0309-043 (SFD)79740 Amalfi Dr
0309-043
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
752884 1S1L f --- 031/3I f
Date I f Signature of Contractory -'-"^ O
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.
O
T 1 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 REPUDIC DIDEMNIT, Policy No. 1156'71641
(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 df the1Labor
Code, I shall forthwith comply withthose prisioRs<—
Date: 0 3'1. "t ! Applicant i[d IJI, IV •cam-- ,
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 pec tt
riinsiiop
'nuyses. `
Signature (Owner/Agent)J' ' ` ' Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT TRACT
/J$191,986M1 ' 29323-1 3f7 -y
JOB SITE
• ADDRESS `79 -74tj AbJAW1; D-WV.f P
!OWNER
APN
CONTRACTOR / DESIGNER / EN INEER
PO.tdL3R..ft0SAH.c`3hMS LY', WC. H.O. tt 11 DIC
6671 OWENIS DRIVE 400 V. YARRIKU.,DR Wrflt B 103
PIZAMW,fON CA 94388 PALM 'WCo CA 92262
(703)IV-710 3UU 2346
USE OF PERMIT
MWGIE RAW.,Y OWELUNG I IIIIIII VIII III VIII IIII 43
IE
NOT3:tty7ei.ArFgCJ- -J
73, PLAN 4tv '. PERMIT DOESDNOTINCLUDEINCLUDE81rOC
YY-1..OT
F1BLOCK-
.M 1'004 SPA OR DRJV'EWAY APPROACH, 75% REDUCTION TO
PLAN C Hk WK PEE DUK TO ISSUANCZ OF SAME PLAN TYPE
TgACT CONSTRUC`1'MI 30 .32,00 OF
PORC$'biPAT1O 306.00 SZ:
GARAMUCAARPORT 50100 3P
MMUM CO&F OF 4.C7I,TMUCTION 191,9620
CONSTRUCTION PER .101.-00..0.418.000 S961130
PLAN CHECK PE,, 101-000-439-318 $799.39
MECHANICAL FLU 101.000.421.000 $98.50
ELECTRICAL FPX 1.01-000-420-l3N $156.66
PLUMBINO FEE 101-000.4.19.000 $192.30
STRONG MOTION .FEB - RESID 101-000-241-000 $19.70
ORA.DINO FEE 101-000-423.000 $19100
DZVZLDPER IMPACT FEE
SM-TOUL,. O'C1AiSITZMMOST ,fiM PLA14 CUEt' K $4,647.71
LtO Pn-PA a MEN $0100
_PERM" Ir:1 %S 1;`dXlaa". NOW $4,W,75
OCT 2 2 2003 /
CITY OF LA QUINTA
Fill
BY
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS/—,MECHANICAL
APPROVALS
Set Backs i A
Underground Ducts
Forms 8 Footings
Ducts
Slab Grade J
Return Air
Steel—Combustion
Air
Roof Deck iZvi
Exhaust Fans
OX to Wrap i
F.A.U.
Framing i
Compressor770
_
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
i
Final
Final
POOLS - SPAS
_g
BLOCKWALL APPROV
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING PPROVAL
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
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit I
Rough Wiring
Law Voltage Wiring
Fixtures
Main Service
Sub Panels /
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)