0008-135 (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
Date a' "� ,o -g 'Signature of Contractor .. �� ✓ _,_ y�
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 owneriof 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 Ownei
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one df 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:
CarrierPolicy No.
��!A7 }� FUND 046.0009330
(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_ I, should become"
subject to the workers' compensation pro sliv ons of Section 3 00 of the Labor
Code, I shall forthwith comply with those provislons."e-
Date: i,4j- Applicant �' `��' '►'
Warning dFailure to secure Workers Compensation coverage is unlawful 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 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 upon
the above-mentioned property.f6'r inspection purposes. fir.
Signature (Owner/Agent) - �� y Date - '✓f
BUILDING PERMIT PERMIT#
DATEt7 VALUATION LOT TRACT
11,16 � 102 294571
JOB SITE '`A9{�,�•q/Ri�•�t�A�•+g+�p•,,7t
APN
ADDRESS -Y H7►7 V.JtSTA.1:+.•JA.Jl.G~...I,i.LAmg-"too
ow
OWNER
CONTRACTOR / DESIGNER / EN (NEER
M DR -M.'1: i7F1VRL• 0-1P1 rr
SPAM CONErMUC7,I0N
1;'O BOX 1716
. 79-293 RAMC' -I -IQ :A OUDUAS7ft,
Q 1NTA CA. 92233
LA OtYDq-1A CA 92253
(700>771.1941 CB19 2996
USE OF PERMIT
OW01Z FAMI1- Y MM.W
'
SM LOT:102 MAN:M3 -PERMIT DOES N(Y INCLUDE t3Ll C WALI.S OR
PC�U1,1a ,AN C'HECit V.RE))0C'�it At In)+li3Trl'1�r'1,E T61CtJa��'K Cid
SAME PLAN TYPF,.
� s
CUSTOM CON81TR1 tTION 4,243.00 SF
PoRmPAT16' SP
0A§MEJCARP RT QIF) 113,916,00
EWAT`kl) MST OF CONS;L7Eti7eWON
35x,398.30
CONSTRUCTION FEE' 101-000-418-000 S1;S21.50
PLAN b`HECK FES 101-0Qa-439-311 Sas.
MECHANICAL FEE 101,000.421.00(1 $1136130
ELECTRICAL FE 9 101-000-420-000
PUJh1 BYNC3 FRE' 101.000.419.000 �Z03.OP
STROT40 MOTI071 FEZ • RP 10 101 -0004 1-000 $35.11
ORATaNO FEB 101.000.123.0.00 ;2.0•00
'*;s
T,B1aV0,0PER. IMPACT FEB
ART IN PUBLIC PLACES ItESM 701.000-255-000 $ 79.47
SrIM-IOTAL COM UC M -D ALAN GI's
y., rM
09
'PAZ Y
:Y'CYT I' Mrs' Y E`�i3 �i7E' -N.OW
RECEIPT
DATE 1
BY,r i
DATE FINALED
INSPECTOR
,'� fly
i , ,
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
—�/��
Ducts
Slab Grade
��_�
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
_ _
B
F.A.U.
v _
Framing
Compressor
Insulation
/3p
Vents
Fireplace P.L.
_D _
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Finalr/
/
Final
A/PROVALS
POOLS - SPAS
BLOCKWALf
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
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enqlosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
_ _
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
O
Appliances
Final
COMMENTS:
Final
Notice
_ ��
Utility (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),p'
Certificate of Occupancy
City of LaQuinta
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: 48-985 VISTA ESTRELLA
Use Classification: SINGLE-FAMILY DWELLING Bldg. Permit No.: 0008-135.
Occupancy Group: R-3, U-1 Type of Construction: VN Land Use Zone: RL ,
Owner of Building: TD DESERT DEVELOPMENT
Building Official
Address:
PO BOX 1716
City:
LA QUINTA CA 92253
By:
KIRK KIRKLAND
Date:
MARCH 13. 2002
POST IN A CONSPICUOUS PLACE
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