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SATT (9808-006)50880 Mango 9808-006 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.A4074 . Class Exp. DOe30199 '/Date / ?,-;i nature of Contractor n" p 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. (V)' 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 carrl i er( & policy no. are: M'' Carrier .'1ST.RJAL.f1b DENi f1 Policy No. ,'1441=4 (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 -1 -shall fo hwit comply with those prov lions. 'Date: Ef y Applicant n n -A•«, 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. r Signature (Owner/Agent) II , -v. µ Date. T v Tt BUILDINGPERMIT PERMIT CONTROLN Z5209'240;5.20 37 x%' DATE' VALUATION LOT TRACT :t JOB SITE -• Y4V fes.' l'V "') APN i3Jt- i !i/ ! ADDRESS WNER CONTRACTOR / DESIGNER / ENGINEER CAPITAL PACIFIC.' TIOL1'UNGS 1N:C CAPYFAL `f'.AC1F1C HOMES [KC 4100 MAC ARTHUR BLVD .9200 4100 MAC Ai l=IJR BLVD 9200 :Nf:i'VPOIC ' F11.sACH CA 92660 N PIWPOW ft1: YACH CA 92600 (714)622,8400 C€ II#F 6C—tW USE OF PERMIT 4N LF, FAMitY.Al'L'AC.HRD @•.A SFA. Y. t1dV ! 7' Yr yx t J`! A .1<L kJ'1 GrJ NOT V.C1 xv&, \ m OR k%00L. CUST011 CONS I eitir'"I'.iON .2,430,00 SF PvIcC1:U1'AVO 290.00 c,,:+.F,` OYARAMCARPO)Cr 627.00 8 PERMIT I FEE SUNFAI1.AZ3 y CONSTRUCTIONNSS 101 -.000 -418 -WO S1,024.50 PLAN CMM". FM 101-0100"4310-318 1&464,54 MECRANfCAi.:1'f:.23 101 -OW -421 -MM M.00 E..LEMUCAL M, 1.Ot-000-420-000 $150.84 PLUMFifN 01 FRE - 101-000-419-000 S167.15 S i 24520.2 Cr ' 0 0 (iitM)ING FEME 101-000-123-000 S20.00 1NFIRAS'IRUC'4'Ufi%R;3="s 225-O00-443-312 X1,623.33,. P'RECISti PLAN 1014)00.441-345 325.00 A r•:r e1 a :@fJ4 i..IC 7'S. ACr 5 •.121511: 701 -(fly -2s5-0570 S27X0 amt: ;fls1'r 101-Oilt3-439-3121 4750.00 SUB -TOTAL C''C)?`?',TT [tUC° L:CSN SNF) PLAN CHECK S7,239.R UESS PRE-PAIDRES 4750,00 TC1t'i'ciL PERMIT FS E'S i)i: E NOW $6,389.39 RECEIPT „i DATE l BY DAT FINALID INSPECTOR D . Z010 — INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs -IO=G� �i �� Underground Qucts Forms & Footings (,( Ducts Slab Grade 111 l�_oJ �'LLl( Return Air Steel Combustion Air Roof Deck r�=G�� �(� Exhaust Fans O.K. to Wrap �� F.A.U. Framing ,j Compressor Insulation �(G Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls .Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath Final Final l6_2c_ l% POOLS - SPAS BLOCKWALL APPROVALS Steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines _ _ �� �� Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection �OlOJ Q� Encapsulation Gas Piping Gas Test Appliances Final COMMENTS: Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power t Final Utility Notice (Perm) _ Building Address 50"wo Mailing Address 2526 a City Zip Cont Add Zip T4', at 4 4 Qum& State Lic. City & Classif. I Lic. # Arch., Engr., Designer Address Tel. City Zip State P. Lic. # P.O. BOX 1504 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 LICENSED CONTRACTOR'S DECLARATION I hereby affirm th t I em licensed under provisions of Chapter 9 (commencing with Section 7000) of DiJI Qr c t e Busin sand Professions Code, and m license is in full force and effect tv`f, ,. . t! .r. i. _s OWNER -BUILDER DECLARATION I hereby, ffirtt$ thatIl am exempt from the Contractor's License Law for the following r"son: (Sect 70311. 5, Business and Professions Code: Any city or county which requires a perrgil to construct,} alter, Improve, demolish, or repair any structure, prior to its issuance also req ds,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) or 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.) O 1 am exempt under Sec. B. ti. P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION 1 hereby affirm that I have a certificate of consent to self -insure, or a certificate of Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No. Company CrI py 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 thg 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 -of this city to enter the above- mentioned property for inspection purposes. Signature of applicant Date Mailing Address City, State, Zip BUILDING: TYPE CONST No. OCC. GRP. A.P. Number b-UM—sa CwArse Legal Description haat 241344-2 Plan 3A Project Description i at 37 Sq. Ft. No. No. Dw. Size 2747 Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Ann. 79 Const. 44-14,00 Mech. 78-00 Electrical -67 Plumbing -50 S.M.I. Grading Driveway Enc. Infrastructure ? TOTAL REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side Setback from Property Line FINAL DATE INSPECTOR Issued by: Date 614/90Permit Validated by: Validation: CCNSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. ® $ 2ND FL. SQ. FT. POR. SQ. FT. ® GAR. SO. FT, ® CAR P. SQ. FT. WALL SQ. FT. ® SO. FT. ® ESTIMATED CONSTRUCTION VALUATION $ UNITS MOBILEHOME SVC. POWER OUTLET YARD SPKLR SYSTEM BAR SINK ROOF DRAINS DRAINAGE PIPING DRINKING FOUNTAIN. URINAL WATER PIPING NOTE: Not to be used as property tax valuation BONDING FLOOR DRAIN MECHANICAL FEES FORMS I WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GAS (ROUGH) GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED OTHER APPJEQUIP. LAUNDRY TRAY AIR HANDLING UNIT CFM TEMP. POLE KITCHEN SINK ABSORPTION SYSTEM B.T.U. TEMP USE PERMIT SVC WATER CLOSET COMPRESSOR HP POLE, TEM/PERM 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/. c SEWAGE DISPOSAL SQ.FT.GAR ® 3/ac HOUSE SEWER REMARKS: 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 PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR' SETBACK GROUND PLUMBING UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING. DUCT WORK ROCKSTORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEQUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. $ plus x$ =$ LUMBER GR. FINAL INSP. FRAMING FINAL INSP. ROOFING REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATUREWINITIALS GARDEN WALL FINAL