0008-119 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty ofperjury that lam 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 ° � / ' Signature of Contractor -O o
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).
() 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 4he following declarations:
O 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 STATY f!J14O Policy No. 046.0007333
(This section need not be completed if the permit valuation is for $160.00 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 tha4'if t should become
subject to the. workers' compensation% sions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions:'
Date:, f r �,. Applicant f I .
Warning: Failure to secure 1 Workers:,,Compensation coverage Is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages .as provided for in Section 3706
of the Labor Code, interest and attorney's fees. '` .•
IMPORTANT' Application is hereby made to the Director of Building and Safety
for a permit subject to the. conditions and restrictions set forth on his
application. ,
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and.State laws relating.to the building
construction, and hereby authorize4.,epresentatives of this City to enter upon
the above-mentioned property, inspection purp 'ses.
Signature (Owner/Agent) "'Date'
BUILDING PERMIT PERMIT #
DATE I VALUATION LOT TRACT
ft 29437-1
JOB SITE
APN
ADDRESS
,,o
649-11P
49-1 'OWNER
OWNER
CONTRACTOR/DESIGNER/EN (NEER
*M a~;WERT DF_V WPV.M
BPATW,; CO 08MUCTfL
POgc3K1716
79.29 C-1101,— c I.M. TA DIS,
itA Q$iI151' A Cel .02251
LA Q1.1.N'A CA 92253
(760)771,-1941 171M14. 2996
USE OF PERMIT•
�+A�
d.SLV �d+G dC1'ilYl.iL d JJ YSIr1v.1.6LG9 t7
~ „ ,
Si'?1 • LOT.26 PLAN:M2 • PERMIT DOM NOT INCLUDE ALOL" M. 'AI.lo OR
P60L. 'AS% PLAN CIi.ECK FRE REDUC1IO14 FOR MULTIPLE ISSUANCE OF . `.
SAME PLAN TYPHY
CUSTOM CONSTRUCTION 3,556.00 SF
p+O.tCH/Prt'1`teJ ` 4.46;00 SF
0AIdAC31II'CARPORT (M 17;46$,60
. ,.
7 i�f+ �l b COSIT OF-CONSM`CiClf'dON
25*j4Q.=
CONST TRUCTION FEE 101.000.419.000 511375.501
PLAN C014ECK FEE $rn.r
MECHANICAL FTE 101.000.4,21.00 5.124,00
ELECTRICAL AEE 101-000.420.000 $221.1;
PLUMBING FEE 101=000.419-000 $329100 •
S'1 RUNIQ MOTION FEE'* RESID 101-1100)-341-000? $29-rA
S-0
Ci.RADINO FEE 101-000.42-(100
DEVELOPER IMPACT
"SF
ARS' IN PUBLIC PLACES - OWL 701.000-255-000
f.)
0
t
L= FRt—PAM FOO
..•
10.00
r
1<` TAL ITU1'' `!I' Z' S DITE .N'OW
$4,36156
RECEIPT -
DATE
BY r f
DA E INALEV
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
_ �/ /�//
_2, [fes
Underground Ducts
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
2 d _ _
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall -Int. Lath
Final l .
Final:
POOLS - SPAS
BLOCKWALL
APPROVALS
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
.3-2 —
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
Pool Cover
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
Utility Notice (Perm)
Rif
v
Certificate of Occupancv
City of LaQuinta
Building and Safe
ty Department
E
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: 49-130 VISTA ESTRELLA
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0008-119
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL
Owner of Building: T.D. DESERT DEVELOPMENT
ate.
Building Official
!W1
��I
Address:
P.O. BOX 1716
City:
LA QUINTA, CA 92253
By:
GARY SHOWALTER
Date:
JANUARY 28, 2002
POST IN A CONSPICUOUS PLACE