0311-125 (SFD)CO
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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
B BIC 131105
Signature of Contractor . x6
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).
( ) 1, 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 ',51i yyyy,,��ppq Policy No.
p
(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 for w comply with those pr v sions.
'Date: / ) `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. ,
• 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. /�
I o .
Signature (Owner/Agent) Date—,
BUILDING PERMIT PERMIT#
DATE - - VALUATION LOT 03.11-1._5 TRACT
$1.4 7,239.70 161/ 29134
JOB SITE ti
APN
ADDRESS
4it-4 a;, MG ROM MM
S -io. ofiI
OWNER
CONTRACTOR/DESIGNER/EN (NEER
lit:A1*1(,-11 LA Q1TirxfA COVE, LII
°? V48 WFS1 Hi'1i.3MaG•;iNC
9968 i•:t1 E11c` al IMI r l OM". i 02
9968 4: .1'-. � BT �I T4102
SAW 1'D 30 CA 921::1
SAW DIR00. CA 92131
(858)653--4003 C'1116 4972
USE OF PERMIT
81.40LE FAMILY MEWING
FD - LDT 167 PIJI 41 IA. PERMIT DOES NOT INCLUDE BLZIC:K'WAI .lS„
P004 SPA OR t'iRUEMAY"PROACH
TRAVT CONST'R.'UOTION 21306,00 SY
PORCH/PATIO 339.00 Sit
QARAONCARPORT 072100 f1;"v
ESTIMEATO) C'€ YN OF €:'OMMKILIC"Mi
CONS'i'RIT01.1'10}7FER 101.00€ -416.000
PLA14 CHECK FEF 101-000-439-318 $693.611
M C:.HANICAL FEE, 101.000.421.-000 $104100
ELF, ;1PR-1CAL Fitt? 1.01.-000-420-000 $145.45
PI,LiT,9T;THOWE 101.000-419-000. $174,50
STRONG MOTION FEE - RZS'!D 101-000-241-1300 $14. n
ORADING FUX 101-.000.423-000 M5104
1701'L:'I.S PHR IA71RkCT FFX $7,40.5.00
WE DEPOSIT 101-000.439.318 -050.00
PRE -PAID FEES
-$750.00
tFIEB�3S
0 6 2004 . MI.. PEWA r.C' , KS TYLE now
CITY OF LA QUINTA
FINANCE DEPT.
$300,77
RECEIPT
DATE _
BY i
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
_
3 - $��
Ducts
Slab Grade
3� _
Return Air
Steel
__:�;-5 3 ,,-
Combustion Air
Roof Deck
- 2
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Insulation
-/�
Compressor
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 Plbg. Test
Final
I I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
�L%�i
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 -y
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm) O ,
COMMENTS: ;z� ccvfD
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
701039 B Inc 1131105
Date 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 andwill 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.
STATE FUND 000-1648813-02
(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 with those provisions.
Date: ADolicant
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, 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 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) Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 0311-125 TRACT
$147,239.70 167 29436
JOB SITE
APN
ADDRESS
48-431 DIG HORN DRIVE
658-140-001
OWNER "'
CONTRACTOR/DESIGNER/EN INEER
IVANHOE LA QUINTA COVE, LLC
TRANS`.WEST HOUSING INC
9968 HIBERT STREET, STE, 102
9968 HIBERT ST ME, 102
SAN DIEGO CA 92131
SAN DIEGO CA 92131
(858)653-3003 CBL# 4972
USE OF PERMIT
MNGL E FAMILY DWELLING
SFD - LOT 167 PLAN IA. PERMIT DOES NOT INCLUDE BLOCK WALLS,
POOL,, SPA OR DRIVEWAY APPROACH
TRACT CONSTRUCTION $386.00 SF
PORCH/PATIO 339.00 SF
OARAGE/CARPORT 672.00 SF
ESTIlVIATI D COST OF CONSTRUCTION
147,239.70
PERMIT FEE SUMMARY
CONSTRUCTION FEE 101-000-418-000 $807.50
PLAN CHECK FEE 101-000-439-318 $683.60
MECHANICAL FEE 101-000.421-000 $105.00
ELECTRICAL FEE 101-000-420-000 $145.45
PLUMBING FEE 101.000-419-000 $174,50
STRONG MOTION FEE - RESID 101-000-241-000 $14.72
GRADING FEE 101.000-423-000 $15.00
DEVELOPER IMPACT FEE $2,405.00
FEE DEPOSIT 101.000.439-318 -$750.00
SUB -TOTAL CONSTRUCTION AND PLAN CHECK
$4,350.77
LESS PRE -PAID FEES
-$750.00
TOTAL PERMIT FEES DUE NOW
$3,600.77
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR