0111-194 (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
Datef Y/ w Signature of Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License La 4,qr the following reason:
( ) I, as owrior 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 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 t, Policy No.
(This section need not be completed if the permit valuation is for $100.00 or less).
O t 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•lf�I should become
subject to•the vkorke a' compensation -provisions of Section 3700 of the,Labor
Code, I shall forthvrft�h comply with those prov[slons.� r Af f
Date, 1 �i;� Applicant—k,.�
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an' employer to criminal penalties and civil fines up to $1.00,000, 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 personhat
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, ind -fy
& hold harmless the City of La Quinta, its officers, agents and empl'
2. Any permit issued as a result of this application becomes null and f
work is not commenced within 180 days from date of issuance o u
permit, or cessation of work for 180 days will subject permit to -cancel o .
I certify that I have read this application and state that the above informaon
correct. I agree to comply withlall-City, and State laws relating to the b ]ding
construction, and hereby authorize representatives of this City to, enter upon
the above-mentioned property for inspection purposes
Signature (Owner/Agent)
BUILDING PERMIT PERMIT# y
DATE VALUATION LOT E111.1 -:N TRACT
p^ry
1Rdi5y.697�7oV'�� .Ci• d /"ii.P'� 4<Y 7.a�.
JOB SITE
APN
ADDRESS s�jr.�'E.L3,a4 rAmm 1.�—�ikd7
OWNER
CONTRACTOR/DESIGNER/EN (NEER
PC" Box 1716
• 79-295 RANCY10 Ski QVINT, AIL
7�,A Qa.�':1.4, CA 05225.3
1A QUIWA CA 92253
(760)771-1941. CID 13996
USE OF PERMIT
silwaT•.Z-T
990 - LOT V kNN'.V155 PERMIT OCIEW IdOT 23!1 7 VD9 ALOCK WALV,_,
P001.6 PA, OR DR1V Kfi8lA.Y-APPROACH k_
�
C�J;3T�A� �t�xy��l?.tJc:l•,C� 3;:s�tS.04 �'F ,
215T.MA' COST (Ar
202,206M .
yyGRyyR 6l1AaIV
101-000-418-000 S1120.40 .
PLAN CHECK`: ME 101 -WO -439-318 W4.23
iUli MNICAL FRE 101 �000421.006 $14.9.50
1°Lk�t ik�lt' t? 1�`l 101.000.4195.0 0 5202,15
,1TR.L'1%f0 MOT YON IfV R&JD 101-000-241-600 $23.31
(RADINO FIRE 1 o I .ami, 000 $20.00
.'I' .A€ l'Ut11uIC P�AM = RRSIE .770-M,445.000 $3tSJ7
5
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DW
MAL PERMT M8 DUE Nt
11� OF QUINTA
PT
RECEIPT
DATE
%Y
DATE FINALED '
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
�� D
`�
Underground Ducts
Ducts—
/�
C
Slab Grade
_� _G Z
/
E
Return Air
Steel
Combustion Air
Roof Deck ,
iJ,p, �i�Z
�bS
Exhaust Fans
—
O.K.to Wrap
F.A.U.
Framing
Z Z .
_
��'
Compressor
Insulation
Vents
Fireplace P.L.
_
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior lath
—
3=2
Drywall - Int. Lath
y _ 9 —�
Final
Final
Q
POOLS - SPAS
BLOCK APPROVALS
_LL
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
Water Piping
Heater Final
Plumbing Final
Plumbing Top Out
-2•,
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
_
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice
_ D�
(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)
_ lye
Certificate of -Occupancy �n
� o
City of La Quinta
Building and Safety Department.
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 ordinances
'of the City regulating building construction or use. For the following:
BUILDING ADDRESS:49-331 VISTA MIRASOL '
-Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: + 0111-194
Occupancy Group: R-3 Type of. Construction: V -N Land Use.Zone: R -L
Owner of Building: TD DESERT DEVELOPMEMT Address:* PO BOX 1716
City: LAQUINTA CA. 92253
By: GARY SHOWALTER
::r� Date: 07-18-02
Building Official
POST IN.A CONSPICUOUS PLACE