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9806-235 (SFD)LICENSED CONTRACTOR DECLARATION I hereby affir"m 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 Cross, and my License is in full force and effect. License # Lic. Class Exp. Date Q1'�i1J 1 IW108 ,/Date f�tf ff 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 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 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 Xde, I shall forthwith comply with those provisions. e: i/r`�'� Applicant :)°i. �,( $..C•t.(.fr: 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 t 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. Signature (Owner/Agent)'tf� s X17 Daterf��' 1� BUILDINGPERMIT PERMIT Ji CIONTROL# - ��w 8®23 DATE7/ ' VALUATION LOT F'9 > TRACT (( �;CFf14,7y7:F)S x , t JOB SITE""" ADDRESS �% :7t�ll�:ii�y �FE� �� r` 604-071141107 OWNER CONTRACTOR / DESIGNER / ENGINEER !i1l..Y.1�tMt',9i��i•1A '.11 1A�.tt tC:"'�� a.F + a,t �e alar. :[Y. t ir.s•i ..,� :.{�... �l ii 1.1n .1� t' 1ht i11 1' r IS A. SOC 4, IAIPHAt r t��:� :. 7a.wr t�V`l:.'1 �:� • id .� A INC,v l'�.C4)t� lkti �, n4►3 't jdl✓, )S}j t�:l%.1 7,-90 ri A V& d1 i fMITES PALM Q3118l:lZY CA, '.•,2111 't•'i\f,,..M DESENT I T CA 92211 r i 7tt1)'tZ:f S-7fi GIN,# 503 USE OF PERMIT ;1 i> - triI i,;1 aim J-5, PI.P.N Irl. MI.IN07 0025 X-01 INCIWal:"s 3i..c;h"`1. Vdl\LLS4 104< I"'C3OL. PLAN fro Fs atls[)UG'1`4:t 7Wa 1 ('Jk MUI.11PLE 0.38 )AKCIF, OF SAN11 KAN TVIY:. � S �^ [ [ { ( l �f }�j' '�,* ry�0 rye(, 17).U.f" 1' 4 �Y�L�Ib 9'f.\ i.�J 7�% 1 tl I itC•t, 0 3 96.00 S I QAR.A()FVCARPC`.Kr '4%,WJ S. 9AST11i%.A ED 0.. :.3'4 OP C.l.rl ` SI SR`Yra,UION 1,04,7 /,80 H'9+.;P.40T PRE S4JArRMA$ Y CONS'11t['tC'°.(`4.(,°:hi,FEE 101-000-418-000 $657,03 i>f:�idl,tll�C��:4+r^:f� � .. � ._10�-�}��-�;�il��•d�iC_ .. . . .-�I��,1�9 "' : .._. f4�a4.tI14t41C;.AL RE iii �141-/a`i i -{f00. $47.00 - 47.00.FE9 FE 9M28AS j't:'4JfkC13t]v`i� FHE �iTl3.(_iNti:ti��f�t`3'�1Rf 3"Ti f11?`jl.!� �t�i-�t4)+�=5} <7i�9i �1Ci.4f3 GRA6111140 rxE 101.000-423- 300 8210.W %'i�RA.'nkwr:`.i'tW6 ME b 225.00-443-342 i?I I�.CrS1 YltAAi d. • t;.'ART f.N=YL�'(q�IC. Pi,�1C�� - �i.1:.15l� t)�"�(1(i-�5 ft1?0 _ 3!3,b'�► A_N CHECK I 1'( TA Ia CCLN9 RI�IG")101 A �i±�y� � ^P�I l 19 MILE- PIVEYFFE Is r :.. 1hr��,(��/��. p.�i� a PE �E�¢(yypp,�y-y���tt.. q•, yip, lL yyi�� ....7. JUL 09 Iv� ,. ,'1111.� ri.r Y1�4'..1119�.t.A!' N` EM.S DUE NO �.�,,:1(�D�F: 19 RECEIPT DATE BY DATE FINALED INSPECTOR 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. 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. 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 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 E BUILDING PERMIT PERMIT9806`235 CONTROL/t DATE VALUATION $104,757.80 LOT 35 TRACT 29-023 JOB SITE ADDRESS 44755 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 35, PLAN 1CR. PERMIT DOES NOT INCLUDE BLOCK WALLS OR POOL. PLAN CHECK FEE REDUCED 75% FOR MULTIPLE ISSUANCE OF SAME PLAN TYPE. TRACT CONSTRUCTION 1,736.00 SF PORCH/PATIO 58.00 SF GARAGE/CARPORT 4%.00 SF ESTIMATED COST OF CONSTRUCTION 104,757.80 PERMIT FEE SUMMARY CONSTRUCTION FEE 101-000-418-000 $657.00 PLAN CHECK FEE 101-000-439-318 $140.19 - MECHANICAL FEE 101-000-421-000 $47.00 ELECTRICAL FEE 101-000-420-000 $128.18 PLUMBING FEE 101-000419-000 $188.75 STRONG MOTION FEE - RESID 101-000-241-000 $10.48 GRADING FEE 101-000-423-000 $20.00 INFRASTRUCTURE FEE 225-000-443-342 $2,339.69 PRECISE PLAN 101-000441-345 $25.00 ART IN PUBLIC PLACES - RESIC 701-000-255-000 $11.89 SUB -TOTAL CONSTRUCTION AND PLAN CHECK $3,568.18 LESS PRE -PAID FEES $0.00 TOTAL PERMIT FEES DUE NOW $3,568.18 RECEIPT DATE BY DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts S10 -Grade Return Air Steel Combustion Air Roof Deck!� Exhaust Fans O.K to Wrap F.A.U. Framing 2"—.24 — k 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 / _0%_g Final Final POOLS - SPAS BLOCKWALL APPROVALS 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 Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection Y Encapsulation Gas Piping Gas Test Appliances Final COMMENTS: Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power .r Final Utility Notice (Perm).