0312-244 (SFD)79840 Amalfi Dr
0312-244
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
7528.34 B MC, FIS 1104
I
Date Signature of Contractor "^--
X-.f vtr v
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) 1, 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
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
Se tion 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 REPi?HIC 94DENIMT, Policy No. 15671606
(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 withythose provisions-- —'>
Date: t_'F,/74- Applicant !/dA11I fit-------"'-_' -
Warning: Failure to secure Wogs' 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 reltrictions 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 Irom 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 inspecti-p..yrposes.
Signature (Owner/Agentlo ^ t """ ' Date
BUILDING PERMIT
DATE VALUATION c1ref LOT
JOB SITE ADDRESS 79-MIVAaLTA
OWNER
,&"C3wI3.h..;1dt7w. 140iv a 1T, D; C.
400 0. %.ARFJ ,L D%t 1V , 3"1U, B 1 X53
PA1241PI' 3v'GS CA
PERMIT #
7b'
APN
TRACT- 29.3x3-1
CONTRACTOR/DESIGNER/ENGINEER
PONDFROSAHOMEUSHWC
4010 S. FARRM. DR DIN17 1:3 103
92.264 PALIA SP.RWOS CA 92262
(703)137410 C BLO 234E
USE OF PERMIT 1111111111111111111111111MM-1240 64
IE
bfldt I.E 1 A1Lf I.Y
SI?D • LOT 7& PLAN 38XL. PERMIT DO&S NOT INCLUDI 13L.00K ` _
wAT,Is, PL)O.(., SPAT OP. DRNRWA'i'APPROACH, IN. -REDUCTION To PW4
CHECK PEZ DUE TO MULTIPLE ISSUANCE OF SF1.NIZ PJ AN TYPZ
T1tAC°T CONSTRUCTION 3.,Oino u
0A. RACEIC.F1RPOU 681.00 SP
Lr11ST1i &TM COST OF C O N 's:I74°'lr ON
PKRMY1 F_X1. t: 9M11URY
CONERI'RUC;TIONFEE
10)-1100.413.000
$940.50
'PLAN CHECK FEE
101.-000-439-318
$194.90
MECHANICAL ITF,
101-000-421-000
39&50
KL.FCTIZIGAL FEZ
101-000.420-000
$153.421
PLltMMO FEZ
101.000-419.OGO
504,50
STROI+10 MOTION FEE - RESIT)
101-000-249 -01D0
$13.58
ORADINO FEE
101-000-42.3.000
SI:TM
i7ZVIt',L.C+PER IMPACT IrEF
$2,40.5.00
H A4,1D PUN CIE $4,000.34
a os O
c7-
r-I at",c DEPT.
RECEIPT DATE BY DAJp FIS /I/PECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
A
Underground Ducts
Forms & Footings
Slab Grade
Steel_
Roof Deck
'O.K to Wrap
_ _
I _ _ _
_ _
Ducts
Return Air
Combustion Air
Exhaust Fans
F.A.U.
iA
Framing
Insulation
Fireplace P.L.
_ _ _
7_ _
_ _
Compressor
-Vents
Grills
✓
Fireplace T.O.
Fans &.Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
-
(
Final:
Final
W, 0!
POOLS - SPAS
BLOCKW
LL APPROVAL
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVAL•,
Q
Waste Lines •'ZJ r
Water Piping
Plumbing Top Out
Gas Test
Electric Final
Heater Final
Plumbing Final
Equipment Enclosure
Shower Pans
2.K for Finish Plaster
Sewer Lateral
Sewer Connection/ _
Gas Piping
Gas Test .
Appliances
Pool Cover
Encapsulation
Final
COMMENTS:
Final
_ _Utility Notice (Gas)/ELECTRIC
V/LLAP
PRO A(LS
Temp. Power Pole 191
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) i