Slab Grade
Return Air
Steel
Combustion Air
Roof DeckQ
t
�y
Exhaust Fans
Oto Wrap
.K.
�j •z.�aq I
�le
wc
F.A.U.
Framing
. Q /
ST
Compressor
Insulation
. d
s
Vents
Fireplace P.L.
Z
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
_
Condensate Lines
Party Wall Firewall
_
Exterior Lath
Z -o !
S-7
Drywall - Int. Lath
_�—
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
Electric Final
Waste Lines
�0,i/
Heater Final
Water Piping
C/ O
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Z7 Z.
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
cfc�-
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
12 — 0a,
Utility Notice (Perm)
Elm
il®
W,Certifica'te -of Occy'pa*ncy a
cit of La'QuAgnta
Building''and Safetep-Dartment°
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 o dinances-
of the- City regulating building construction or use: For the following:
BUILDING ADDRESS:' 78 -460 -VIA SEVILLA _
Use Classification: S.F.D. Bldg. Permit No.: 0107-294
Occupancy Group: R-3 Type of Construction: V -N Land Use Zone: R -M
Owner of Building: CENTRURY AMERICAN Address: 55-487 SOUTHERN HILLS
DEVELOPMENT CORP.
' City: L;A QUINTA CA.92253 '
". By: GARY SHOWALTER
Date: 07-12-02
Building Official
t
W,Certifica'te -of Occy'pa*ncy a
cit of La'QuAgnta
Building''and Safetep-Dartment°
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 o dinances-
of the- City regulating building construction or use: For the following:
BUILDING ADDRESS:' 78 -460 -VIA SEVILLA _
Use Classification: S.F.D. Bldg. Permit No.: 0107-294
Occupancy Group: R-3 Type of Construction: V -N Land Use Zone: R -M
Owner of Building: CENTRURY AMERICAN Address: 55-487 SOUTHERN HILLS
DEVELOPMENT CORP.
' City: L;A QUINTA CA.92253 '
". By: GARY SHOWALTER
Date: 07-12-02
Building Official