9806-239 (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
til ti is ,ttt;:�ai
/Date/ Gy% Signature of Contractorx � � ^�•
OWNER -BUILDER DECLARATION
I he affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) 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
Date f 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 carrief & 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 L should become
Subject to the workers' compensation provisions of Section 3700 of the Labor
Gode, I shall'forthwith comply with, those provisions.
/Date: 14¢ Vs'_ f ' Applicant "'r %' tk�2,"": /
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 atV
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. r
� r
Zature (Owner/Agent) /• r T-'% Date
PERMIT # CONTROL H .
BUILDING. PERMIT
DATE VALUATION ' LOT' j9 r TRACT
�l3 28029
9
w..�-
_
JOB SITE
ADDRESS 44415_QAitAi flt e ► >,
�1�d {��% -�1{f�
OWNERf
CONTRACTOR DESIGNER
11 r t pf�i1 y t J 1 t p♦
A 1
�.. � g:.i.ir 'i#1 vl.`,j 1'l.)�ia.. icy i�v f...
w/ENGINEER
(/y
1a�er�i'�i'rfi,•iii���.flJwi ] v:�.1f:., L.il•l IV'�♦3 .C�.y9�151i,..� ii VrS,-..
t :viiiAVE. OVIBJ �[.AU,5 ..
7i•0t7.r"*tV.E''.Ot: HE'VA1IVS
E'AirM DESE11,0' 92TH
PALIM. DESERY CA 922H.
(7ff115-2tyN +_.6'si.,lj 5183
USE OF PERMIT
ii1.3. -
:l ,D - PH, I,..Wl; 37, 111,60 '_tAk M—KNICt DOES NOT WC"LUR3£3 BLOCK
WALiJ3 CA t"tai iL. PLAN C:0t.;C'K... f3f', RWLtC`E:D 7,14, V01.2 �iCli: l lTH:ts
fS31 ANC:Fa Or S,AAB3, PLAN `s YR76,
63t3.0i)
C:0Nti11 t3,tJf 7M0N H13 101-i1W-418-000 $776400
Ruku duce w. !,Itl�, 101.000-43941.8 $165,49
X•si 1i;;1;1'IRCA-L FRE 101 -000-421�000
I .i:C; f tt%t;Ai : 3 f i-t�iit3-42Q S150,48
;t'.t.o.fbT.F.r w.FEA, L01 -t10 -419-00I
'f'Ott`?Tv�Gi>`?�''+;!`iG��i!�.�t3E ��'>!3� ;.ti4.{)t�t)••��-(�t3�_ ��3.SF;
..
fJr..aD;i 40111 o 10 1 -4,213-00-0
��f[ ie ►�� fit+>:E��r�ar:t r °225-000-44-35-342'
PRr_1CV4E, PLAN
�; a��'!' fY*� 1''�3f?II�•' �'3dA�`1 � �:��9�+ S9s339
.t,•i�4fy:�55Nti!)ff
SF C"�' fJ �ND.P�:�AN C1 Cit.>r
$4a0 ,8`
• :. Uss,S ''Sue-(PA:ID F,; ;.,'�3
%0.00
JUL•0•9 199
' . - `t`l)' 'A.i:. $"i! 21. '��'�' �: ��i tALf 1\1f.�W
'$�f;.til!46,83
�*�/• y�^r� �[{: f• t'
.1A it ll . �O 'J� !- f � 'L: � ` h �tj �' �,• .
_
RECEIPT
DATEBY'
DATE FINALED
INSPECTOR
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
_
/2_/6 -Qfj .�.
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
Exterior Lath
D - Int. Lath
` /II
_
Final
Final
POOLS - SPAS
BLOCKWALL APPROV LS
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
_
, T�
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
�,�.
Pool Cover
Sewer Connection
��% Q,
Encapsulation
Gas Piping
Gas Test
w S
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS_
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbctures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
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
697117 B 10/31/98
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. 70.44, Business & Professionals
Code).
( ) I am exempt under Section , B&P.C. for this reason
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION
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.
STATE FUND 467-98-0000120
(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: 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 Cuinta, 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
X --'/Z 146
PERMIT # CONTROL #
BUILDING PERMIT
9806-239
DATE VALUATION $138,556.40 LOT 39 TRACT 4028
JOB SITE
ADDRESS 44-875 CALLE PLACIDO
APN 604-071-007
OWNER
CONTRACTOR / DESIGNER / ENGINEER
OLIPHANT AND WILLIAMS ASSOC., INC.
OLIPHANT AND WILLIAMS ASSOC., INC.
77-900 AVE. OF THE STATES
77-900 AVE. OF THE STATES
PALM DESERT CA 92211
PALM DESERT CA 92211
(760)345-2626 CBL# 5203
USE OF PERMIT
SFD
SFD - PH 1, LOT 39, PLAN 3AR. PERMIT DOES NOT INCLUDE BLOCK
WALLS OR POOL: PLAN CHECK FEE REDUCED 750/9 FOR MULTIPLE
ISSUANCE OF SAME PLAN TYPE.
TRACT CONSTRUCTION 2.292.00 SF
PORCH/PATIO 120.00 SF
GARAGE/CARPORT 638.00 SF
ESTIMATED COST OF CONSTRUCTION
138,556.40
PERMIT FEE SUMMARY
CONSTRUCTION FEE 101-000-418-000 $776.60
PLAN CHECK FEE 101-000-439-318 $165.49
MECHANICAL FEE 101-000-421-000 $".50
ELECTRICAL FEE 101-000-420-000 $150.48
PLUMBING FEE 101-000-419-000 $211.50
STRONG MOTION FEE - RESID 101-000-241-000 $13.86
GRADING FEE 101-000423-000 $20.00
INFRASTRUCTURE FEE 225-000-443-342 $3,081.61
PRECISE PLAN 101-000-441-345 $25.00
ART IN PUBLIC PLACES - RESEC 701-000-255-000 596.39
SUB -TOTAL CONSTRUCTION AND PLAN CHECK
.$4,606.83
LESS PRE -PAID FEES
$0.00
TOTAL PERMIT FEES -DUE NOW
$4,606.83
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR