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0309-090 (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 mg License is in full force and effect. license # Lic. Class Exp. Date 1' 64 f3/3 I/i4 Date. ,Signature of Contractor- ti, 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. ( ) 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: Cartier 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 suhjprt 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: t, 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 in�'pectton purposes.Signatui-e`(OwneNAgent),.- -•.^. Date .11 BUILDING PERMIT PERMIT# .• DATE VALUATION LOT ��,(j(, TRACT JOB SITE APN ADDRESS OWNER CONTRACTOR / DESIGNER / EN 1NEER HINIA 3.!041�'J %201 II0XIIES- fs1.26x;i`YIAVR, ,;c 81-.iNAVMU`w:2 LA QU1. 1,11 CA. I".A C?t3Na'.A x :A iSt't?n�'.�3^ti�tiK�i E'•.t3I,,€� %3"16 USE OF PERMIT I3xiif.3��i .�".'',���.`!• . �=1.1.� �.,T.T.'tiy' SAV •- L% ' 4:411' Pi.fx[a 4':Vi1.1L Pal MIT ,10ff ; NOT 1NC3.d377L• SLOCK SXAI,W, P�,>01t SPA. '11.1. L. ftT 9WA iy ;fa ►.C.i! C:r;tx'�IRIIL'T➢ � },sili� l: fW S;ZRMlk. MI i 96syJMii'd.'f.FJA CIONS7'ROVI3':t.(M "RIP 101-000-41'8,000. KA'N CHFIC:vC PIr I W •000-R 39-319 ;G�i,��•.7'; . i IE-1.HIM11ICAL FISL, 101.000-421.000 SE.L•rZTWIC.A f., 7.CZ•+'i . 0.420—IMO 1''I114Mili 90 FEE y tl1-000-Al 9.000 STRONG Mi)'F1014in°::-RF-41L) IGi (.;S=Co-241-W0, i}+t.ltl 0.t7,f#I.NP90 i3'F.E ;-4' ) DXV1VL0P sUt J_VPt;Cf 211.k " CsPAi. CORPMR TIU9 AND X.AS CIiW X *i, i .�I.Iaq �.rer��in� PRE, -PA -113 XVU MOO r .7. .} 7eX� .0 "QJ. 1D V.L4TOW S4:1N.5.09 • 1I i. I t 01 RECEI T n aDATE t,' F -,x BY DATE FINALED �f 1/�$'pECTOR INSPECTION RECORD OPERA -ION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck 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 POOLS - SPAS BLOCKWAL A ROVALS Steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final Gas Piping X PLUMBING APPROVAL Gas Test Electric Final Waste Lines Heater Final Water Piping Plumbing Final Plumbing Top Oul Equipment Enclosure Shower Pans O.K for Finish Plaster Sewer Lateral Pool -Cover Sewer Connection ZEncapsulation Gas Piping Gas Test it rcrur Appliances Final COMMENTS: Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Vottage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Pourer Final _ Utility Notice (Pern) U V CO ( W O � M W rZ it oZI� � o P: to J U� �a CO Z M LO N ON U_ °) Z `r�cc 0 XW1L mVU O tl 0) NT _Z. cb Z) t, d R .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 . 3/31/04 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. NATIONAL UNION F: 7083309 (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. 1 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 PERMIT# DATE VALUATION LOT 0309-090 TRACT 3 30023 JOB SITE APN ADDRESS 81-883 PRISM DRIVE 764270-018 OWNER CONTRACTOR, DESIGNER / EN INEER SHEA HOMES SHEA HOMES 81-260 AVENUE 62 81-260 AVENUE 62 LA QUINTA CA 92883 LA QUINTA CA 92583 (909)833-8996 CBL# 6876 USE OF PERMIT SINCILE FAMILY DWELL]NO SFD - LOT 43, PLAN 4520A. PERMIT- DOES NOT INCLUDE BLOCK WALLS, P0014 SPA OR DRIVEWAY APPROACH CUSTOM CONSTRUCTION 1,662.00 SF PORCH/PATIO 177.00 SF GARAGE/CARPORT 488.00 SF ESTIMATED COST OF CONSTRUCTION 141,388.70 PERMIT FEE SUhDAARY CONSTRUCTION FEE 101-000-418.000 $786.50 PLAN CHECK FEE 101-000-439-318 $636.77 MECHANICAL FEE 101.000-421-000 $73.50 ELECTRICAL FEE 101-000-420-000 $101.43 PLUMBING) FEE 101.000-419-000 $122,75 STRONG MOTION FEE - RESID 101-000-241-000 $14.14 GRADING FEE 101.000.423.000 $15.00 DEVELOPER IMPACT FEE $2,405.00 SUB -TOTAL CONSMUC' TION AND PLAN C"IMCK $4,155.09 LESS PRE -PAID FEES $0.00 TOTAL PERMIT FEES DUE NOW $4,115.09 RECEIPT DATE BY DATE FINALED INSPECTOR I 11. INSULATION CERTIFICATE This is to certify that insulation has been installed in conformance with the current energy regulation, California Administrative Code, Title 24, State of California, in the building at 81-883 PRISM DRIVE LOT 43, LA QUINTA CA CEILINGS: TYPE: SLOW MAUNFACTURER: Certainteed THICKNESS: R-38 WALLS: TYPE: BLOW MANUFACTURER: Certainteed THICKNESS, R-13 GENERAL CONTRACTOR: SHEA HOMES LICENSE # BY: TITLE: PARAGON SCHMID BUILDING PRODUCTS A MASCO Company LICENSE # 221517 8Y: Gs.aw�6 f� TITLE: ACCOUNT REPRESENTIVE DATE: A INSULATION CERTIFICATE4' This is to certify that insu tion has been installed in conformance with'the current energy regulation, California Admi'histrative Code, Title 24, State of California, in the building located at CEILINGS: TYPE: BLOW MAUNFACTUR ER: Certainteed THICKNESS: R-38 WALLS: TYPE: BLOW MAU N FACTU R ER,.,Certainteed THICKNESS; R-13 GENERAL CONTRACTOR: SHEA-HOMES LICENSE # BY: TITLE: PARAGON SCHM.I.D46ILDING PRODUCTS A MASCO datmpany LICENSE # 221517 By.. TITLE: ACCOUNT REPRESE4TIVE DATE: