0309-047 (SFD)79745 Amalfi Dr
0309-047
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
7528.4 13 MC OIy2,i
Date` to} 7, Signature of Contractor F W \
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' cdnipehsation insurance carrier & policy no. are:
Carrier .REPIJBIC ZNI7Ew1i`., Policy No. I101601
nF:
(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 profsiQns=--ti
Date: I r ;' :)Lt6 • 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 whose1rbenefit 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. j{
gnature (Owner/Agent) '..'NDate
BUILDING PERMIT PERMIT#
03tf O47
DATE VALUATION LOT TRACT
4F.10 244.70 65 . 293.7.3• y.
r;
c: •t.J
JOB SITE
ADDRESS
APN
603-800-M
OWNER CONTRACTOR / DESIGNER / EN INEER
PONMROS.&HCyLbSM Its INC. P0110FROSA1101 M U INC
6671 OWEMDMVE, 400 8. FARRW. DR :7CTf'L 73) 03
PIEASA1rTI'O:tw CA 94588+ PALM SpRa-Two Cl` i. 92262
(703)187410 CMM 2346
USE OF PERMIT "—
SIiJ,MIE, P'AI 1. Y D911M.I..1AK3 I ILII IIIIIIIIIIII 44
1111111
SEED a LOT 66, PLAN 188_ PERMIT DOES NOT INCLUI)E BLOL'K IE _ . -- ----
WALIA POO'," SPA OR DRIVEWAY APPROA031. -
TRACT CONSTRUCTION Z728.00 OF
PORCIVPA'TI0 313.00 SF
0A1ZACi XAt31 ORT 654,00 SF
EST. lAf,A.TED COSI' O3FCON',7r UC*17Oid
105,2*4.70
PST FEE 6MMARY
CONSTNUCT16N FU 1019000-418.000 SM.50
PLAN CHit K FEE 101-60"39-3113
I+R1::MA141CAL- FEE 101-000-421-000 $92,00 ;
L!LECTRIt~AL HI•.,ff: 101-Qe.Xt-420.000 $142,06
PLIUM8940 FEE 101.000-419.000 $1672
STP.ONOMOTIONPUZ -RESID 1,01-000-241-000 If.33
GIZAUr90 FRE 101.000.423-•000 31SAU
DFV f11,OPfM IMPACT FE -Z $2ti40*.40
SUB -TOTAL. COM RU =09.WD 1-11AX CIM -K
,$4,431.07
LEIN PRErP.AI) PM
$0,00
D e
1'1'Ai. F' $ PlIlT1 1b'%.E' a 113 i'i®4 '
54,431—.07
OCT 2 2 2003
CITY OF LA QUINTA
FINANCE DEPT.
RECEIPT
DATE 1
BY A TEF
INSPECT
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms 8 Footings
Ducts
Slab Grade
Steel
Return Air
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
Insulation
Compressor
Vents
Fireplace P.L. r I
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final QL
Final
POO
S - SPAS
BLOCKW L APPR V
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APP OV LS
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 .APPRO _. S
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) r /
• L/