0008-099 (SFD)LICENSED CONTRACTOR DECLARATION
I h%eby affirm under penalty of perjury that I am licensed under provisions of
Chaalter 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
`;- 1131 /2-(
Date ,"' ` °�Si nature of Contractor
OWNER -BUILDER DECLARATION 1
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).
() I am exempt under Section B&P.C.°for this reason
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION
]-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 STATEFUND Policy No. 046.00"XM
(This section need not be completed if the permit' valuation is for $100.00 or less).
O 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 becoesubject to the
workers' compensation" laws of California; aid agree that If I mshould become
subject to the workers' compensation provisions of.,Section 3706 'of the Labor
Code, I shall -forthwith comply with th,'ose provisions.
Date:. + `!rc ;•: r Applicant f ,,!,f"
Warning Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,0'00, 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 herebV�authorizerepresentatives of this City to enter upon
the above mentioned property for inspection purpos s. fj
Signature (Owner/Agent)_17
)• 1 J/ Date
BUILDING PERMIT PERMIT#
DATE 1 VALUATION LOT ^t�9 TRACT
1907-1
JOB SITE1 a
ADDRESS ..' 1!..��4xv.,=A
APN
649—IW
OWNER
CONTRACTOR/ / EN INEER
Iia D:E11MT 7 PIVE .OPWA T
8PARKS COWSMUC 1014
BOX 1`t 16.
79-295 RANC21Q 3.,A QCI?N'TA 1A
1:;A t1UWfA Cis. 92253
1A QtMJTA C'A 92253
(76OX/71-1941. CAS 2996
USE OF PERMIT /
$124'O E EA ..Y 7'V1W__J_WG
SFlD-.I,OTr6b'PLAN:M3R • PUMIT DORS NOt INCLOOF, fILOCb WALLS OR:
P001. %sosro P LAN CHWK PPE RED T3OTION FOR Ml1'la3`I1"'i1 1SS,U'A.t40E OF
SAME PLNX `t'Y'PL?,
r �
CUSTOM CONSTRUCTION 4,?43,9D9F
INJRC:WPATI0 522.00 SP
S3AP,.RovaAPr_POAT pu 13,916100
. t.
I
EUTMN C()�f OF CONMUMON
-35133313.130
P'.Is'i2l'+/ H F;W 4St MMARY
CONSTRUCTION ME 301-00041t-000 $1,521.50
PLAN CHECK FEE 101'000-439-318 $309.73
MECHANICAL, M. 101000 -421-000 $136,50
X1.: TRJC.AL Iq,9, 101-000-420.000 $246.71
P1R3@v BIPiC3 M r 101-000.419.000 $205.00
STRONG MOTION FEE - kESID 101-000-241-000 $33.14.
• ,
c PIADINO Fid 101.000-$2:3µ000 $20,04
1DZVELOPL!i IMPACT FLE
ART.IN PUBLIC PLAC'G�-1�[�,9Ii 'dt?1-flt'Itie2�5«Od}0 $x08.47
PTTs -TOTAL Cd1ei9'I`�EtiTC'1ION AND PIM (_WC6X
ISW PRR( PAID FM
$0.00
TCYTAL ITIIR, L■ IT ME D IJrE ND
RECEIPT
DATE. f
BY.'
�C'�.s�
�i
DATE FINALED
INSPECTOR
i
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS/—
MECHANICAL APPROVALS
Set Backs , `�
Underground Ducts
Forms & Footings
Ducts
Slab Grade _ -p
Return Air
Steel
Combustion Air
Roof Deck ,,-�
Exhaust Fans
_
0. K. to Wrap 3
F.A.U.
_ _
Framing d
Compressor
Insulation _ - �j l
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
.Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
_
Drywall - Int. Lath
Af
Final
Final L3_�
POOLS - SPAS
BLOCKWA L A PROVALS
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 a —
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection 2�
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (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 �A
l�
Utility Notice (Perm)Zv���
..%
cupancy
o�c o
iinta I
)eivartmen* t OFr,..
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: 48-730 VISTA ESTRELLA
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0008-099
Occupancy Group: R-3 Type of Construction: 'VN Land Use Zone: RL
Owner of Building: T.D. DESERT DEVELOPMENT Address: P.O. BOX 1716
City: LA QUINTA
By: GARY HARTMAN
d Date: JULY 23, 2001
Building Official
o
POST IN A CONSPICUOUS PLACE
I