9903-300 (SFD)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
j -2129/00
D4t'e..: f f {' 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 conseni 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 nAle completed if the permit valuation is for 8100.00 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
subject1to the workers' compensation provisions of Section 3700 of the Labor
C90e`I shall forthwith comply with those provisions. r )
Ate. k^ —/- .-?Applicant
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 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 pursuan to
any. permit issued as a result of this applicaton agrees to, & shall,. indemnity . .
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null acid 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.
Ignature (Owner/Agent) * '" Date !C rf .
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 9903-300 _ TRACT
$J2i;251.90 20 211890-0
JOB SITE
APN
ADDRESS
7M'20 LIGA
1 769-680-020
OWNER CONTRACTOR/DESIGNER/ENGINEER
DESERT HOUSING Li,C CKrFLLUS RESIDENTIAL C01VINIUi+l1'I' ES.
PjMK PLAZA STE 400 5 PARK PI,A&A, SUi'IiY 400
1PINgNE C.A. 92614 1.R4'INE CA. 92614
(949)'251-6100 C$L# 5072
USE OF PERMIT
i
a ,
r i3. LOT# 20, PLAN 3CR-M .I�..Sti4I1T DOES -JOT INC`i WEE BLOCK
SPED *
WALL 001 Pool-
ool—{JUST
OM CONS7'£tUC PION 3,879.00 3
CUSTOM
PORCH)PATiO 310.00 SF
GAR AC£IC.ARPG3,If`'1 63.00 SF
t#:�TI1t A E0 COST OF CONST R1.IMION
321,2$1.91
Pic, Rs I FEE S1.iMtNtARY
CONSTRUCTION %-Re 101-000-418-000IA 16:,50
Pi -AN CHECK FEE 10 1,000-439 319 910 59.f37
AVICRANICAL'FEE 101-01)0-421-(300 $174.00
EL -E RICAL,FW, 101-000-420-000 $235.03
PLULN181140 VEE 101-000-419-000 $229-25
STROiJCY MOTIONFU - RESM 101-000.241.000 $32.13
GRADING FEE 101-000-423-000 $20,00
1 VRAS'I`tVUC'ttt'ArR13 F M $6,000voo
A.R'1 '1N PUBLIC PL AC FES -R1f Tr. 701000-255=000 1553.7:3
6 ,
SUBTOTAL CONS77RUCUO.N .A .N f.) PLAN CHECK
$9,769.91.
LESS Mr. -PAID FEES
$0.00
MAY � :,41999 `�OTAL'VERIM FEE$ DUE NOW
59,769-91
N
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Ai
�R�ECEiPT DATE k
B f
t
DATE FINALED
INSPECTOR
NC
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
C
Underground Ducts
Forms & Footings
-7
Ducts
Slab Grade
—
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
OX 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
tE�
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
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
- 5 - -- <
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) ` .-.
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Nottage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final N
Utility Notice (Perm)
COMMENTS: �^ I �/�
6—l' C /. i2 r`'L�
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