0207-225 (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
TRC
Daie Z/�•R/f 0Z- 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.
t(Q I have and will vaintain 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: d
Carrier STATE MID Policy No. W-11112-0014319
(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 y
Date: / 7 �� . a !_ 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 & $ach":person at
whose request and for whose benefit work 'is performed under'or pursFpinl�!Oany permit issued as a result of this applicaton agrees to, & shall, ind& hold harmless the City of La Quinta, its officers, agents and empl2. Any permit issued as a result of this application becomes null and
work is not commenced within 180 days from date of issuance of c
permit, or cessation of work for 180 days will subject permit to cancell do .
I certify that I have read this application and state that the above informaon is
correct. I agree to comply with all City, and State laws relating to the bu Idin
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purpose t:
,,,Signature (Owner/Agent)''-)` r'f, "A",", - r Dated -7',
BUILDING PERMIT PERMIT#
DATE VALUATION LOT z = TRACT :f0k,429 164
JOB SITE _ /J
ADDRESS • m SS ' 4 73 ga4" y /Ll% ��3�'6'' `+
.+.. .txra....
3 •'�' +-'�r
OWNER
CONTRACTOR/DESIGNER/EN (NEER +
L,& (`Ij•�li`rm CA 9225,'i',
UPLAND CA 91786
(9L1; 9i 2uS%Jf t" 7 3539
USE OF PERMIT
—=G Lu iV4-&Y�bv9nLDtd
S1?r;1 .. e>t4,R.CHA, 4 9.44 IT DOES "t+ft' T INCLUOt F11.DCK •13TAL3.Nro POOL'
SPA OR DIUVEMAY, APPROACH
CUSTOM COURTRUCTION U-71,1100 31?
POxtf:;H/P.ATIO A1100 Sir
G.f IRA(#ffaAlLPORT .aU Sly
C mmm.A.i'�"D Cosa OF d:Q.mmtran.C?w
32.3 oo "
C914,241DRti� TIO14 FER 101.0004 MOOD S1,423.30
Y,e..AX CHECK PEE, 1d;%4-000.439-..315 $1,16434
FU .trbir.':t"ORIT 101-000-439-418- 47S0.00
iMW 1ATOCA'LFE4 iC31-ClC7G= ' i il!r`t� $L (3.Oti
1,L,TKt"..TRICAll, MR9, 101.000-420.000
p1.aylla.11*90 PTFE 101-000-419-000
SMO- O KOWN F -.R&SID 101-e00-241-QOO
C1iZ R .131; ' +a t 01-Otaf)�A2 3' 000
ajEVEY PER IMPACT FM $'440MO
ART 11 PUBLIC PLA.QL'� k E31 270.000-•45-000 slo!"n
11;
y, 4�p� �` �aN y��^�• i�T�p�y�
i t �9. h.1.&AL 11MM U.1�I.�+iti S .!/ E Nb+Y'Y
TOTAL
p� 2 1Ui12.
6 q f'.s CLEC
Ni.��fd.4.c7.G.a7
ITY OF LA QUINTA
FINANCE DEPT. a
F
/
RECEIPT
T11
DATE =
I c•!• (:-Z,
BY r
TE D
IN
CTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
A
Underground Ducts
Forms & Footings
Ducts
Slab Grade
441,
Return Air
Steel
Combustion Air
Roof Deck
JA
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wali Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
03
Final
Final
POOLS -SPAS
BLOCKWALL
APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground PI . Test
Final
Gas Piping
PLUMBING APPPOVALS
��i
Waste Lines ` _
Gas Test
Electric Final
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
COMMENTS:
?1epet �
Ale
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
final
Utility Notice (Perm)
LICENSED CONTRACTOR DECLARATION
.x••+hereby affirm under penalty of perjury that I am licensed under provisions of
o&apter 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
692234 B MC 7/31/04
Date Signature of".Contractor•
OWNER -BUILDER DECLARATION }
1 hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) 1, 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 (Sar. 7(144, Ri miners A Prnfasslnnals r .nd0)
( ) 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.
STATE FUND 044-02-0014319
(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, 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-mentioried property for inspection purposes.
Signature (Owner/Agent) Date
09 _ ^AA
BUILDING PERMIT PERMIT# y
DATE VALUATION LOT 0207-225 TRACT
11 /2110? t323.1 00.90 PM291'64
JOB SITE
APN
ADDRESS ,
58-4 73 QUARRY RANCH ROAD
76&060-014
OWNER
CONTRACTOR /DESIGNER / EN INFER
QUARRY RANCH,LLC
C & G CONSTRUCTION
1 QUARRY LANE
965 NORTH SECOND AVENUE
LA QUINTA CA 92253
UPLAND CA 91786
(909)982-9965 CBL4 3539.
-
ucc or rrntalT
I
SINGLE FANfILY DWELLING
SFD - PARCEL 2, PERMIT DOES NOT INCLUDE BLOCK WALLS, POOL,
SPA OR DRIVEWAY APPROACH
CUSTOM CONSTRUCTION 3,877,00 SF
PORCH/PATIO 782.00 SF
GARAGEICARPORT 545.00 SF
ESM4ATED COST OF CONSTRUCTION
3?3,100.90
PERAHT FEE SUAD4"Y
CONSTRUCTION FEE 101-000-418.000 $1,423,50
PLAN CHECK FEE 101-000-439-318 $1,164.14
FEE DEPOSIT 101-000.439-318 4750,00
MECHANICAL FEE 101-000-421-000 $156.00
ELECTRICAL FEE 101-000-420.000 $229.10
PLUMBING} FEE 101-000-419-000 $200.25
STRONG MOTION FEE - RESID 101-000-241-000 $32,31
ORADINO FEE 101-000-423-000 - $15.00
DEVELOPER IMPACT FEE $2,405.00
ART IN PUBLIC PLACES - RESIL 270-000-445-000 $307.75
SUB -TOTAL CONSTRUMON AND PLAN CHECK
�5,93's.05
LESS PRE -PAID FEES
-$750.00
TOTAL PERMIT FEES DUE NOW
$dS110105
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR