0309-040 (SFD)79690 Amalfi Dr
0309-040
LICENSED CONTRACTOR DECLARATION
U) I hereby affirm under penalty of perjury that I am licensed under provisions of
F_ Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
04 W Professionals Code, and my License is in full force and effect.
O =) M License # Lic. Class Exp. Date
r- d Ln
r- w "1528 A ] ?iT
r- Z -,Date ) ? Signature of Contracto 1\
W 0. '
J I. -
C:) OWNER -BUILDER DECLARATION
W W I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ fl License Law for the following reason:
Z ( ) 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).
ce) () I am exempt *under Section B&P.C. for this reason
L
N Date Signattke. `of Owner
O0
d Q WORKER'S'COMPENSATION DECLARATION
o Z I hereby affirm under penalty bf • perjury one of the following declarations:
LO O ( ) I have and will mairitaln a certificate of consent to self -insure for workers'
X W = compensation, as'provided for.by Section 3700 of the Labor Code, for the
O J Q performance of the work for which this permit is issued.
m Q L) (() I have and will maintain Workers' compensation insurance, as required by
O U Q Section 3700 of the Labor Code, for the performance of the work for which this
rn H permit is issued. My workers' compensation insurance carrier & policy no. are:
ob z Carrier ,PUBIc 1_#4D r1oflQV Policy No.
co RE..15.671601
J (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
3 subject to the workers' compensation. provisions of Section 3700 of the Labor
.`e ,R.. ^- _
Code; I shall forthwith comply with those provisions. >
,D to e: t'`` , •.Z j ' ' 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. } ;.
Si nature (Owner/Agent rt n ' Date
BUILDING PERMIT
PERMIT#
P'LVIMT.TEE SUT @i.'G'dAN'
OY"-040
DATE VALUATION LOT
9"1.20
TRACT
'..70 29323.1
JOB SITE
ADDRESS r ,'" `A ATi f F VL
101-000-418-000
APN
603- DO -23
OWNER
CONTRACTOR / DESIGNER / EN (NEER
POIME i.C1SA HOMES U, INC.
PO:QDF., OSA T30.1=- Ts" WC
66571 OWENS DTaVF
400,91 FARAF-d,,D.R SUM" B 103
PLEASAN70X CA 94588
PALM WMNGS CA 92262
(7103)187-110 CB1,ft 2346
USE OF PERMIT
`
ff)WO . FAMMY DVW111NCY
I IIIIIII VIII III IIIiI IIII 30
-'
IE
.ID • IOT'l0, PI. AN %CL (I PERMIT OOPS -i;OT INCLLIDF BLC1CK - - --_- -_-
WALL% POO1„ SPA OR-6RIVEWAY APPROACH
TRACT CONSTRUCTION
31051.00 RF
P(?RCHPPATIO
3rt.00 SP
O.ARAGUCARPOR'I'
449.00 SPF
X51'04AIM) COST OF OON91RUC'iTON
279,597.20
P'LVIMT.TEE SUT @i.'G'dAN'
CONSTRUCTION FEE
101-000-418-000
$919,50
Pf AtJ CHECK FEE
101-000-439-31£3
$761.63
A!)W.HANX71AL FEE
101-400.411.000
$10%00
I.LECTRICAL V99
101-OD0-4.20-000
0149.25
PLU1vi13THO ME
101.000.419-000
513640
.STR.ONQ PA011014 PEE - I'ESID
101-000-241-000
$17.96
GRADING FEE
101-000-423-000
DEVELOPER IMPACT FEE
),4GS:Oi1
OCT.*2 2 2003'
CITY OF LA QUINTA
'(1171014.011) P;L.A9 0a, CK $4,565.84
'AL P r1.1,.:Nff ) XXIS DUE Jt'OW
4
RECEIPT I /lDATE BY r ( 1144&E9 0 1/FIN ECTO
S4, k34
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Slab Grade
Ducts
Return Air
Steel
ombustion Air
Roof Deck
O.K to Wrap
Framing
Insulation
Exhaust Fans
To oz
F.A.U.
Compressor
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
oe
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPAS Ir-'
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 APPROVALSGas
Test .
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Equipment Enclosure
Plumbing Top Out
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection /
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Y
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service 10 oe
Sub Panels
Exterior Receptacles Alor
-L
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)