0111-191 (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 r '+��''''•Exp. Date
' 67#91�4 F, kT40�
Date Signature of Contractor.
OWNER -BUILDER DECLARATION
1,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'
corripensation;'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 4v , Policy No. r,
(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;
1 shall not employ any person in any manner sp a to become subject to the
workers' compensation laws of California,; and agree that if I should become
subject to the,wor�drs' compensation.pfovisions of Section 3700 of.thOCabor
Code; I shall,forthwith comply with,tfiose provisions.
•
Date: rr�, /?.&T/ APPlicant ...•
Warning:, Failure. to secure Workers"Compensation coverage is unla ul and
shall subject an employer to criminal penalties and. civil fines up to $100,000, in
addition to the cost.of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director.of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each.person upon whose behalf this application is made & each persona
Whose request'and for whose benefit work is performed under or pursuant t D
any permit issued as a result of this applicaton agrees to, & shall, indemnif
& hold harmless the City of La Quinta, its officers, agents and employee .
2. Any permit issued as a result of this application becomes null and void
work is not commenced within 180 days from date of issuance of su
permit, or cessation of work for 180 days will subject permit to cancellatio .
I certify that I have read this application and state that the above information s
correct. I at
to comply witli all. City, and State laws relating to the buildi
construction, and hereby authorize represeotftives'of this City to entef Upo;'
the above-mentioned propetty r.insp'ection-purposes.
Signature (Owner/Agent•) - Date r
BUILDING PERMIT PERMTII
DATE S• VALUATION LOT 0111- Q TRACT
JOB SITE
ADDRESS
APN
�+d8.ia^,�F�•OOiP.� �. .
OWNER
CONTRACTOR/DESIGNER/EN INEER
TD DIM2RT
PO DOX 1716
i 9>.29.5 i?mcm.) :I h (Ti".,2'1*.� DIZ,
L a�� (Z-1 A. cA 92253
L,%. Qu.TA3-1-A CA 92233
�.16P)771-1941 MR. 2996
USE OF PERMIT
310=i 714 'Pl,f*l141, PEMT+ ITDOVS 'It, TrNCf.iJT)K,5Irl X.'W,` 1,J_%.
K104 SPA OR DRIVEVAY APPROACH
CUSTOM (,(YNqTRts(w' ION V4.110 o
POPIC;i1 PA ATO uaw y
G.AAAWC'TaarRPt RI T 71 f1, 6i OF
id4Ss.>i?',� Cs���lf oye C:0�3"arti1( �,�.osq
(jy�!a',�� 'yq��� W.%�.' { 1 �,�• g'� Q.s�%.�
S .IrL.A�J UT FILM i�vA.�yYi�'+1�1' R X
PLAN CHPX7K Me BQa�C1CFt��3�-�t$ $3id�.73
MECRAX (;CAL ATF 9 01-{)60.421 X000 $136.30.
F.Lit',U}:Jir.r I r P 101 1-000-4 20-000 $24455:71
Pi..t1MMINCI MR, M oM-419.000 4�5S,pR
S't'RCM WTIOW ME A REBID 101-•t�flf➢ iA3 t3�fl ���i.ld
Ci[iAD1N(1WE 101.000-4•77.3.000 �2Q.I1S1
PWUXIPER IMPA rr PRS
ART qq PUBLIC 1.11 AC03 'XES11: 270-M -1-45-0 $ .43°
SM -TOTAL C;O.I�t�P�'iris; �`3OM.P M) PLAN C1?X kC
$4,159,05
Itt
DEC U b ��.,Q"ae.��i�C�.�!•ni;i.Di'!.
2001
yloAt
C OF
RECEIPT
DATE,;.,
BY
D F A D
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Z _
Underground Ducts
Forms & Footings
Ducts
Slab Grade
f -D Z �'
Return Air
Steel
Combustion Air
Roof Deck
2 c Z3- CrZ•
Exhaust Fans -
O.K. to Wrap
g -�_
F.A.U.
Framing.
fj _d. 2 �r
Compressor
Insulation
2/ v
Vents
Fireplace P.L.
Grills
Fireplace T.O.�_
_
Fans & Controls
Party Wall Insulation =
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
_ zy
}
Final US
Final
-�z-S
POOLS - SPAS
BLOCKWALL APPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
I
Approval to Cover
}
Equipment Location
Underground Electric
Underground Plbg. Test
Ficial
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
_ _
%
Heater Final
Water Piping
I
Plumbing Final
Plumbing Top Out
_ �f, OL (%�
Equipment Enclosure
Shower Pans
Sewer Lateral
Sewer Connection
_
li ���
O.K. for Finish Plaster
Pool Cover
Encapsulation
Gas Piping
_ p Z `�
Gas Test
Appliances
Final
COMMENTS:
,
P•cxc a2c � �1 j�z
Final
!� _
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
i
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
-
Main Service
I
Sub Panels
t
Exterior Receptacles
G.FJ.
j
Smoke Detectors
Temp. Use of Power
Final
- - —
✓�
Utility Notice (Perm)
_
((
Certificate of Occupancy
�
City of La Quints 7
GG�w
_ Building and Safety Department.-
FM OF
This Certificate issued 'pursuant to the., requirements of. Section 109.of the Uniform Bui/ding 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 ' fol%wing:...
BUILDING ADDRESS: 49-361 VISTA MIRASOL _ ,f
Use Classification: ' SFD �� Bldg. Permit No.: 0111-191
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL
Owner of Building: TD DESERT DEVELOPMENT Address: `PO BOX 1716
City: LA QUINTA CA 92253
By: GARY SHOWALTER
• -_� �l"'t 'Date: 6-14-02
Building Official -
POST IN A CONSPICUOUS PLACE