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LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
;ihapter 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
-
Datea �^`� �?�' Signature of Contractor-
OWNER-BUILDER
ontractor
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:
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' compensationrprosioris of Section 3700 of the Labor
Code,Tshall forthwith comply with thomprovisioi
pate: '. '.2da-Applicant_fez_., - ✓�d�fs
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) <'U'Z Date =&.
BUILDING PERMIT PERMIT#
DATE VALUATION LOT TRACT
JOB SITE APN
ADDRESS
OWNER CONTRACTOR/DESIGNER/EN (NEER
78<495 C;ALM" Tt "IC 0 73 097 CC/MMY CLL<t DMZ ME -2
1,&(�Y3N'. A CA 92M PAUA E�Mt."s' CA 92260
(760)3604433 MIA 4968
USE OF PERMIT
:31 V 2.:5' CIAKDEN 'Sell IoCI ;E XC.1114DALRD
$1 X.3"e6'Wn4;YDW. NC'E
CPT, WOOD PNCE
3L00 ly
CaNSTRUC.'T1014 MEE 1011-000-418-,000 $1.5.00
SUD-7D'3":N L Ci' N `fid UCI RM tti.WD TATA CIMCK
L',633 PRE-PAIDFM9
TUTALFTINWr KETS DUE NOW
RECEIPT DATE, % BY D I L ) INSPECTOR
200
$15.00
$0.00
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
Ext'erior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
? _ ' >
5
Electric Bond
Footings
�/ ji <
Main Drain
Bond Beam
—
-/
Approval to Cover
C
Equipment Location
Underground Electric
Final
_a =Q r S J
Underground Plbg. Test
Gas Piping
PLUMBING APP 'OVALS
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
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
Final
Utility Notice (Perm)
TOTAL CONSTRUCTION
73-091 Country Club Drive, Suite A4-2
Palm Desert, CA 92260
NAME/ADDRESS
Rosenow Spavacek Group, Inc.
John Yonai/M chael Garcia
540 North Golden Circle Suite 305
Santa Ana, CA 92705-3914
Estimate
DATE ESTIMATE # t
2/26/2001 498
_2,33
J
PROJECT
'z 52=985tCarranza:l
DESCRIPTION
QTY
RATE
TOTAL
Landscape -Garden -:Walls :3—S L #.
8,286.00
8,286.00
Paint `
2,800.00
2,800.00
Address Letters
100.00
100.00
Electrical / _ /
%i�
600.00
600.00
G sulated w/opener l,(�
960.00
960.00
WoodemFence Steel Gate over existing wood fence w/29 LF of new posts & tails.
4,000.00
4,000.00
ves & walkways
500.00
500.00
HVAC - Remove and dispose of existing 4 ton Payne Heat Pump Split System, to be
4,080.00
4,080.00
replaced with a new 4 TON LENNOX High Efficiency 12 S.E.E.R. Heat Pump Split
System including Lennox Value 12 Condenser 12.3 S.E.E.R., Lennox Fan Coil Model
C1330M46, and sheet metal platform Cap including connection to the existing
refrigerant lines and existing electrical. Connection to the existing supply and return
ductwork. Pressure test on the existing lines and equipment for leaks. Condensate
drains. Line voltage and low voltage wiring. Start-up and test.
WARRANUES: 5 YEAR COMPRESSOR - I YEAR PARTS.
Permits, clean up and debris removal.
350.00
350.00
TOTAL
$21,676.00