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0301-123 (SATT)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 58406 13 01 /:l 1/2( 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 constrl.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. vp 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: Carver C°Oi!oIPt'i1s1€M&MI)US' Policy No. WC9G9Z11 3 (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,pf.Section 3700 of the Labor Code -l --shall forthwith comply with"those'provi"sio s:d: O'4tex ! Applicant!'" 7 /',` 7 /�;j'•;;-'F.�. " Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his application. 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned, operty for..inspeotion purposes. / Signature (Owner'/Agent � f - �1 > '771 Date S BUILDING PERMIT PERMIT# 11 DATE VALUATION p LOT TRACT (I JOB SITE ADDRESS il�� J1�1Td� jt. IE 1,"-A APN 7704 a L-Q~XII.. OWNER CONTRACTOR / DESIGNER / EN (NEER CASTi'.AS 1AS R.08.AS 11,0 �"'�'iTWIF C. STOM 1:51♦ A MWMM B01MER; P,O, BOX 1503 4700 VONKMMAKA4r10100 LA QL9MA. CA 92253 14WPORT BRACE.1 CA 92660 (949)450-9911 C1I31 USE OF PERMIT BU11.1)1NG 01 TYPR 131xc, 5644 S.F, 8-UrMT3. PERMIT DORS NOT TDIMUDE BLOCK WALLS OR POOLS. 75`3C,1 EDUCE ,O PLAN CHECK YZE FOR MULTIPLE PLAN CHECK OF SAME TYPE PG>LC.H1FATIO 840.0 OF COA1i'1t.FsCT AMOUNT "1,230,40 1 ,FE—Rh"$ M 9U1b',�',I$.RY CONSTRUCTION ME 101.000.41.8-000 $11350.00 PLA13 CHECK FEE 101-000-439-318 $3T1.32 MECHA141CAL FEE 101-000.421.000 $263.00 UIECTRICAL ME 101-000-420-000 $ 713.02 PLUMBENO FEE 101-000.419000 S3$9.0 STRO1 0 MOTION' FrWl - R=ID 101-000-241-000 $30.24 DR-VPSLQP1w:.RIMPACT % $16,!008.00 $:E"afi.01 ART IN PUBLIC PLACES 9 RF81E 270-000-44-1-000MJ s '°-TC+'1 a�L O`C?.iJ'E1Ti`:C30°1iUN r1ND x_TkCYC st1 6,96.tr I..LW :PRE -PAID FEWS $0.00 D 0 iC 4. :1, FERWr Ia'EES DUE 14OW 6-V , AUG 11 2003 OF to QU(PiTA ' [!�CEIIT FROODE D BY DAT4 FINALED INSPECTOR ! - (. � l, 1 _� Ir i _ . 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 584656 B 01/31/2( 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&PC. 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 3760 of the Labor Code, for the performance of the work for which this, permit is issued. ( )J f 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: Carer COMMERCE&MDU3' Policy No. WC9692M (This section need not. be completed if the permit. valuation is for $100.00 or less). O 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 i§ unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000,. in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application Is hereby made to the Director of Building and Safety for a permit subject. to the conditions and restrictions set forth on his application. 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not' commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspection purposes. Signature (Owner/Agent) Date BUILDING PERMIT PERMIT# 0301-123 DATE_, . • ; , VALUATION LOT TRACT S302AOZiO . B-17 29909 DRESS , 50-6.SANIA IMA" PLAM JOB SITE ADDRESS00 APN 7 1 OWNER CONTRACTOR / DESIGNER / EN INEER CAMOW I -AB ROSAS LLC JEFFREY C. STONE DBA SU1AWr BUILD P.O: BOX'1503 4700.VONKARMANAVE:0100 1AQUIN?A:�. CA 92253 NEWPORTBEAICH. CA 92660 {9493450-9911' CBI# USE OF PERMIT SWG1k.FAMMY ATTA0iED' BUILDING 017. PE,B1ic .5644 S.F.' 8 -UNITS. PERMIT DOES NOT INCLUDE BLOCK WALL3 OR POOLS.;:75WREDUCED PIAN CHECK FEE FOR MULTIPLE PLAN.'CHECK! OF SAME T.YP& PORCH/PATIO 840.00..3F CONTRACT AMOUNT 291;230_.40 LS. ES DIATED COST OF CONSTRUCTION' 302,402A0 PERMTT.FEE 9111304ABY:. CONSTRUCTION'F'L$ , 1:01=000.418-,000 $1;330.00 PLAN. CHECK FEE 101-000.439-318 $127.32 MECHANICAL: FEE - 101-.000=421=000 (263:00. ELECTRICAL FEE 101-000-420-000 =373:02 PLUMBING FKE 101-000-419-000 (389:00. STRONG MOTION FEE - RESID 101-000-241-000 130.24 DEVELOPER IMPACT FEE (16,008:00 ART IN PUBLIC PLACES.' RESIE 270-000-445-000 $156:01 SUB TOTAL CONSTRUCTION AND PLAN.CFWXK $18,996.59 LESS. PRE -PAID FEES $0.:00 TOTAL PE nW FEES DUE NOW.: 48"&" RECEIPT DATE BY DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings �d - Ducts Slab Grade Return Air Steel Combustion Air Roof Deck / .0 3 S7 Exhaust Fans O.K. to Wrap F.A.U. Framing Compressor Insulation Vents Fireplace P.L. Grills , Fireplace T.O. Fans 8 Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath TW1,0 Caste 0-�29 /o • 9. o z 3/ . v 117 Final Final• BLOCKWALL APPROVALS Steel POOLS - SPAS 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 a 3 Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection /o ;�/ •o .ST Encapsulation Gas Piping Gas Test Appliances Final 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 T",-np. Use of Power Final Utility Notice (Perm) COMMENTS: �14 N'�G'ly to 3/ • d 3 ST r .