0312-247 (SFD)79825 Amalfi Dr
0312-247
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 #.0 coq LLiic. Class Exp. Date
752884
A
752884 B .4 -1c 31104
Date "r Signature of Contra 1.
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 RE'PUDIC INT EMNIT' Policy No. 136714.02
(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-o Labor
Code, I shall forthwith comply with t/hose provisioRs
,,1E)6te: i —F'0i '- Applicant ( / j{ 1 1 1 ".
it
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. }
Signature (Owner/Agent), Date
_., (/
BUILDING PERMIT PERMITk
I3311-0-947
DATE VALUATIONLOT2 TRACTJOB
SITE
ADDRESS °f9-1325 A1b1KGF.aY DRWE
APN -n"23
OWNER
CONTRACTOR/DESIGNER/EN (NEER
P0)MMWS. J. -'f0 E8 A RIC.
P0)4?UF'•€,C)SA HOMES If WC:
400 S, r,AI LL riR1S'1 13103
4 00 8, FAShc ML DR SUSS% B 103
PALM SPI2WGS C.,"A. 92264
PAIAA SPRMS CA 92262
cm) I S -m I 0 GM1.9 2346
USE OF PERMIT
SIA1OIX, xAlaff 1J 4VL<<LI STG
SM3 . 1X)T 63, PLAN 1.PXR, PERMIT DOES W6T INCLUDE SIX)CK
WAIaLS, POOL, SPA OR DRIVE, WAY APPROACH
TRACT C(3NST UC` IO1d 2,728.00 3F
PORC H11PATIO 323.06 8
GA:RACIFICARPORT 634,00 31;
MrI'l ".I' ID COST Or, CONSTXIT'C.i OYN
165,244.79
YUMIT It 0,1 SrQTMMAi' Y
CONSTRUCTION FEE, 101.000.415.1000 3810.30
PLAN CHECK FEF 101-000-439-318 5727.74
ME, CHANICA 11I Z 101-000.4.21-000 $92.00
ELrrCTRICAL "KE 101-000-x120-000 $142.06
1'I.17i+ RING FEY, 101-000-419-000 $167.2$
STRONG MOTION FEE - IdF.SID 101-000-241-000 $I6.52
OR.AMNO FEE. .101.000.423-000 315.00
0WPLOPER I M PACT YZZ $2,405.f1fa
SUB-'rOT'AL CONSTMCI lIOW MD P.T-01(".131x'0
$4;331.07
LESS :PRE .PAID FM
$0,00.
TOTAL !'ffmaT 1 mrs m1:Ii Now
39,431:07
08 °
SIT'; it '. ' ^" • ",
.. /
RECEIPT
lk••,
DATE
f . i ; r • /
BY
/--,41
D L IN TOR
J
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footingso
Slab Grade
CLQ ►rW J
Underground Ducts
Ducts
Return Air
_
Steel
Roof Deck
_
—
Combustion Air
_
Exhaust Fans
F.A.U.
Compressor
_
f
O.K to Wrap _
Framing
Insulation
_
Vents
Fireplace P.L.
rills
Freplace T.O.
Fans & Controls
D
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
/—
Final
POOLS - SPA
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 APPROV
Gas Test
Electric Final
Waste Lines
_
Heater Final
Water Piping
Plumbing Top Out
_ _
Plumbing Final
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
_
Gas Test
_
(/
Appliances
_
Final
COMMENTS:
07
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
_
Sub Panels
Exterior Receptacles
G:F.I.
_
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)