0101-145 (SFD)LICENSED CONTRACTOR_ DECLARATION
l 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* aLic. Class Exp. Date r gg y .
>'9-10 d 12C
Date '� r Signature of Contractor
OWNER -BUILDER DECLARATION
I hereby afflrrn'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)., ° .
() 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:
() I have and wili'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. .
(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 thgse provisions.
Date: 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 on his
application.
1. Each person upon whose behalf this application is made & each person atT 4'a
whose request and for whose benefit work is performed under or pursuant tW
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) �~ ' -""'rte Date A'
BUILDING PERMIT PERMIT#
DATVALUATION LOT,TRACT
.
f
Y )0! S 1 23971
JOB dITE
APN
ADDRESS
V 45 15 NIA, ST, VILL.A
604-212,01.2
OWNER
CONTRACTOR/DESIGNER/EN (NEER
R CU3'C3'Bt S CW&ANY ZIC
R C HOBBS c0ly ? Y WC.
Lk Q'f iWA }' CA 92253
1A e�1::4`Iia& CA 927,53
(`760)364.5612 CB1b 54 -
USE OF PERMIT
AUdl''O4',1LrdlP9?R,OPX11 DRIVIKWAY
Tga.AC°r. 341,,4°f 3dR)•CTION SF
PORM11'A'k ID 177,06 S'
A��. �iisID COST 0' CONSI U�r ,ON
m),1 1(A� o -
�y y�y
�4:Y86C'�.p.d J!! 37nik-• '96.D1Y/J.IA'8.N16C.XP
OMS`3519.K310N NES' 101.ODO.419.000
TrSL9a 14 C i•9YCK IEL? 101-000-439-318
MrX.,HAN11111A.;0�'1;41�:
I;i4.EC 1TRIC.;,t T, Vtr6� i f?1-+J 1-� 2Q-Q0Q f 6. Zf1
11.O +I0PNO FEE3�i1«C`f`St? 6i��f)€80 $S ti. 0
Is3'RUND LIOTION FEE- $.EM1') 101-00fi-:2,,,Q'1-4)00 $19.01
0,1,*,1A'DT £Q FE 1,03-000-421-000 $20,00
isiIM?:1.ii}PHIZ IMPACT PER
Fh`'a°:. EN1091T 101-000-4391-318, 0.00
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RUMTOR ININ'D 1:+'€�,X GM''.,K,
54
MEIN PRE,-PAIDRIM.
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4750,00
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JAW -1,21-2001 ,
t'
RECEIPT DAT r By, DATE FINALED INSPECTOR
r,
9 _
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
F,
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
%
Underground Ducts
Forms & Footings
Slab Grade
Steel
I.ZS�
I_? -CG
CQ�'�
��
�i�
D ucts
Return Air
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Insulation
3' Z
�� 1�
Cp_1Mp3Z
�''
Compressor
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
t�lft�- iiia\L11.s�
21 t2
����
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 I
I
Gas Piping -
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
I_I�
Com—
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
Sewer Lateral
. �� (q
(��
O.K. for Finish Plaster
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
s 12
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)
u'
. - F
fite,of-Occu anc Znl
Cern ca- �
Cit of La', Quin ta
5
c�
Bu►lding and Safety Department �1! Of -[t'►
i This Certificate issued pursuant to the requirements of Section 109 of the Uniform Bui/ding:Code,
3 certifying that,, at the. time of issuance, this structure was in compliance with the various ordinances <.
of the City regulating bui/ding- construction or use.' For. the, following: .
BUILDING ADDRESS: 7&515 -VIA SEVIL-LA
Use Classification: SINGLE FAMILY DWELLING Bldg..Permit-No.: 0101-145
Occupancy Group: -133 Type. of Construction: VN Land Use' Zone: RL
Owner of Building: CENTUURY AMERICAN~DEVEP. Address:, 78-520 VIA SEVILLA
-City: LA QUINTA CA. 92253 -
' r By: GARY. SNOWALTER ,
�! d� Date: 09/03/02
Building Official n ,
POST IN A CONSPICUOUS PLACE - '