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RPL (9607-017) + SFD (14029)78800 Lowe Dr 9607-017 14029 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 47oX07 131 C5_ 7/11/97 Date 1 Signature of Contractor * -;' 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's uetd N l orkers' compensation insurance carrier,&1 policy no. are: Carrier Policy No. (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 provisions. Date: Aoolicant 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) e -C 7 i - f'i Date ate- 4 BUILDINGPERMIT PERMIT# CONTROL# 9607-017 3 G 7 4 DATE VALUATION LOT TRACT S 14,(W.00 JOB SITE APN ADDRESS 78,10 !GOOF, DR OWNER CONTRACTOR/DESIGNER/ENGINEER I%IR C:AS1T',U 1QUAQUFKV PCKX r 78-800 LOWE DR 80-975 IND1O BLVCt. LA QUIWA PALk1 DESF.(tr CA 0225% (3600)0-3 (619)3-15-5070 CBI.# 130 USE OF PERMIT PWI, AN DAA SPA IAN)). ANI)SPA ONLY t tt Vii.» i1NIXOR SPA WAAK JAI (.S IoWT1A1<XFFAo C NT OF t.tiNYM1)1;"TION 14,(f(i11.00 f' tM1 i' i'1' 1s tiJR1A3Alf'fr PLAN !`'RUCK FEE 101ARk-439.318 St1/:IS ., 4NN'1*RtIC"1' QN 1.1F 1G1.000 -118 -IM $133 flit NU IIAN14 "Al. FliTi -- POKA, 101-000.121-M) $11410 L11%.71416 -A1. I 1T44. I0I.0(1)420-(X)0 $45.00 V11.1I011NO f -Ti -- PCXA. 101-{1!10. 1141.000 S2",00 SUB '1 OTM, C"ONS1T UCrlQN AND PIAN C.11ECK $318.:1; - IXSS_ PRE' -VAI IEE !'1'AL $0.00 D- 1 14MII11I' FFFA 011E NOW 5348.45 AL 14 1111 By RECEIPT DATE BY .er DATE FINALED INSPECTOR' INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck Exhaust Fans OX to Wrap F.A.U. Framing Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath Final Final BLOCKWALL APPROVALS POOLS - SPAS Steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final Gas Piping PLUMBING APPROVALS 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 Final Utility Notice (Gas) ELECTRICAL APPROVALS 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) COMMENTS: OF LA QUINTA j' BUILOI G -SAFE ®EPARTMENCONOMNALLY xQ ACCEPTED FORMNSTRUCTM SUBJECT TO INSTALLATION AS PERAmb A. DATE BY J V M CJ G tb to com w oV O m uo cp • ` tet^ Q _C Twy 4 4 Q" Building Address 78-'800 lie Drive Owner Acacia Construction P.O. BOX 1504 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 Address 8341 H. Raiser Blvd. #310 City Zip Tel. Anaheim, CA 1 92848 (714)282-5800 Same (dress ity lZip IT State Lic. B-1 293954 (City 1612 & Classif. Lic. # Arch., Engr., Design gn AdL(11a53 xrvin® AVQ. Tei714) 642--150 City Zi,pp State $arta Aria Hellc >Ilts, CA 9290W LICENSED CONTRACTOR'S DECLARATION I hereb rm that I am licensed under provisions of Chapter 9 (commencing with Section of fec of visits 3 of the Business and Professions Code, and my license is in full frotrce and ` SIGNATURE i DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). ❑ 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, Buisness and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he did not build or improve for the purpose of sale.) ❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) ❑ 1 am exempt under Sec. B. & P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION I hereb y'affirm that I have a certificate of consent to self -insure, or a certificate of Worker's5mpensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Polic-1 Company ❑ Copy is filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) valuation 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. Date Owner NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code.) Lender's Name Lender's Address This is a building permit when properly filled out, signed and validated, and is subject to expiration it work thereunder is suspended for 180 days. I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives sof this city to enter the above- mentioned property for inspection purposes. Signature of applicant -Date- Mailing ateMailing Address City, State, Zip No. 14029 BUILDING: TYPE CONST. VN OCC. GRP. R3 A.P. Number 604-232-035 Legal Description Lot 164 Tract 23268-3 Project Description SPD Plan D Acacia Homes. Validated by: Validation: Sq. Ft. 1835 Size No. No. Dw. Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation $112066.90 PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. 573.26 Const. 685.00 Mech. 55.50 Electrical 140.41 Plumbing 138.00 S.M.I. 11.21 Grading 20.00 Driveway Enc. .00 Infrastructure 2,521.51 Arts in , c places :30.11 TOTAL . U5 REMARKS I ZONE: BY: Minimum Setback Distances: v Front Setback Setback from Cent e I'3 — "r Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side Setback from Property Line FINAL DATE INSPECTOR Issued by: Date Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SQ. FT. ® $ UNITS COLL. AREA SLAB GRADE ROUGH PLUMB. l YARD SPKLR SYSTEM 2ND FL. SQ. FT. STORAGE TANK FORMS SEWER MOBILEHOME SVC. BAR SINK POR. SO. FT. ® FOUND. REINF. GAS (ROUGH) 1 GAR. SO. FT. ® POWER OUTLET ROOF DRAINS REINF. STEEL GAS (FINAL) DRAINAGE PIPING CAR P. SQ. FT. GROUT WALL SQ. FT. ® SERVICE DRINKING FOUNTAIN SQ FT ® BOND BEAM URINAL ESTIMATED CONSTRUCTION VALUATION $ GRADING cu. yd. $ plus x$ WATER PIPING NOTE: Not to be used as property tax valuation FRAMING FLOOR DRAIN MECHANICAL FEES / �� WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER VENTILATION GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED FIRE ZONE ROOFING LAUNDRY TRAY AIR HANDLING UNIT CFM FIREPLACE KITCHEN SINK ABSORPTION SYSTEM B.T.U. TEMP USE PERMIT SVC WATER CLOSET COMPRESSOR HP POLE, TEMIPERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SQ. FT. ® c BATH TUB SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 11/a c SEWAGE DISPOSAL SQ.FT.GAR ® 3/ac HOUSE SEWER GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE CONST. FEE ELECT. FEE SMI FEE PLUMB. FEE STRUCTURE PLUMBINGELECTRICAL HEATING & AIR COND. SOLAR - JQ SETBACK GROUND PLUMBIN UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB. l BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER ROUGH WIRING DUCTWORK ROCKSTORAGE FOUND. REINF. GAS (ROUGH) 1 METER LOOP HEATING (FINAL) OTHER APPJEOUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM FINAL INSP. FINAL INSP. Z GRADING cu. yd. $ plus x$ -$ LUMBER GR. FRAMING ROOFING rJ 7'11�ylfry/��ilj�-j � / �� REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION _1 CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL