0005-186 (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
597117 B MC 1101311W
Date
Date Signature of Contractor'�'r-n-�,.�-�4 a .'j
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.
>40-1 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 STATE FUND. Policy No. 467-99-0000120
(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 provisigns.
Date: Y,ZQ Applican J �{
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 io,
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) !�//Z%Date f -rz,
NIM
BUILDING PERMIT PERMIT#
000.486
DATE VALUATIONLOT TRACT
$138,556A 99 25-91,
JOB SITE
ADDRESS 44-700 CALLF PLACIDO
APN j
604^:328-•OUh"u
r
OWNER
CONTRACTOR / DESIGNER / ENGINEER
r
OLSPHA NT.AND WII.LJA`MiS ASSOC., INC.
OLIMANT AND WII.�T %At&S .ASSOC., ?NC.
77-900 AVENUI3 OF THL, STAT.E,S
77.900 A:VZtTI~LFE, OF TI -M— UrA lln
PALM1:7L,.%Wf CA 92211
PA1:MDESEXT ,CA 92211
(760)345=2626 CBL`J5203
USE OF PERMIT
SWOLB FAIt9L►'. Y DVIMUNO
SF0,LOT 99 PLAN 3A / PERMIT D1D&,S NOT INCLUDF, BLOCK W.P.M1 OR
POOL. ALL OTHER PERMITS RKTKb CT 7:1V5:t EDUCTION TO PUMN CHWK
FEE FOR MULTIPLE ISSUANCE OF RAW PLAN TYPE. ;
TRACT CONS',IRUCT1CiN 229100 SF .
PORCHfPATIO 120.00 SF
0ARAWCARPORT (SFj 12aSO4,H9
EsT.CIUTATED COST OF CONSIlWanoll
139;556A!D
P'ERl4m MWhWARY
CONSTRUCTION FRE, 101-000-4I6.000 rmoo
PLAN f HWX MAA 101-000-439-316 $IC•2.88
JMT CI +YJICt1i.1 B 101-000-421-000 S66,50
LLLCTPJC.AI, FEE 101-000-420-000 Ifi1sU.a0
PLUMB1140 FEF, 101-000.419.000 8169,so
STRONG MOTION FEE - RESID 101-000-241 -OaO $13.86
ORADINO ISE, 101.000.423-000 $20.00
DEVELOPER IMPACt FLEE
a
�
F
1
s 9
SUB TGTAL 'C0'9'i'i UC'fJ_ON AM PLAN CHECK.
$3,266.20
LESS PRE -PAM FEW
S0100
TOTAL MOW FEES DUE -40W
24)
JAN 12 2001
.3 •d C v0 LNab UU0
`
RECEIPT
DATE !
BYn
�..�
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs ; [
Forms & Footings G
�P Q?i
Underground Ducts
Ducts
Slab Grade I
Return Air
Steel (
Combustion Air
Roof Deck
�H
Exhaust Fans
OX to Wrap [
S
F.A.U.
Framing
Compressor
Insulation' i`
Fireplace P.L. [
Q (_'{ t�'0�
Vents
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall;
Exterior Lath
Y/t
Drywall - Int. Lath 11
I
};
Final
Final II -O /
BLOCKWALL APPROVALS
POOLS - SPAS
steel
Set Backs (
Electric Bond
Footings i I
Main Drain
Bond Beam i
Approval to Cover
11
Equipment Location
r
Underground Electric
i }
Underground Plbg. Test
Final i {
Gas Piping
PLUMBING APPROVALS
l
Gas Test
Electric Final
Waste Lines
02
Heater Final
Water Piping ; I
Plumbing Final
Plumbing Top Out;
Equipment Enclosure
Shower Pans [
O.K. for Finish Plaster
Sewer Lateral ; i
1
Pool Cover
Sewer Connection {
Encapsulation
Gas Piping I
Gas Test
��C
Appliances 1,
Final
I
{
Final
Utility Notice (Gas) I
ELECTRICAL APPROVALS
Temp. Power Pole I
Underground Conduit
Rough Wiring I I
Low Voltage Wiring
Fixtures ] I
Main Service I
Sub Panels
Exterior Receptacles
G.F.I. {
Smoke Detectors I
Temp. Use of Power
Final l /
Utility Notice (Perm)
COMMENTS: