0106-402 (SATT)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
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Datee 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 &.P;rofessionals Code).
I, 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
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
S&ction 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.
S,TA"T& AIND
(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 sha (,forthwith comply with those provlsio�.
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Date: 7 •, , 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 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) ✓'f Date 2 .4.e
BUILDING PERMIT PERMIT #,
///
DATE J VALUATION LOT 0106-02 TRACT
80
JOB SITE
ADDRESS
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OWNER -
CONTRACTOR/DESIGNER/EN (NEER
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CA 3
PHOENIX AZ 85034.
(602)257-765€ CT.14 4990
USE OC�F�PERMIT
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TOTAL '.ft—MMU Ypr,!'1)1%ASW
$3,77395
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BY
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INSPhGIOH
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INSPECTION RECORD
' OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck4f��
��_ –O(
Exhaust Fans
O.K. to Wrap
��—�" UC
F.A.U.
Framing
�v �l�rU(
Compressor
Insulation
Vents
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
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
Heater Final
Water Piping . '
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral_ �/�/// -
Sewer Connection ! �`L� U 2— �Gi�
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)
_
a' P.O. Box 1504
�J 78-495 CALLE TAMPICO (760) 777-7000
ShgpingBrighter Than Eve, LA QUINTA, CALIFORNIA 92253 FAX (760.) 777-7101
.April 11, 2002
RIVERSIDE COUNTY ASSESSOR
Attn: Mapping Department
P.O. Box 12004
Riverside, CA 92502-2204
Dear Mr. Hargis:
Please be advised of a correction to a street name for the-following structures.
The structures formerly addressed as 79-710, 79-730; 79=750, 79-770 and 79-835
Via Sin Cuidad, the construction for which building permits #0106-407, 0106-404,
0106-402, 0106-398 and 0109-019 were issued, will now havea street name of
VIA SIN CUIDADQ.
Please note this change and contact me directly at (760) 777-7019 if i may be of further
assistance.
Thank you.
Sincerely,
Diane Aaker
Building &-Safety Department
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INSULATION CERTIFICATE
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This is to certify that insulation has been installed in conformance with the current energy
regulation, California Administrative Code, Title 24, State of California, in the building located at:
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79-750 VIA SIN CUIDADO, LOT 80, LA QUINTA, California
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CEILINGS:
TYPE: BATTS MANUFACTURER: Certainteed Thickness: R-38
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WALLS:
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TYPE: BATTS MANUFACTURER: Certainteed Thickness: R-21
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SCHMID BUILDING PRODUCTS, A MASCO COMPANY
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LICENSE # 632072
TITLE: ADMINISTRATIVE ASSISTANT DATE: 11/13/2003
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