BLDG (0309-212)54425 Avenida Martinez
0309-212
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
'Date's* '1 z• 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 issued. My workers' compensation insurance carrier & policy no. are:
Cartier EXEMPT Policy No.
(This section need not be completed if the permit valuation is for $100.00 or less).
( ) I certify that in the performance of the work for which this permit is issued,
I shall not employ any person in any manner so as to become subject to the
workers' compensation laws of California, and agree that ifI should become
subject to the workers' compensation provisions of Sectio n3700'of the Labor
Code <I -shall forthwith comply with -those prov.,Islons.'"a-,
_._ • O/ rte'$,,--°---: r" :.. ' _. .
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indem '
& hold harmless the City of La Quinta, its officers, agents and employ
2. Any permit issued as a result of this application becomes null and vo I
work is not commenced within 180 days from date of issuance of s
permit, or cessation of work for 180 days will subject permit to cancella
I certify that I have read this application and state that the above informati n is
correct. I agree to comply with all City, and State laws relating to the buil Ing
construction, and hereby authorize representatives of this City to enter pon
the above-mentioned prroppeeft for inspection°Purposes.
/ Date
Signature (OwnJY r/.Agent) ''d ry
BUILDING PERMIT PERMIT#
DATE VALUATION LOT (poq %1.2 r TRACT }
S784A0 9110
JOB SITE 1iebrd!L-wbp yylFZiJyy .[AA . ry7J.Y/I.€ 10Ai1••
ADDRESS
Amisi
APN
4M027 .
774
OWNER
CONTRACTOR / DESIGNER / EN (NEER
1tA.MDY SIT -LB
LEGACY HOMESy
P.01. BOX 696
47-750,ADAMS M- , Tfi2U
1AQT:iM'1A CA 92253
I..1+1,QN 11*r A. tom,. 9,7252
( 60)56#-71320 ('k3UP 02063
USE OF PERMIT
C3E)W--RAL DU1T.,UNG
UPPLIWEN d TO PERMIT 4 0307.00$ ADDINrll40 &Pi -SHIED TO SIDE
61< HOUSE
GAURAC3& ARPOR`I` 40,00 BY
EM3MAT.F.D COST OF C0198'1WIC111¢' N
CONSTRUCTION FIRE 101:-000.4116.000 $11.00
PLAN CHECK FRE 101-000-439-:318 $19.34 '
ELEt:TRICA.1. FEE 101-000-420-000 $17.30
SPROWN 1 MOTION "J!, F RMIT9 101-000.241-000 3,50
S1.YB-TOTAL C.0) S7RTIC7.7014 A140 PIAT C'H1? X
i
LESS PRE -PPM FM
SO'Go
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W.1.4
SEP 16 2003
CITY OF LA QUINTA
FINA
RECEIPT
BYr
DAT I LED
INSP R
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
O.K 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 Pibg. 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
t
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:
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CITY OF LA QUINTA
BUILDING & SAFETY DEPT. I
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FOR CONSTRUCTION
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*** CITY OF LA QUINTA
DATE: 9/16/2003
*** BUILDING DEPARTMENT'
LOG FILE NAME:
0309-212
JOB ADDRESS:
54-425 AVE. MARTINEZ
OWNER NAME:
RANDY BILLS
MAILING ADDRESS:
P.O. BOX 696
CITY, ST ZIP PH#
LA QUINTA
USE OF PERMIT :
40 S.F. ADDITION
CONTRACTOR NAME:
1LEGACY HOMES
CONTRACTOR ADDR :
SAME AS ABOVE
CONTRACTOR PH #:
SAME AS ABOVE
LOT/TRACT:
0
ASSESSOR PARCEL #
0
(C)OMM or (R)ESID : R
"BUILDING CONSTRUCTION VALUATION
UNIT UNIT $ TOTAL
GOOD CONSTR (SF)
0
77.90
p
AVERAGE CONSTR (SF)
0
54.30
p
PORCH/PATIOS (SF)
0
13.30
p
GARAGE/CARPORT (SF)
40
19.60
784
BLOCK WALL (HT/LF) 0
0
0.00
p
BLOCK WALL (HT/LF) 01
0
0.00
p
WOOD FENCE (LF)
0
8.50
p
SPRINKLERS (SF)
0
1.70
p
A/C -- RESID (SF)
0
2.90
0
A/C --COMM (SF)
0
3.50
p
CONTRACT
0
0.00
p
ESTIMATED VALUATION TOTAL
***SUMMARY OF FEES
UNIT
784
CONSTRUCTION FEE
21.00
PLAN CHECK FEE
19.34
PLAN CHECK DEPOSIT
0.00
MECHANICAL FEES
0.00
ELECTRICAL FEES
17.30
PLUMBING FEES
0.00
STRONG MOTION (RES)
0.50
STRONG MOTION (COMM)
0.00
TOTAL VAL
GRADING
0.00
784.00
DEVELOPER IMPACT FEE
0.00
PRECISE PLAN
0.00
ART IN PUBLIC PLACES (RES)
0.00
TOTAL FEES
ART IN PUBLIC PLACES (COMM)
0.00
58.14
Page 1
*** CITY OF LA QUINTA ***
JOB ADDRESS:
BUILDING DEPARTMENT ***
54-425 AVE. MARTINEZ
** ELECTRICAL FEES
UNIT UNIT $1
TOTAL
FLOOR AREA (SF)
0
0.04
0.00
GARAGE/CARPORT (SF)
40
0.02
0.80
ELECTRIC UNITS (EA)
0
3.00
0.00
SUB -PANELS
0
7.50
0.00
CONSTRUCTION POLE
0
15.00
0.00
SERVICE (AMPS)
0
18/37/75
0.00
SWIMMING POOL (EA)
0
30.00
0.00
SPA (EA)
0
15.00
0.00
FIXTURES
2
0.75
1.50
OTHER
0
0.00
0.00
PERMIT FEE
1
15.00
15.00
ELECTRICAL SUB -TOTAL
17.30
** PLUMBING FEES
UNIT UNIT $
TOTAL
POOUSPA (0, 1 OR 2)
0
21/27
0.00
WATER PIPING
0
3.00
0.00
ROOF DRAINS
0
6.00
0.00
SEWER CONNECTION
0
22.50
0.00
GAS PIPING
0
4.50/1.25
0.00
WATER HEATER
0
7.50
0.00
FIXTURES
0
6.00
0.00
SEWAGE DISPOSAL
0
45.00
0.00
LAWN SPRINK. SYSTEM
0
9.00
0.00
OTHER
0
0.00
0.00
PERMIT FEE
0
15.00
0.00
PLUMBING SUB -TOTAL
0.00
** MECHANICAL
UNIT
FEES
UNIT $
TOTAL
DUCT ALTERATION (FF)
0
4.50
0.00
EXHAUST, HOOD, FAN (EA)
0
6.50
0.00
HEATING <=100000 BTU
0
9.00
0.00
HEATING > 100000 BTU
0
11.00
0.00
EVAPORATIVE COOLER
0
6.50
0.00
COMPRESSOR <= 3 TON
0
9.00
0.00
COMPRESSOR > 3 TON
0
16.50
0.00
SWIMMING POOL HEATER
0
24.00
0.00
OTHER
0
0.00
0.00
OTHER
0
0.00
0.00
PERMIT FEE
0
15.00
0.00
MECHANICAL SUB -TOTAL
0.00
Page 1