0008-122 (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
674074 13 ,—,�"'� 07;� 1 M
Date r �`%'w Signature of Contractor �' P//'`
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 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): • t .
( ) 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"
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
Policy No.
STATE FUND D4b<00Di33R .
(This section need not be completed if the permit valuation is for. $100.00 or less).
() 1 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 agree4 atif I should become
subject to the workers' compensation provisions of -Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.
Date. 1`* `f.' .Applicant', A t'�•�.'"`"".�
Warning: Failure 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,f6r inspecti n purposesf' ..
Signature (Owner/Agent) ; :`�� Date
-BUILDING PERMIT PERMIT#
00081,7.2
,
DATE j VALUATION LOT ..d�TRACT 5 z+
s 'D:7w'<R rntv..�ai 89 � !.�"�J �'1
JOB SITE I ?
APN
ADDRESS'
OWNER '
CONTRACTOR / DESIGNER / ENGINEER
TD i1EF..£ T DEWJ OPMMT
SPARKS C:ONS�'.£�i3CTIO1:4'
PO BOX 1716
75;-295 U-10 LA QUINTA,.M
L.A. QU@1T•A • CA 32253
LA QUWTA CA. $2253
(760)711-1341 CF" ?W6
USE OF PERMIT
MNOT 1� i2diil.Y V il+fC
3FI7» tOf:39 PI. AN:M39 . PEkMI'T W!G -S ATO T INCWOE K-OCK`WAL0 OR
POOL. 75%PLAN CHH -01K FFRWTUC:`tION FOR ML#LTIP1,13 ff"SUX401 Fl. OF ,
SAME FLAN TYPE,
003TOM COIdOTRUCT190 4,M-00, OF
,
BORCHIPATIO '6312,00 .SIS
0ARACIWCAAPORT CU) 13$916,60
E,'�N"139D COST Cid' CONV1"R`UMO
�Y. 8 3CD
COld;" R,UCT'ION ME 101-000:,418-000 $1,521,50
PLAN CHECK CK FEE 1,01-000-439-318 8. »610-439-31 n
fl�
� r
MECk1A•AWALFEE 101-E)do7 21.000 ffi136 0
w„
f�.s!?CT.RICALFEE
�C..»•4
PLUMBING r 101'-000419-000 $205.00
STIZONO MOTION FRE • REStD 101-000-241-000
n
ORADINGFFKE 101-060.42%4000 $20,00
;,
LS.i+VE OPEP, IMPACT FFM �?,90>* lIO
� � • t
ART IN PUBLIC PLACO - RES.11 701-000,255=000 5378.47
RUS-70TAL Ct11 OTRUC 11014 A14D PLM C..91h Xo4,i33.6a
LsW PRE -PAID F=-
$0.00
.cyan, rmmw M~ S DVE Now
$13,.),05
RECEIPT
DATE
r
BY
M
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings ��
Ducts
Slab Grade !% _
Return Air
Steel_ _ _
Roof Deck l4
Combustion Air
Exhaust Fans
O.K to Wrap _ _
F.A.U.
_ _
Framing _
Compressor
_
Insulation_ J �'
/
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lathriy`- u
Final
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
_
Waste Lines /r6 �G4"
Electric Final
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test !�
Appliances
Final
COMMENTS:
1
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) _ �'
r
Certi. c at* o of Occupancy
City of -La Quinta
'"
' ..t�? G fM
Buildi9►
n and Safety De*partment
O F
'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 following:
BUILDING ADDRESS: 49-190 VISTA ESTRELLA
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.:. 0008-122..
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, CA 92253
By: GARY SHOWALTER
Date: JULY 8, 2002.
Building Official
POST IN A CONSPICUOUS PLACE