0206-208 (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 'l XP. Dates
'744091 13
Date 7 ! Nf c; Signature of Contractor, x -'"-
'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 fhe property, am exclusively contracting with licensed
contractors to `construct.lthe project (Sec. 7044, Business .& -Professionals
Code).
O 1 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.
r S c(� 1 have and will maintain workers' compensation insurance, as required by
tion 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 1fffH FUNri Policy No. 229-02-0029714
(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,
.l shall not employ any person in any manner so as to become subject to the
workers"compensation laws of California° and,ag +ee that if T`"sh'ouldµbecome
subject to the workers' compensationrprovislons•off Section 3700,of'the Labor
,Code, I shall forthwith comply with those provlslos.
Date: :i E f /,+: �. APPlicant
Warning: Failure to secure Workers' Compensatio6 coverage is unlawful nd-'
shall subject an employer to criminal penalties and civil fines up•to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to' the conditions and •restrictions set forth of his
application.
1. Each person upon whose behalf this application•is made & each person at .
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2: Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date. of issuance of such
'Ipermit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application: and, state that the above information is
correct. I agree to comply with all City, and State`Iaws relating to the building
construction, and hereby authorize representatives chhis City to enter upon
the above-mentioned property forrinspectio purposes. `
Signature (Owner/Agent)'f
PERMIT#
BUILDING PERMIT
��n.t�e�v�ty
DATE { VALUATION LOT - TRACT
JOB SITE _1_ �p�r =
ADDRESSC-0; 1 �,� io Lw7�fr �.'`"4�i.,�-s_.,
APN
754-n,104 .C'.
OWNER
CONTRACTOR /DESIGNER / EN (NEER
.0p C.4A :..r
SUN VISTA :1)� .�01AMEi!d""ii"CORP.
LA QUN A C k 92253
LA Q. -U -NIM 4.eA 92253
0760)77 -4722 (IBLO 53914
USE OF PERMIT
SM, WY 4.3..P)1RYJi!'t MRS NOT INC JIDE KZCK VZALIA POO.,
"CON _711ON
USTOM STRUC Van 8F
Ste
PtORR.C...i�'yI�P`A♦�p,ZO7yp�Tg
c361./00
�o
- -. f�j2J•1.91V#bP�.�+7'�.}'M'.4i„.i !�.(:�4�V 'AAS`
r..' ..
%;SIMATED COST OUF CONS°Ji`��.UMON
%70
Cvt�'�u`j RUC TIO14N,F: 1 C►J: 4VO-41AR-000 111"1150
:PLAN ;.H�E;Cr. 3�'i•E %3p0tk.��gi00-479wr28 S�yt,Iia3p5p$y.(��[,"y
.S'S'i�✓.�a EP0,1M 1fJ .0 i6'4I'Jr^Vt��+^-ah� 1,_VNV.YY?
WZHAN I CAL h% 101 4004 �Wo $137.04
F�:i d°`'i' tiCAd., FPI? M
PLIUMBING FRIE 101-000-419-000 $382,59
S'ROM MOTION IFEK ,. RES1D
io AArJ]W0 ,1:.�,'.t� 101 _000141,3-000
,t*Ri' PSMS .'UBUIC I'lt,J?..CK..Rmir 270-000-445.000
r
D Li
MAMITIFITSUMENOW
NOV 1 1 fi -
CITY OF LA QUINTA
FINANCE DEPT.
RECEIPT
DATE �J�/
Bi'
D FI �
INSP
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPRO S
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Oq
Ducts
Slab Grade 4oReturnAir
_
Steel
j�zRoof
Combustion Air
Deck
Ah
Exhaust Fans
O.K. to Wrap
3
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
v-rA i o3
Final
Fina -
,.5t_W
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground PIN. Test
Final
Gas Piping
PLUMBING APPROVALS
Waste Lines'��
Water Piping ' a
/
Gas Test
Electric Final
Heater Final
Plumbing Final
Plumbing Top Out
_—/
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
_
Encapsulation
Gas Piping
Gas Test
_
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Re^.,eptacles
G.F.I.
Smoke Detectors �-�� —
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
/ A#M I�_Vg ' 7nF
Svc,
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�-a-�—�' CertifidateQf Occu''pancy
oil
I.rcaoc+rtn4/ -
GOFw Building & Safety Department
This Certificate is issued pursuant to the requirements of Section 109 of the. California Building
Code, certifying that, at the time of issuance, this structure was in compliance with the
provisions of the Building Code and the various ordinances of the City regulating building.
construction and/or use.
BUILDING ADDRESS: 56-345 VILLAGE DRIVE
f
Use classification: SINGLE FAMILY DWELLING
Occupancy Group: R-3 Type of Construction: VN
Owner of Building: SUN VISTA DEVELOPMENT
--b
Building Officia
Building Permit No.: 0206-208 -
Land Use Zone: RL
Address: P.P. BOX 1144
City, ST; -ZIP: LA QUINTA, CA 92253
By: KIRK KIRKLAND
Date: AUGUST 15, 2003
POST IN A CONSPICUOUS PLACE