0112-076 (SFD)LICENSED CONTRACTOR DECLARATION
_I'hereby affirm under penalty of perjury that I am licensed under provisions of
'Ch apter 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
4786889 13.� 11/0.2
Date ^� ~ rJ? 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)..
( ) 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 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) 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 ;C E. i E.-WIX. Policy No. NWC...14Wi.401
(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, •1 shall forthwith comply with thos@,povisions.
Date: '2- °3`2.Applicant ll •M, .
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his- r`
application.
1. Each person upon whose behalf this application is made & each person at, .
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this.applicaton agrees to, & shall, indemnify r
& hold harmless the City of La Quinta, its officers, agents and employees
2. Any permit issued as a result of'this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon'
the above-mentioned property foP inspection purposes.
Signature (Owner/Agent) F`" -� "'""" Date ••`�=
PERMIT# '
BUILDING PERMIT
DATE VALUATION Jt63k7,24A.10 LOT 4 TRACT 23971-1
JOB SITE ADDRESS M-620 IASI -VILLA
APN 604-211.1-0132
OWNER
CONTRACTOR / DESIGNER / EN (NEER
Ns'i#RY AMERTCC-04aR T95' 7lk..f' ..C1nri w., Ca
w. ow,
78-520 VIAS IL-1
7.•,U. QU1N1'A C'a. 92253
Lik.(tU'i'uITA CA .9225:
USE OF PERMIT
SIQ - I..C,t`; 'X VIL&N ,it AR. P11,r:M T DUE.$' NOT ?'NCLL1DZ.k3i..OUX
WAJMS', ,YC O14 VA; OR DRijTWA5'APPROACH.
TRACT CONSTRUCTION :; iM xo OF
Ps', RC HIP.Fi TIC.? W.00 S
GA3AC1E3C'ARPORT 3.(if9 SF
EsTawm. COST OT, C01450FMCITION
163111211.19
CONSTRUCTION PRE i 01-000141 &,,!DOD W3..io
PLAN CHECK PEPS 101.-000-439-118 r""1"/10.24
Tvl�•t;�ila:t�YC�1F. i+C:•� X01 M0f3��%� �U�t3 ��S ?,+�
I?1X,CTR1raI,E FEW 101 a000420 -W-) X34.09
PLUMti1xW FEF, 101 •0004-19-000 SWIM
STRWIC9 MOT1014 112 - RL•�a7"3D ? Q1 -S}00-241=,000 $16.37
C}#1.+P 0111101°im 014)00-423-000
�1..J-��..};t.:;�C�B�'�7ukL1.7�.��.�d.i�•.l5ia�,l,.1���..'�lc`4 �:,��:1;.
��y���a.�6�
iIAL 1 MPT E1 8 DUE NOW
V.,938A4
MAR Q 7 7_Qt01.:
.,
MY 6iH,A WRTA it
RECEIPT
DATE �'
BY
DATE FINA D
INSPE
W
.N.
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
_ 2Co - Z
Ducts
Slab Grade
Return Air _
Steel
_ 2rm -
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
"�
F.A.U.
Framing
_ _
Compressor
Insulation
Fireplace P.L.
Z
Vents
Grills O� _
Fireplace T.O.
Fans & Controls
_
Party Wall Insulation
Condensate Lines
Party Wall Firewall
-
Exterior Lath
Drywall - Int. Lath
7—
Final
Final
=2G-pz
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 3 - —Z
Heater Final
Water Piping
ZPlumbing
Final
Plumbing Top Out
Shower Pans
_
— �5
Equipment Enclosure
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection - 2
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final �( j
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Furfures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final G - 0 2
Utility Notice (Perm) W—ZJ -0 Z
Bin #
City of La Quinta
Building *8r Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking. Sheet
Permit #
Project Address: -7R-`
Owner's Name: 6�1�-ry 4 Am
0
A. P. Number:
Address: C-AOV� *U'E7-
Legal Description�rje-�( 27E�Jl
Contractor: f�L�.� o!f o.
City, ST, Zip: � . ........
Telephone: ?/�— 6 53 - �7 2 &--6 xx`
Address: -2-0 L) 5E2),
Project Description:
City, ST, Zip: h i. -47.-P,
Telephone, 3 3 0-'-5
?�c -
..........
... .......... ......
. .............
............... .................
............... ........
............. ..........
. .................
V\.k A,, CC5--tr� (2o�
State Lic. 4: k L�E City Lic. #:
Arch., Engr., Designer: I<-- 0 15�
K-� 0 fz �'C,77--'PVO� .
Address:
City, ST, Zip: C ADO, C,
.. ...... .. .........
.. . ..... ... . ..........
Telephone: .... ...... . ...
X .............
State Lic.4:;p,,,L XX ...... ........................
,:�,Pme of Contact Person:
Construction Type: Occupancy:
Project type (circle one)(, Add'n Alter Repair Demo
Sq. Ft.: 2g4Lk # Stories: T4 units:
Telephone # of Contact Person: o —5
Estimated'Value of Project: 0
APPLICANT: DO NOT WRITE BELOW THIS LINE
N
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
9/1-1
Item
Amount
Structural CaIcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss CaIcs.
Called Contact Person
Plan Check Balance
Title 24 CaIcs.
Plans picked up
Con struction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2" Review, ready for correc
Electrical
Subcontactoi List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
3"Review, readv for correctionslissue
Developer Impact Fee
Planning Appr.oval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
Ce'dificate of
T C,
-
City of LaQuintc!
Building -and Safety Department, OF -
This Certificate issued'pursuant to 'the_iequirements 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: '78520 VIA SEVILLA
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0112-076
Occupancy; Group: R/3 Type of Construction: V/N Land Use Zone: R/L
Owner of Building: CENTURY AMERCAN Address: 78-520 VIA SEVILLA
DEVELOPMENT
City: LA QUINTA CA. 92253 v
By: GARY'SHOWALTER
e< b' Date: 08/26/02 .
Building Official