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0304-283 (SFD)U) H 04 W O Z) (h d r w oZl� cc)ro H � LLr w a - U) Z M LO N O N U .Q d — T a 0 xwu- m Q U fi 0) NTZ ob =) �O J LIULNStU UUN I KAL; I UH ULULAKAI IUN 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 k 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 F.' 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, 1 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 BUILDING PERMIT PERM] 0304-2M* DATE VALUATION $1g 7,231.70 LOT 91 TRACT 30023 JOB SITE i ADDRESS 60-321 POINTSETITA PLACE AP" 764-270-017 OWNER CONTRACTOR / DESIGNER / EN INEER SHEA LP, Q=A, LLC SHEA HOMES 60-311 TRILOGY PARKWAY 81-260 AVENUE 62 LA QUINTA CA 92233 TIEERMAL CA 92883 (909)833-8996 CBL# 6876 USE OF PERMIT SINGLE FAMILY DWELL IlJG WALLS, POOL, SPA OR DRIVEWAY APPROACH CUSTOM CONSTRUCTION 2,208,00 SF PORCH/PATIO 221.00 SF GARAGEICARPORT 627,00 SF ESTIMATED COST OF CONSTRUCTION 187,231.70 PFJZbHT FEE SUbD&ARY CONSTRUCTION FEE 101-000-418-000 $947,50 PLAN CHECK FEE 101-000-439-318 $762.54 MECHANICAL FEE 101-000-421.000 $75,00 ELECTRICAL FEE 101-000-420-000 $123.32 PLUMBING FEE 101.000-419-000 $142.00 STRONO MOTION FEE - RESID 101-000-241-000 $18.72 GRADING FEE I01.000-423-000 $15.00 DEVELOPER IMPACT FEE $2,405.00 SUB -TOTAL CONSTRUL. ON AND PLAN CHECK $4,489.08 LESS' PRE -PAID FEES $0.00 TOTAL PERAM FEES DUE NOW $4,489.08 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 ,j4 (*:;,A 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). 11 () 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 S96tion 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 WATHMAL+l ACIN !f: Policy No. V'1 309 (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' compensationEprovisions of Section 3700 of the Labor Co,dej I shall forthwith comply'iWh those pr'o'visions., Date.'e e'1L;.-. Applicants 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. r 2. Any permit issued as a result of this application becomes null and void if l 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 Cifoifoenter upon the above-mentioned property for inspection purposes. % f F Signature (Owner/Agent) ,€ r"~" Dater -T' PERMIT # BUILDING PERMIT DATE VALUATION $187,231.70 LOT j� TRACTJOB dl S ii 321 VMUM�i��i.�r.�',��ACIK` ADDRESS APN OWNER CONTRACTOR / DESIGNER / ENGINEER ►g11;1.sA LA QUfW.aA,1 TJ_- T�ietL.U�"rt €��1r•�•2.c��OA�����i NCTS 62� A LAatJf_r,3'{.�t�i. Qk 922S.i [(ss en���N�ivtt•:.L. CA 72MIZZ USE OF PERMIT M."LIT-2 FA.?•11i Y IMM.f M10 SI.13 • S4TT 9.1, FL -12l ;� t1t3. i'L!� l:x lJIJIti ,i�{J'Y LRL;. l'.i}S� DLAJW: WALIA KART„ SPA OR iN.Rf 'ls'WAY.ApPft('%.A.Crl PO11 1.41PA°.f 10 Xil.00 SP .yAYLA.OWCat:�'t`PORT t"n'. 0 CIA` FS"ITIV'Fr'1,l C'C+YV0FCCt!q=VC-M aN 1133,23.,70 1;"h'A+M:fT YKE 911MMi1;,ky . . . CONSVIU4,"3'3013 FZZ 103-0(043idti(>!0 SM61a [ri W s (` F9:it 101,000-439-318 1wiFCHAHICIhLME 101-000-421.000 �7Jt.tJQ FLF,CTRIC,;.A3, M, Y 611-000-4?Q_f00 7x3.33 P1JlAtit3THOr"'C13,?.. 10I.-OM4)�.00� al'i'T:ca.K-0YC)TI0£1PEE -RZMD GRADING Pt?Ts $15.0 f)EVZA.0>'0 IMPAC PRE ���®�•f10 9U.B-T'OTII . r'..O�T2 TP,U0. 1101,1 AWD PLAN i.'�.H' T 3 :ME-1'AU :, SES $I).00 LrNA XOTA , P.T.t.�: twin'` v:L� ",S .S?ut NC.`►W APR 2 8 2003. CITY OF LA QUINTA t• FINANCE DEPT RECEIPT DATE BYD T FI D INSPEffR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms 8 Footings 4 44 4�2Ducts Slab Grade Return Air Steel Combustion Air Roof Deck — Exhaust Fans O.K to Wrap Framing F.A.U. 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 AP ROVALS Gas Test Electric Final Waste Lines LIZ 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 Condit Rough Wiring Low VoRage Wiring Fixtures Main Service Sub Panels Exterior Receptacle£ G.F.I. Smoke Detectors Temp. Use of Powee Final Utility Notice (Perm) D. 1'5-0;1 COMMENTS: