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9806-256 (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 intfull force and effect. ` License # Lic. Class Exp. Date' ti�li,i.1. E _ ate J ��i �� Signature of Contractor - r11 `�' P� < 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 (Seca 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 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 nee not be completed if the permit valuation is for., 100 Ol0 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 C9de, I shall forthwith comply with those provisions r t,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. r 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 alf•Cay, 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. f �. I /nature (Owner/Ageht) Date—,; BUILDING PERMIT PERMIT# DATE VALUATION LOT �341f-25f► � TRACT 97 $ .134,373.110 t 25953 JOB SI ADDRESS 4,1460-C:ALU; PLACtDO Of APN 604-+071-007 OWNER _ CONTRACTOR/DESIGNER/ENGINEER OLIPHANT AND WILLIAMS ASSOC, INC, OLIPHANT AND WILLIAMS ASSOC., INC. ?7-900 ANM. OF THE STATES 779®0 Atm. OF'THE STATES PALM DESERT CA 92211 PALM DESERT CA 92211 (760)315.2626 C11L.# 5203 USE OF PERMIT r, S'FiD - P14 1, LOT 97; PLA& 2C. PERMIT DOES NOT INCLUDE BLOC. WALLS Olt .POO.t. P11.kN CHECK FEE- REDUCED 75° o .FOR. MULTIPLE r4.qqYrawrn7 n ...czAmr w Am Tvpy TRACT M4,STRUCTION Z-2*4.00 SF PORCH/PAT 10 150,00 SF GAR AGWCARPOR.`.I 13411,110 SF E,44T I MATE D COST OQ+ CORi&3'a`tLIC7fWN 134,37:3.181) PrERllI f' FEE x'31&URS' CONSTRUCTION FEE 101-000-44£1-000 $7612.00 PLAN CHECK FEE 401-M-439-318 $161.51 NIECRANICAL FEE 101-000-421-000 35330 hC I'1tTCAL :N`EE 101-000-4,20-000 3117.60 PLUA (SING M, , 101.01X-.494= $203.75 STRONG NOTION FEE - "R> SfD 101-000-241-000 $13.44 G1L'kf5fNG FEE 101-000423-000 $20,00 INFRASTRUCTUREFE, 225-000-443-342 $2,978.51 PRFW1SEPLAN � Idl»000-444-3<t5 $25-00 ART ISI PUBLIC PLACES 1,M -3 -ST 701-000-255-000 $85.93 i .. cd S 'Bi,�OTAL CONSTRUC11014 AND PLAN CHECK . $4,451.24 LESS PRI -PAID FEES $0.311) ),,TOT AL PERMIT FEE,* DUE NOW $4,451.24 ,RECEIPTDATE BY DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs e Underground Ducts Forms & Footings Ducts Slab Grade 4Return Air Steel Combustion Air Roof Deck - Exhaust Fans 0. K. to Wrap - 3 - 8 F.A.U. Framing $ 51-- Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath DW.vall - 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 Pibg. Test Final Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines - Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K for Finish Plaster Sewer Lateral 62 Pool Cover Sewer Connection p Encapsulation Gas Piping Gas Test Appliances Final Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Condtit 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} ;111717 7 COMMENTS: