0008-056 (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
Date ' �%f fy'Y 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`'TATE P13N'� Policy No. 046.000" 328
(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' compensationzp"rovisions of Section -A60 of the Labor
Code, I shall forfhwi�th comply with those provisions i x
Dater fe/`42'4 Applicant
r'
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 auth6r06\r�epresentatives oft is City to enter upon
the above-mentioned property for insoe tion purposes
Signature (Owner/Agent) Z Date Zl a
BUILDING PERMIT PERMIT#
OW8-0
DATE VALUATION LOT TRACT
$220,952 AO 28 7.9457-1
f
I 1 >
JOB SITE i 1
APN '
ADDRESS 79-€= z?Axaro iA. tdutiN'�',A _')RTL'
649-10"19
OWNER +
CONTRACTOR / DESIGNER / ENGINEER
oppa S CobTS0110MON
SPARKS C014SMU ON
79.295 RM4CTIO d h QLMnA 10
79-7,95 =4CM0 Lia QITDTf A DR.
LA (aUINTA CA 92253
LA QUDTrA CA 9?253
(760) 71.1941 CL24f. 2996
USE OF PERMIT
84GLE FAMLY DW LLWO
SFD—LOT 211 PLA14 `Elk - PERMIT DOn NOT INCLUD? BLOCK WALL Of
POOL, 75% PLAN CHECK FEE REDUCTIO14 roR muLTiPLE ISSUANCE OP
RAME PLAN TYPX.
CUSTOM CONSTRUCTION %625 00 SF
POR.CHIPATIO 261.00 SF
CIAPA0El ARPORT (SF) 12,034,40
F91MWA' COST OF CONMUC ON
220,852.00
CONSTRUCTION FEE 101.000-118-000 51,063.110
PL ?I CHECK FLE 101-000-439.31€3 $21,7.30
MECHANICAL FEE 101 -000-421 .000 EIOS,00
ELECTRICAL, ME 101-000-420-000 $152.01
a .
P1AJMB040 FEE 101=000.419'000 $179,25
�a
STRONG MOTION FEE. RESIN 101.000-241-000 $'22.04
GRADINO Fist 101,-000.423.000 $20,00
DEVELOPER IMPACT FEE $1,50?.00
ART 11:4 PUBLIC PL&CES - R:ESIE 701.000-253-000 S52,13
SU13-10rrAL COMOST 2.IJL"`rIOl4'.AATi7 PLAN ClfW,=
$3,728.38
L=S . *-P.A.T1) FM,
$0.00
` WTAL PERMF?' S D17E NOW
RECEIPT
DATE
BY _
DTE FI LED
1 INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
-_
Underground Ducts
Forms & Footings
Slab Grade
_/—
Z /�
!
Ducts
Return Air
Steel
Combustion Air
Roof DeckExhaust
_
Fans
O.K. to Wrap
F.A.U.
Framing
_
_Q
Compressor
Insulation
Vents
Fireplace P.L.
_�/
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lathd/
_
Final
Final
POOLS - SPAS
BLOCKWALL
A PROVALS
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
�Z�—�
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
l�
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
Final
Utility Notice (Perm)