0111-239 (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
67 Vol
Date'" f��'s Signature of Contractor
!'
OWNER -BUILDER DECLARATION
I her affirm under penalty of perjury that I am exempt from the Contrac[or'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).
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:
Policy No.
Canier ', `e ww(ft.1"fi4
.(This section need not be completed if the permit valuation is for $100.00 or less).
' ( ) t bertify 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 provisions of Section 3700 of the Labor
Code', I shall forthwith comply with those provisions.
.Date: Applicant
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
3 l
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 pursuarifto
any permit issued as a result of this applicaton agrees to, & shall, indemnity
& 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 authorizeJ,representatives,.of this City to enter upon
',the above-mentioned prop e ty for inspection pur ores.
Signature (Owner/Ag nt)^• `Y✓ Dat
fi
- BUILDING PERMIT PERMIT #
�:•
DATE VALUATION LOT 'Dill -'2-W TRACT
72 2957.2
JOB SITE
ADDRESS 45�-230 V AKT A NSMEL". L".
APN
64.9 00-M
OWNER
CONTRACTOR/ DESIGNER/ EN (NEER
° x RSCz'► �' ' i f� 6s° % f fSPAR'M3
CoMf M) MION
PO BOX 1716
79.295 MOM) 3A. Qi3•. 'A Vit
.QX)DUA, CA 97251
T.A QITNfA. 011h 4 92253
29%
USE OF PERMIT
Vf) .n 3;; )T 72 PLAN M. PAfiAMIT TOES NOT INCLUJI,MI, HLOC K WALLS,
l'001, 3P:4.OR DRUFMAYf' APPROACH
CUITQM CORSTRUCTIM4 A5,56,a 5F
F'�. ckflpwrlO 446.00 s
C." ATtAOEICARPORT 636.00 OF
ESTIMATED TED COM," OF CL'9NVET1'(M6, N
235409
i'%�Yp(.���,j}�ct�Yf1~p(�)pitgg�,���p�f
y,�M1 (�(j /� 7 (] {j(�,}� Apf ) JQ pj�
C'1f.�1+151'�ti�t;"StC^t)�H Fee 101.000 418.000 11,32,i,d•'V
PLAN CHECK E�� i�1�Q3t�0.4'�f1�:318 $1,091.28
i
..11AECH lrNUML '7B?:S 101-000-421-1000 5124.00
LFICT 3da:AL "Of, 101-000.420.000 $221,19
'
:. PJAM1911M, RM I oa -000-4,1 $229.05
r`t i`s,MHO MUM TI.OX M, � "MID D 101.000.241.000 $39.54
> 3RAJDAIRO FRE ,° - 101-000-4U-000 $20,00
D?E'U"EWPER IMPACT FEZ $1,007.00
.ART IN PUBLIC PLACED . RUNE 27i1r000.4 •5 -CI OO Sa18.52
3
3t3S3-°i^t'b°� ti�T10 MB) PLAX a.0',C..K
$5,186.02
,i'.b
ktZn
2001
WYOF LAQUINTA
ftl�lPT.
RECEIPT
DATE S/
BY
DATE FINAL D
INSPEC t
9
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
Set Backs
APPROVALS
Y— /g— Z , y�
MECHANICAL APPROVALS
Underground Ducts
Forms & Footings
Slab Grade
4/ —/f - L
y —Z3— Z.
Ducts
Return Air
�—
Steel
y — i$ -�Z '
Combustion Air
Main Drain
Roof Deck
Exhaust Fans
O.K. to Wrap
_ 2� Es 2_
F.A.U.
Framing
—9_®�
Compressor
Insulation
Final
Vents
Gas Piping
Fireplace P.L.
APPROVALS
Grills
_
Fireplace T.O.
Electric Final
Fans & Controls
-�/ - i2 _ Z , v�5
Party Wall Insulation
Water Piping
Plumbing
Condensate Lines
Plumbing Final
Party Wall Firewall
f
Equipment Enclosure
Shower Pans
Exterior Lath
Drywall - Int. Lath
O.K. for Finish Plaster
Sewer Lateral
-----
Final
Final
-� %Z,
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
Set Sacks
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 ��
-�/ - i2 _ Z , v�5
Heater Final
Water Piping
Plumbing
_�% v
Plumbing Final
Top Out
f
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
y �Z_L�
Encapsulation
Gas Piping
Gas Test
_ b_ I_
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole _
Underaround Conduit
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp.. Use of Power
Final
Utility Notice (Perm):
Final
COMMENTS:
rw%
_ t
IN fien
1`� � � � ;� a� yS �'' �_,� , " nim"�: ofe.Occupancy
u_f��; ��1 5' G_ Vii.
,rn
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: 49-230 VISTA ESTRELLA
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0111-239
Occupancy Group.- R-3 Type of Construction: VN Land Use Zone-.' RL
Owner of Building: T.D. DESERT DEVELOPMENT
r-& L4_1
Building Official
Address:
P.O. BOX 1716
City:
LA QUINTA, CA 92253
By:
GARY SHOWALTER
Date.-
NOVEMBER 8, 2002
POST IN A CONSPICUOUS PLACE
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