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0111-189 (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 61146 M, 1.1 P6 bate&:,,."/`�"`,, Signature of Conti OWNER -.BUILDER DECLARATION •I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the following reason: ( ) 1, as owner.of tlie 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). 1, as owner of ithe '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: O .1 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 p e rf.ol - �rfian.ce 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: 6arrier',Policy No. Su'ra nfl.; D Ct4�r ii (This section need not be completed if the permit valuation is for $100.00 or less). that in the performance of the work for which this permit is issued, 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 th4orVers' compensation provisions of Section 3.700 of the Labor Code) I shaltJorth4th comply with those provisions. Dater'Applicant— Warning Failure to secure Workers' Compensation coverage is unlawful -and Shall subject. an employer to criminal penalties and civil fines up to $106,000, ini addition to the cost of compensation, damages as provided for in Section 3706. of the Labor Code, inteire§t 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 ori, application. 1. Each person upon whose behalf this application is made & each perkn.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 pdrmit issued as a result of.this application becomes null and void i work is not commenced Within 180 days from date of issuance of*suc 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 i correct. I agree to comply �flh all City, and State laws• relating to the buildin construction, and hereby - authorizerrepresentatives of 'this City to enter po the above- mentioned property forin's'pectionu'r' p I posel.. Signature (Owner/Agen Dite. BUILDING PERMIT PERM T# DATE VALUATION LOT TRACT 22 JOB SITE APN ADDRESS -tn, Wxx,�,% Mawm (A94MI-02 OWNER CONTRACTOR/DESIGNER/EN INEER 7. 4.) PSMT 1XV a''OPWITr 11TRARY's 0014611RUCalow PQ BOX 11716 .79-7,9-5 R£ -11`101A QIMUADR. LA Q-�U&17,Cts. CA 02211 LA, Q.bMTA CA, 922531 USE OF PERMIT S,K0 n 1aLA14 M-3. 1V&RMPr DOPS NOT MCLUDE MOMW LL; P'ool, ol?'o. OR muVIMAY.tomom"N M131110M CUKTRUCTION 4.24.%00 8F 522.00 sp 710.00 115F ESMAKIED CO',Tr OF CONSTRI)MON Mid W-U151M. 19ATMVIRY CUHSTRUCT104 sl,$21.30 PLANI C13' Z= F99 S 1, rm. 9 witraipancFa S1.36,50 &LWT R.14^Al. FEZ '101-000-420-000 $2A6,71 PUIDAB11140 FEE 301.000''- 4 19-000 1205.00 STROHO MOT1014 11ZE • RM- A) 161 -4600-24 1.4-40 $35.24 (MAJAM10 ER I (11 -000.423 -000 M.00 MVELOPER im-p-W111 FVII . - S1,907,00 ART IN PUBLIC PIA' ' M, - K&SH: 27 0-000-445 -000 SUB - MnIAL (-,,OM� ri ION AND PLAN Cl- 47K 1VTAL P=Wfff DUE NOW 2nol f .. BY INSPECTOR $5,1685.25 50.00 S1591115012-5 INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING, Set Backs Forms & Footings Slab Grade APPROVALS % Z /��0 Z 41 MECHANICAL APPROVALS Underground Ducts Ducts _ Z Return Air _ 7— 2 - Steel ( Combustion Air Roof Deck 7— '©� - Exhaust Fans O.K. to Wrap ,771— S e_-, S F.A.U. Framing — /— Compressor Insulation ,k_ o Z ,k Vents Fireplace P.L. Grills _— Fireplace T.O. J _ Fans & Controls Pao 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 r Equipment Location Underground Electric Underground Plbg. Test Final Gas Piping PLUMBING APPROVALS Waste Lines �Z`z( "' Gas Test Electric Final Heater Final Water Piping Plumbing Top Out (� / Plumbing Final Equipment Enclosure Shower Pans O.K for Finish Plaster Sewer Lateral Sewer Connection _ _ _ Pool Cover Encapsulation Gas Piping Gas Test -Z� Appliances Final COMMENTS: _ <2 Z/ Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fixtures Main Service Sub Panels JA Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final - _- — - - Utility Notice (Perm) Certificate of 'Occupancy. Citkbf 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 bui/ding construction or use. For the following: BUILDING ADDRESS: 49-381 VISTA MIRASOL Use Classification': SFDBldg: Permit No:: 0.111-189 Occupancy Group: Y' 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 - Date: 6-14-02 r Building Official POST IN A CONSPICUOUS PLACE. 1 F A I