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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
728102 B 1.2C 9r30104
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.
SecI have and will maintain workers' compensation insur,aa cue, as required by
tion 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 OLDALI�IIDLICINe, gI Policy No. Wft!ill�°ii6i1S3
(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, I shall forthwith comply withithose'pr v.9iorr 1-1
Vie: �A (7-) 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 a permit subject to the conditions and restrictions set forth on his
application. I
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 /foK inspection purposes.
Signature (Owner/Agent) %��1�`l`�'r+!:C Date
BUILDING PtRMIT PERMIT#
DATE VALUATION LOT 04M435 TRACT
$107,10).70 6 29323
JOB SITE APN
ADDRESS 751-86513ARMONA I)IUVI•. 6.09,380-024
OWNER CONTRAG TOR / DESIGNER / ENGINEER
LENNAR H OWS OF CA,i.ilvtifRNIA Lk NNAR HOWS 0-F CAUFUR3.32A
78.401 C IRC3HWAY I Ill 78.4.01 C YUGHWAY I I I
LA►QCTWTA CA 92M 1A QUINTA CA 92233
(360)777-0131 CBI.# 34.34
USE OF PERMIT
1
WNGU, FAMILY'.TAV [.L%. G
SPD . LOT 6, PLAN IC. P RKIT DOES NOT INCLUDE BLOCK W.AI V,4
Ptu_)I, SPA CC6 CJrSVf^i1ii _ APPROACH
TILACI' CONS` RUCM14 11006.00 SIi
POIZCWPATIO
53,00 SIF
IC,,AE��f (MC,ARPORT
425.00 SF
x5r1wW1`2D CO .r€ T Wr C0111ST UC -1,10H
1.0 7,100.70
CONDMILIC'TI N FEE
101.000-118,000
$667.50
PLAN CHECK FEE.
101-000-439-318
$510.513
M CIiANICAL FEE
101-000.421--000
$47.00
91.8-CTRYCA.L FEE
101-000.9120-000
$ You l
PI,iMBING FEI4
101-0100.413=000
$140,73
STR(iNO MOTION' IrZFE- , REr,SED
101-000-2$1-000
1110.71
(TRAD1140FEE
101.b000-4-23.000
sis.oa
DEVELOPER IMPACT F -RE
113,405. 00
;OHMMUTrV17ON -AND PI A9 CIM419 $3,,941.67
n• LESS P:RE-PAID• r 1I
I
MAR 2 4 2004 R MWH FOES DUF. Now
CI'e a OF LA Q1(II, I aA
FIP9AN1Ct DEPT. --
RECEIPT DATE �% BY , / DAT IN ED J/ INSSPPEC OR
1.1111k&121 =144061,
, e 3 ,1°
*1 0101
OPERATION
DATE
INSPECTOR
OPERATION
DATE
I INSPECTOR
BUILDING
APPROVALS
MECHANICAL.APPROVALS
Set Backs
Forms & Footings
Underground Ducts
Ducts
Slab Grade
Retum Air
Steel
Combustion Air
Roof Deck(-_
_ _
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
_
ti
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wali Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
_
Final
Final
POOLS - SPAS
BLOCKWALL
APPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Ping. Test
Final
I I
Gas Piping
PLUMBING. PPROV L
Gas Test
Electric Final
Waste Lines
/
Heater Final
Water Piping
k9
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
/e>r
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit Ole
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)