SFD (0311-052)50465 Los Verdes Way
0311-052
LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
In Lo Ghapte? 9 (commencing with Section 7000) of Division 3 of the Business and
cv W Professionals Code, and my License is in full force and effect.
O 0 M License # Lic. Class Exp. Date
I-- d U-)
LLJ
777699
6Zt fate Signature of Contractor
O
J U CD OWNER -BUILDER DECLARATION
!L W I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ CD License Law for the following reason:
Z ( ) 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. 704:4, Business & Professionals Code).
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the, project (Sec. 7044, Business & Professionals
f
Code).
I am exempt under Section , B&P.C. for this
reason;—Date Signature of Owner
O a,
Q WORKER'S COMPENSATION DECLARATION
0 CC I hereby affirm under penalty of perjury one of the following declarations:
Lo
H-. O () 1 have and will maintain a certificate of consent to self -insure for.workers'
X w LL• compensation, as provided for by Section 3700 of the Labor Code, for. the
O J Q performance of the work for which this permit is issued.
m Q U ( , I have and will maintain workers' compensation insurance, as required by
O U Q Section 3700 of the Labor Code, for the performance of the work for which this
[I: uI— permit is issued. My workers' compensation insurance carrier & policy no. are:
z Carrier Policy No. .
00 O UBER.TY MUTU.A1:, IT W71<262LO04723012W
(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 Segtjgn 700 of the Labor
Code, I shall forthwith comply wit th 2 prguislo s.- r
Date: t ." a Applicant ` I,,,
Code,
®e /r Warning. Failure to secure Wor a 9 -Compensation coverage is unlawful and
a shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to thelcost of compensation, damages as provided for in Section 3706
of the Labor C'o'de, interest and attorney's fees.
IMPORTANT !Application is hereby. made to the Director of Building and Safety
for a permit Isubject to the conditions and restrictions set forth -on his
application.
' 1. Each persron upon whose behalf this application is made & each person at
whose requgst 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 perm t 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 lave read this appHcatiori arid 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 i spe tion purpogS,
I .-Signature (O i ner/A ent Date _
BUILDING. PERMIT PERMIT#
DATE VALUATION LOT ffill-JID 2, TRACT
JOB SITE .dD
ADDRESS
OWNER CONTRACTOR /DESIGNER / EN INFER
XY T.; BR(MIER,111C '.MLt,1:i1( GIME RS INC
73-121FRED WAWNGr 0100 733.-121 FRED WAR.I IOT
0.100
FIALM DEISM CA 92260 PJU t+1T MOM
Cit. 92260
(100)4.74.9699
17BIA 3832
USE OF PERMIT
i I
3FD - LOT 106, BELL?i?nA PERP,9IT DOES NOT INCLULSP: `BILE) X
WAL,L'.% POOL, SPA OR IJPRiti'EWAY APPROACH. 75 o III DU TIt I+i'Ttj
:; , ......
I+I.N CHP.CI{ FEE wJ1JL .1'L1 MU1L'('1PI F: L:;SIUAAIGE OR M1L :IaAUT.PE
CUSTOM CONSTRUCTION 3 04ij.00 SF
PORCf11PATIO 231.00 SF
f: 1AitA(4W(;ARPORT G23jA0 SIF
MST.124AM C09f OF C(r0RTJC'H0ff2a2,7A0
€1
pmwrFrE g'i7 iNuuy
CONSTRUCTION FEZ, 101-000418.000 511175.00
PLAN CHECK ISE 101-000-439-318 i $2M.25
MECRANICALFFE 101.000-42.1.000 ! S1J,50,00
ELF-.CTRICAL FEE 15
PLUMB1140 FEE 101-000-419-000
STRONG )AGITION FEE - RMSID • 101-000-241-000 $25.27
OkADIAtO FEE 101-600-423-000 ; $15.00
DEVELOPER { IMPACTFEE $2,405.00
ART 1N PUBLIC PLACES - RES112'1'0-000-44 5-000 $131,78
SUB-'r(3'TAL.00WJTPc.0 `101`TAND PLAN C''I1f3CK
$4,543.70
LE 13 PRF. -PAID FFIES
$0.00
13
,,.
R C.EIPT
DATE tiY
BY
DATE FINALED
INSPECTOR
Owner
CITY OF LA QUINTA
BUILDING & SAFETY DEPARTMENT
777-7012
,"`INSPECTION REQUEST LINE
,' 777-7153
TOLL BROTHERS, INC.
Contractor TOLL BROTHERS, INC.
Permit Number ' 0311-052
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
50-445 LOS VERDES WAY
JOB ADDRESS C qV"s„Q -
SFD - LOT 106, BSE -A. PERMIT DOES NOT
INCLUDE BLOCK WALLS, POOL, SPA OR
DRIVEWAY APPROACH.
TYPE OF INSPECTION I DATE I INSR
TEMPORARY POWER
SETBACKS
U/G PLUMBING / WASTE
U/G ELECTRICAL/ GROUNDING
FOOTINGS / STEEL
CONCRETE SLAB
• • •• - • ::• l
-•• PRE -ROOF / ►i'
/►i 07 TO
FR'MING COMBINATION
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH MECHANICAL
INSULATION -moi
COVER NO WORK LIN TI BOVE SIGNEZ
INTERIOR GYP. BD. DRYWALL
EXTERIOR LATH
GAS TEST
SEPTIC ABANDONMENT
SEWER CONNECTION
SEPTIC /GREASE INTERCEPTOR
MASONRY INSPECTIONS
FOOTINGS / STEEL
BOND BEAM
POOL / SPA / WATER FEATURE INSPECTIONS
PRE-GUNITE / SETBACKS
U/G PLUMBING
U/G GAS
U/G ELECTRICAL
PRE -PLASTER ALARMS / BARRIERS
FINAL INSPECTIONS
TEMP. USE OF PERMANENT POWER
ELECTRICAL
P9111111111111BING
M WANICAL
PUBLIC WORKS DEPARTMENT
COMMUNITY DEVELOPMENT DEPT.
FINAL / JOB COMPLETED
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING