9903-308 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions -of
1— Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
04 W Professionals Code, and my License is in full force and effect.
C) License # Lic. Class Exp. Date
�0
LU
ti W 63 72 5.2 8 "' N 1 021296201
Z ate �''1 d•�,� Signature of Contractor
�.0� f t..
J U � • OWNER -BUILDER DECLARATION
W.W 'r I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ a_ License Law for the following reason:
Z ( ) 1, 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
LO
' N Date - Signature of Owner
U` Q WORKER'S COMPENSATION DECLARATION
p Z I hereby affirm under penalty of perjury one of the following declarations:
un . O () I. 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 _ • Q performance of the work for which this permit is issued.
m
<, C) ( ) 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
.1— permit is issued. My workers' compensation insurance carrier & policy no. are:
:t• Z Carrier Policy No. w
'ROYAL. IN..S. Co. OF i PITC � Sy -2
g(This section need not be completed if the permit valuation is for 100.00 or less).
O I certify that in the performance of the work for which this permit is issued,
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
v Code I shall forthwith comply with those provisions.
te: � � � �f/ a Applicant—
Ra
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall S„b;ec+ ,..: mpl
.. ,.,... «�, cn,N,Gyer to Cririiinai penalties and civil tines 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
p.
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-purposesl.
ignature (Owner/Agent) Date I14YXI
BUILDING PERMIT PERMITk
DATE # VALUATION LOT 9903-308 TRACT
?� $277,022.80 47 24890-6
JOB SITE
APN
ADDRESS
79-45' LICA
769-70114)27
OWNER
CONTRACTOR / DESIGNER / ENGINEER
DESERT HOUSING LLC
CAML;US RES113ENTI.A:L COMMUNITIES,
S PARK PLAZA S"TE 400
S PARK PLAZA, SUITE 400
IRVINE CA. 92614
IRVINE CA 92611
(949)251-6101 CBLr ." 072
USE OF PERMIT
000 01 L- "C'. 44411 % Wr a "i "\iQ.
.SYD. LOTA17, PLAN XR . PLAN CIiEC'K FEE REDUCED 75D,46 FOR, .
Nf(ILTfPI.F 1S,SUANC'"E OF `;AXLE PLAN TYPE. iPCRMT 000 NOT YNCLUDE
BLOCK WALL Olt PML.
CUSTOM CONS'1RUC CiaN 3,328.00 SF
PORCWPATIO 31100 Sl:
GAR OFICARPORT 695..00 SF
M .O.I4iA. f ED COST OF CONSTRUCTION
277,022.80
PERMIT FEE SUMMARY
CONST:RUC'.t'101N FEE 101-000-418-0W) $1,262.50
PLAN CHECK FEE 101-000-439-318 $256.01
NXMANIC".AL FFE 101-000-421-000 592.00
F, LECT.RICAL .FEE 10.1 -NO -420-000 $206.88
PLIAISING FEE 101-000-419-000 86,50
uTia itiV lYiVI�AWik .CL'b ^• tt.tr•SiU i0f-090-241=000 $27..70
ORADING FM 10.1-000-423-000 120.00
1N- RA.SMUCCU.R2:E FEE 225-000-at43-342 $6,000,011
x R1 1N:RUBTACPLACES-;ltF.SIL' 701-010-24-11-000 W2,56
f , e
PAND L CONSMUC'I'ICIN AND PLAN CMICK
$€1,494.15
MAY 141999 ; HSS IRE -PAW -RS
$0,00
TO'iM :PE11AM FEV -S DUE NOW
$8,494.15
-a1Ty0FLA
_
RECEIPT
DATE
BY.j'y
DATE FINALED
INSPECTOR
(NC
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Z
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
O -
Exhaust Fans
OX to Wrap
Framing
_ �_ �61
F.A.U.
Compressor
G�
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
a
Drywall - Int. Lath
Final ev
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
6,- -
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) .e-/
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) ef!
COMMENTS: