0003-252 (SFD)LICENSED CONTRACTOR DECLARATION
�ti heieby affirm under penalty of perjury that I am licensed under provisions of. '
Vapter 9 (commencing with Section 7000) of Division 3 of the Business and
CIN:Uj,_,' ` Professionals Code; and my License is i6 full force and effect.
O ch License # Lic. Class Exp., Date
r—Q LO
r; w 69711 7 B 10/3112C
oZ r-- Date �� _. Signature of Contractor '
cn O 11� r
J U � OWNER -BUILDER DECLARATION
LULU I hereby affirm under penalty of perjury that I am exempt from the Contractor's
U) License Law for the following reason:
Z_ ( ) 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 (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).
C'`) (;) I am exempt under Section B&P.C. for this reason
LO
N Date Signature of Owner
ON
d Q WORKER'S COMPENSATION DECLARATION
C:) Z I hereby affirm under penalty of perjury one of the following declarations:
U-) �!r
O () 1 have and will maintain a certificate of consent to self -insure for workers'
X UJ compensation, as provided for by Section 3700 of the Labor Code, for the
O _ Q performance of the work for which this permit is issued.
m Q C) (/) I have and will maintain workers' compensation insurance, as required by
& U Q Section 3700 of the Labor Code, for the performance of the work for which this
d 0 Z permit is issued. My workers' compensation insurance carrier & policy no. are:
Garner STATE FUND Policy No. 467-99-0000120
(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. r
Date: r ! 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 purposes.
Signature (Owner/Agent)"�, Date
BUILDING PERMIT. PERMIT"
DATE LUATION5M LOT 0003-252 TRACT
/7 �" f:.�t3�2 2535
JOEMITE APN
ADDRESS 44-6" CALIX SANTA BARBARA 604•.38Z4040
OWNER CONTRACTOR/DESIGNER/ENGINEER
OLIPHANT MID VJILI.IAAIS ASSOC., INC. OLiPHANT AND VI.ILY..IMM ASSOC:, INC.
77-900 AV1T.13UE OF T3E STATE 77-900AWIMOFTBESTATES-
PNIM DnTIRT CA 92211 PALM DESEW CA 92211.
(760)345.2626 CBL# 5203,
USE O�gFp�PERMIT
� Y
17JiV �. LE F ANL 1, D F7 MaFr7.11 V • ` r
SFC? LOT 131 PLAN 3RA - PERMIT DOES NOT .INCLUIDE SLOCKWALLS
OR POOL. 755% PLAN CHECK FEE REDUCTION FOR MULTIPLE ISSUANCE
FOP SAME PLAN TYPE.
TRACT C014STRUCTION 2,392,00 SF
PORCHMATIO
130.00 SF
GARAOEICAR.PORT
639.00 SF
RsTa T71) COW OF C0XS1i4.>~ (7r1OX
138,x%.40
PERAW FRE SUAGAARY
CONSTRUCTIO14 FPE
101.000-418.000 $716.00
PLAN CHECK IEE
101-000-435+-518 $162.06
MECHANICAL M3,
101-000-421-000 $66.50
'
ELECTRICAL VEX
101-000-420-000 $150.49
PLUMBING FEE
101-000.419-000 $169.50
STRONQ MOTION FEE? - RESI.D
101-000-241-000 $13.iE5
ORA, WO FEE
!7L'VLLDPL7R IMPACT FEE
101.000-423-000 $20.00
-TOTAL CONS'TRUCMON AND PLAN CHECK
$3,266.20 -
LESS PlIE-PAID FFES
$0,00-11
TOTAL PERMIT ISS DXTE
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
r -
INSPECT ION RECORD
OPERATION
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
O/
F.A.U.
Framing
ompressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
(Ji
Drywall - Int. Latho
Final
Final
a
POOLS - SPAS
BLOCKWALI_
APPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final I
I
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
3\
Pool Cover
Sewer Connection
Fj 3
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final (�
Utility Notice (Gas) y
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 C01,
Final
Utility Notice (Perm) CANW
4 i
Certificate of Insulation
Your Home has.been M nlatea with Cestain'Ieed Me rg;m Insulation pro hm% whrA aye desigued
for today's sale4y standards and tomorrow's e�rpr regyimm�ts.
t? moass is kwpn is and thentom penmw=W numb MMe, so it dors nat have to be treated
with fxm-fit chemicals that w d blmly lose their effanveness aver rim It las not been treated
with chemicals that can coirodevMag or metal famsiass will not absorb moistum nor will it
settle ova time as may other msdi ion miateaialL
This also eerti5es brat CerimnTeed Fiber Guns Inswladon bas � ma�Ssianalty installed m this home
to provide the ialhwving E mal perbr .
hob Nam 3onriBs 15racb Plam 3 Phasin 4
Lot N&: 131 'Job Address: 44-695 Carte Ssrft Barbra, La stay CA
Ceiling Ards: R-39 ilahmd
Interior Wags:
Party Waft
Players)
. Sigtttld
With Mviug!Abave
overbalow -Ba:rriw. Waft R-13 Used
TAM Diving Above
Krsee WAS:
sqbcox&Qa0r- Orli ca, AM
'$. VlawroR,.
Cb gr= 1 06) Hj� =timm 466709
/!�1j
Concitittr Ortel Secretarylrremrer —or— Acott Jenkins, Pres&efti--or
Loa MeroI4 Mjreetor of Opeia0w Officer
A means Mance to beat gow The high the R value, the peater the iosuladag power
Ask your buMu for .the fast sheet as R- vahm.. Keep this seat COC with yom Odw
valued OW If yon ever sell this home, grin oerb&cate should be pamed on to the beym: