0103-200 (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 •- ;� - }* 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,) I -have and will maintain workers' compensation insurance, as required by
Sipction 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.
PACIFIC. FUPLOTEM.I
(This section need not be completed if the permit valuation is for $100.00 or less).
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 sh II forthwith comply with those provisions.
Da' ' 77 fW W 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
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 applicator 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 represent ives of this City to enter upon
the above-mentioned property for in ection u poses.
Signature (Owner/Agent) Date p
BUILDING PERMIT PERMIT#
DATE VALUATION LOT Oj&f2f .0 TRACT
Q ��,M• ,7i� 29349, - I
JOB SITE
APN
ADDRESS 81-200 1M1a9r0,NHF.AD,1
'16,7490 -OM
OWNER
CONTRACTOR / DESIGNER / ENGINEER
ul 3iarIV'TxSe
i"
TOLL kROTHMf
.
.74-K-3 HOS7Y S:CL`ff 3111112-2210
*4-923 HOYDJSdk�'�(`..E(KUT 3U.Wr_1n "220
PAT.14 D 9RT CA. ,26(E
PA124 DESERf C-ik 92260
,76, )674.9699 CBL 3632
USE OF PERMIT
S?rI.`I•IrLAN LOT • P9,RV,IT SKS I101' INC' Ui?Z BIDC:KWA1..1JP0OL/SPA. �k
DRIVw AYAPF°EtO CH,
CUSTOM CONSTRUCTION Vi41,00 V
PORC:#iO.F.ffTIO 3800 SF
CONST'n- 101-000-438.0.) S1'13y oo
yQ
K.104 CRECK F-11019 301-0-W-4-39-318 on
MX,X WHCAL VgE 1 i -Cioo-421.000 $09.50
S%1X.'TR.tCAL.. Fid 01-0K)O-420-000 $1In.
PWK6,f1+10FRE14)'ky61M, 419.000 S10.09
STIIONOWOTIONiFF,— RESID 101-000.241"000 J $31.
OR,ADI1 O let. 9 40.aa
z.or. wa
h SVL?Lrt VZ9IMPACT FIS
.ARI' iV+i't:?UBWC I'IACFZ-REIN 701-000-255-000 3�Td.3
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CITY OF LA QUINTA .
e FINANCE DEPT
;
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
xG r
r(',.,
wt
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
l BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
_ _
Return Air
Steel
Combustion Air
Roof Deck
O.K. to WrapQ
Framing9
Insulation
Fireplace P.L.
l b/ ` _
! 6 =
����/df G/I/
Exhaust Fans
F.A.U.
Compressor
Vents
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
WA AIM41
Finale/
BLOCKWALL APPROVALS
Final
POOLS-SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING APPROVALS
Waste Lines%
Gas Test
Electric Final
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
Sewer Lateral
Sewer Connection
Gas Piping
Gas Test
_
/ 3/
O.K. for Finish Plaster
Pool Cover
Encapsulation
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. r
Smoke Detectors
Temp. Use of Power
final
Utility Notice (Perm)
�r
Certificate of Occupancy
City of La Quinta
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.regu/ating building construction or use. For the following:
BUILDING ADDRESS:
use t-iassmcation: WNVLt
Occupancy Group: R-3
81-200 KINGSONT HEATH
LY DWELLING
Type of Construction:
Owner. of Building: TOLL BROTHFRc INr
#e -
Building Official
vni
Bldg. Permit No.:. 0103-200
Land Use Zone: RL
�ddr ess: 'i 4-923 1-10 V EL Y LANE E S I t 2-220—
City: PALM DESERT, CA., 92260
By: BILL GORDON
Date: 4/9/02
POST IN A CONSPICUOUS PLACE