0305-227 (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
640934 B 6/30/03
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 NATIONAL UNION Y Policy No. 7085309
(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
PERMIT #
BUILDING PERMIT
0305-227
DATE VALUATION $153.732.8o LOT 89 TRACT 30023
JOB SITE
ADDRESS 60-277 POINTSET11A PLACE
AP" 764-270-017
OWNER
CONTRACTOR/DESIGNER/EN (NEER
SHEA HOMES FOR ACTIVE ADULTS
SHEA HOMES
60-311 TRILOGY PARKWAY
81-260 AVENUE 62
LA QUINTA CA 92253
THERMAL CA 92883
(909)833-8996 CBL# 6876
USE OF PERMIT
SINGLE FAMILY DWELUNG
WALLS, POOL, SPA OR DRIVEWAY APPROACH
CUSTOM CONSTRUCTION 1,821.00 SF
PORCH/PATIO 221.00 SF
GARAGE/CARPORT 456.00 SF
ESTMIATED COST OF CONSTRUCTION
153,732.80
PERIVIlT FEE SUMMARY
CONSTRUCTION FEE 101-000-418-000 $828,50
PLAN CHECK FEE 101-000-439-318 $667.09
MECHANICAL FEE 101.000-421.000 $68.50
ELECTRICAL FEE 101-000-420-000 $106.36
PLUMBING FEE 101-000.419.000 $124.00
STRONG MOTION FEE - RESID 101-000-241-000 $15.37
GRADING FEE 101-000-423-000 $15.00
DEVELOPER IMPACT FEE $2,405.00
SUB -TOTAL CONSTRUCTION AND PLAN CHECK
$4,229:82
LESS PRE -PAID FEES
$0,00
TOTAL PERAUT FEES DUE NOW
$4,229.82
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
ri'-
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
enww
Date f, i i Signature of Contractor / `+• i"�'•"
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:
Carrier1::':'z~s3iC.1.t1Cr?F y�: Policy No. 1483.3'31
(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,rand agree that if I should become
Subject to the tworkers' compensation of Seetldn 3700 of the Labor
CodeJ shall forthwith comply with th"ose°prloovisions.wsjriN . .
Date–w" 3 � � . 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, 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�pu�poses. t q.
Signature��Ow er/Agent]° °"j tk _-1 ff wA Date AG
f�
BUILDING PERMIT PERMITN
DATE VALUATION i'LOT' — " TRACT Mr,%s3
JOB SITEAPN
i{ ��g•�
ADDRESS L +r � f' i r�)W 111iat
.' 7041I T
OWNER
CONTRACTOR/DESIGNER/EN INFER
!(D!'.l►. sj YD= I401 AC UVE diDU LT
5- Ea ,P.1,7(7I lui
4:11A J2.25'i�t/:J�'�`14.f?eL
r1tP.1, 921S83
(al) ))b'? • n3�'G 1MY11 (1877,
USE OF PERMIT
,:
1 • &.UI �V4 F'L XtUU:. rZ W1 r. ui°.ea *'i k;,', 1X4l. i13 JI.F..
t1NALf.%'.«`064 VA
C US C04 sziUCTION" 1,321.10c, may;
�'TOIA
0A!fwf PT'l'�"lf0 270.00:5''
ar+AACII�'lt,",.t' it,P(,.v;dT 1iSPn is 81 e
t�°!'T2.P1r'iPl4�I,; I'AE 102�U~lt%-�' d3L1C)8eu.�)
PLA -W CI,°St'X Icy?It? 101-000-439-3V9
FiT 301-000-42I-000 %'s o
rIsW1TP19i AJ.1KIM101-000-420-6300 11106.3
PLUM -RD, 10 M 101-COI)<4 V1 00t) S"AW
Tkt:?t• OXO 3'WN F79 P.013D 101-000- M'1-ed0{J
OV,.istwc RKEpVJI�000-42.5-000
O:L�J%!:lO�'4":at 511�'i'.A,C'!' I°,x•.r� �1,4�'_i,€�i
F US -11`C3 M., Q'O.W. JULU.M1011 AND (•��.IEp r7K�
/t
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' L�:'53 �'k?.4s••.f?aaa1T.1 nl:.1i
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PM&U .' • 1-nS 1•T . NOW
i•1�
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CiTY 0P L'? QUJR 17A
RECEIPT
'DAT .iz OF—PT ' B'1
INSMR
I/ r
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs A
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck 7 —
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
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
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines Cj
Heater Final
Water Piping
. 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
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Finalz WL
Utility Notice (Perm)
COMMENTS: