0111-199 (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
'/A
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).
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
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 S t ;1. 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 1 Should become
subject to the workefs' compensation.;provlsions of Section 3700 of the.Labor
Code, I shall forttiWfth comply with those provisions.,,,,'?'
Date /".1 a.(2 Applicant—
Warn lng:
pplicant Warning: Faildre to secure Workers' Compensation coverage is unlawful anb
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 upono-
the above-mentioned property for inspection purposes
Signature (Owner/Agent)-....,..- -,.� t- .*- -r` f Date`-"
/
BUILDING_ PERMIT PERMIT#
..a
DATE VALUATION . LOT TRACT
(� ssyy��tt ryrya�� a, 47 R
294574,
JOB SITE
APN
ADDRESS
491-W. WITTA. k4ft.M.ASOL
sk-l;oa-002
OWNER
CONTRACTOR DESIGNER EN61NEER
'
SC1flws CVYp.RCC17.0Z
79b95 SQ OJ.k{�MSA DR ,
L:A QUIA CA 92153
LA C CID fA (-,A 92253
USE OF PERMIT
SWGrZ FAMLY MMUNG
SrD - LOT 22 K4A14 M311. PERMIT DOES ivfOT 1)X.I UDE t3.i..(:1t; K'tAi„O.S, s,
P004 SPA OR DRFVFWAYA.PPR(_').WH
CUSTOM MW'Trt'bl;;ifiION 4,243.0 U
322.00 Sle
°
WAD V
ZX"MITATED cols"T OF CONS:€RUC' ION
351X81-30
CC�4�9�'R'I,I�;TT�SN h'E� 1C�'l�yt)�C41��C1t'li� $i,521.�d?
PJ. 01 C"t FX11X ..VEE 101 -EIDE) -x•39-318 $3it€i:'Ti
101 -000-421 -000
d,L1X1T,PJC.AL FEE, 101'000-420-000
PIaUMB1'1<Y0R>c-, yfyg�� �� 9M�Ct30 �a s.00
0:;RAz?g,HO PER 101-000.423.000 fbdL+.t10
�?C.9fyY�1tf1.0y
FJI1�drJ?yy➢,,.��t��1y�rI'Euuxi1MPgg��A./CTgtrgpF��ir.�j��ygy
�p}•�/7� na
ART:1114 S•"OOLIC' R"8sA(�.P8 - L.4'{sCi'7L Z70 -000 -405 -No
AYB.ai;6fA_C COMTM7TC;',i4011AW) PLAN CHRCK
IDTAL FEW ?C:fir":E?;E9 L`iUB N(YW
RECEIPT
DATE `` /
BY j J
DAT INA D /j
INSPEC/Tf�1�-
n
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms& Footings
�_ 2
—cp $
Underground Ducts
Ducts
q
A pp
�o'Z
Slab Grade
`— Z(p ,®Zy
Return Air
Steel
�Z _ v�S
Combustion Air
Roof Deck
- fr .. v Z
Exhaust Fans
O.K. to Wrap
Lir j �$_ �, _
F.A.U.
_
Framing
y —/� -z
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
l
Party Wall Insulation
Condensate Lines
Y
Party Wall Firewall
EiRerior Lath
Drywall - Int. Lath
Final
69 �S
Final
—� o�
_
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
s' Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Waste Lines O
�/_�L —� ,y�Y<
Electric Final
Heater Final
Water Piping
_ c� _ /C
w L •.�y.�
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
f+ _ L — ��
Encapsulation
Gas Piping
Gas Test
r) 2 --
Appliances Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
r
Temp. Power Pole
/
Underground Conduit
Rough Wiring
Low Voltage Wiring
I
Fixtures
Main Service
Sub Panels"
'
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
— D
Utility Notice (Perm)
Certificate of OccupancyT
.Cit of L.a: -Quin to54
Bdildihg and Safety-Depadme'ht of '
This Certificate issued pursuant to the -requirements of Section 109 of the -Uniform Bui/ding .Code,
certifying_ that, at the time of issuance i'this, structure was in compliance with the various ordinances
of the City regulating building construction or use. For ttie fol%wing:
BUILDING ADDRESS: '} 49-360 VISTA-MIRASOL-
Use Classification: SINGLE FAMILY :DWELLING • Bldg: 'Permit No.: 0111-199
Occupancy Group: : R3. Type of Construction: VN: .•" ° Land Use Zone:.,•RL- ,
Owner- of,Building: -,SPARKS CONSTRUCTION Address: 79 -295, -RANCHO to QUINTA .
City: LA QUINTA CA.'92253
By: GARY SHOWALTER
Date: 08/06/02
1.
Building Official ^. f
POST IN A CONSPICUOUS PLACE