9911-078 (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 ander
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
Date Signature of Contractor
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 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.
�.;J1(a
r aar�r
;rp�_oa�s.i;�iv,a. �� �sf
(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 provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.
Date: �, d`^. Applicant—
Warning:
pplicant 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 for inspection purposes.
a
Signature (Owner/Agent) v �f "r� Date
BUILDING PERMIT PERMIT#
--�
DATE �'� VALUATION+'*q�, LOT � TRACTJOB
SITE
ADDRESS+ %� L1{I YI tok�ibF°�fifi.i.if �.���Yo.
APN�dQ�
OWNER
CONTRACTOR/DESIGNER/ENGINEER
i��;t�_S'P9 Yf� l+l1i i •�ildRl YT,�i`{"1�
f�}3?�`�9 ta�L (°�ii/[ F L t''�"��d11��11�tT'i,t�
\: YlA 7..I )p 4 E t
SO. -LYWE, 6200
9.51,3*5� SO.. ".i.�" �y[ .. �42�.eQ`Cf{��y
+153.5
�Sy7['�fcyi�~1e l'�,
Fri
SAN +f'�fe.1.w1`!t�[l.Nat'- O ' C,A 9?44W,
y��iR7�t��•EY,
SAN tJ[:2'i.,1NI'1.�N-��e'�O �.A .`lLeW3
t�U�l3fot••�>i)fl! i`'�a.4� �I2o
USE OF PERMIT
PtX)L,
mAC'.1iva 1rZA 11%-1 ii?
. y ' .0 141,1A. [ 5. 9 COST O6'' i.•�J�i y'� iRW�N� £ ii�efi�i
1 Q1�1,,J� I.AIi U
PEANUT FICIVISUAMARY
a~0,N,k ntVc7I:c)N. FFE I094"j•43�-i)it�J
P1,A-N C"VK VFR I()I-000 4iAd!• '�tS; 'SRS) 40
w,is � x�, i b�� r r : Iut,titto-'-12t_o� y 700
PJ.W`ti ,Ad..t+)<d d�R'-(?itt5 b2 �Uft£i 11.tio S)
F'. 1.04tq,Nc.i
1;1V0'N( 1',*i'TI'0'NVFW-RVfon 101 41�f�"r�l I�13fj9
,F;g r4N(,,14 ti: anti 960 11117 1 0011) "t),+}•�
L)1i�L(�+NE)i kN1PJ%k:;'1 V*-
A.R`.I' IN KJOL C 131.Ar. YS - 99
Fht= Ol r1�t .iw�S (' $ tt i • fNtd)=:A't�- a b ft �'¢34f i orfs
Rf,1WRY` AT. V NP F t JMOV, X ti's u° : AN t 4, PCilz
.59
COTAL PEAMII9j .VdWf N DUX' NOW
W
X3,222.oSi3
.
RECEIPT
DATEBY�
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
f— % -Q6 !/4/
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
'L - tG - c
v Ka
Exhaust Fans
Q.K. to Wrap
r 60 4tf
F.A.U.
Framing
Compressor
Insulation
3 . tcf
Vents
Fireplace P.L:
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
, t
Drywall - Int. Lath
3-77_ �p
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
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 Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
41
Appliances
Final
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)
COMMENTS:
March 18, 2015
Ann Croudy
Title 365
78100 Main Street, Suite 209
La Quinta; CA 92253
Mrs. Croudy,
The, site address assigned to Assessor Parcel Number 604-423-002 wish the Legal
Description of .18 ACRES IN LOT 19 MB 282/033 TR 23995-7 within the County of
Riverside is incorrect. The correct address for this site is 78-950 Wakefield Cir, la
Quinta, CA 92253.
This information has been relayed to the County Assessor Office as well as being
provided to you for your records. Updating of the record will be in accordance with the,
policy set by the County Assessor Office, any inquires of this procedure shall be directed
to their offices.
In addition a copy of the Building Permit for the construction of the Si-igle Family
Dwelling has been attached for reference.
Thank you.
AJ Ortega
Plans Examiner/ Inspection Supervisor
Direct 760.777.7018 1 Fax 760.777.7011
aortega@la-guinta.org
Attached (1— Building Permit)
78-495 Calle Tampico La Quinta I California 92253 1 760.777.7000 1 www.ta-Quinta.ors