0205-041 (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
Pfefessionals Code, and my License is in full force and effect.
License # Lic. Class- _.Exp. Date
533670 B WC 06/3012(
Date Signature of Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under -penalty of perjury that I am exempt from the�Contractoes
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, (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 3700 of the Labor Code, for the
BUILDING PERMIT PERM T#
DATE VALUATION LOT 02054M1 TRACT
$226.549.50. 37 30125-1
JOB SITE APN
ADDRESS 50-110 PALENCU COURT 773-022-021
OWNER CONTRACTOR / DESIGNER/ EN (NEER -
SEDONA HOMES, INC SIJNROSE CORPORATION
77-564 COUNTRY CLUB DRIVE SUITE In 77-645A COUNTRY CLUB DRIVE SUITE l
PALM DESERT CA 92211 PALM DESERT CA 92260
(760)772=8224 CBL# 1137
USE OF PERMIT
MNOLE•FA14LY DVIELU NG
{ ) I have and will maintain workers' compensation insurance, as required by
.Section 3700_of.the Labor Code, for the performance-of_the_workior.-whicmihis..
permit is issued. My workers' compensation insurance carrier &policy no. are:
Carrier STATE FUND Policy No. 062
'(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,
.1 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, l 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.
SFD - LAT 37 PLAN 3R. PERMIT DOES NOT INCLUDE BLACK MALLS,,
P001. SPA OR DRIVEWAY APPROACH.
CUSTOM CONSTRUCTION $741.00 SF
PORCH/PATIO 116.00 SF
ES'TD4A= COST OF'CONSTRUCTION
PERma FEE.BQNIIKARY .
-'CQNSTRUCTION FEE
101-000-418.000
11;084:00
PLAN CHECK FEE
101-000-439-318
=87870
MECHANICAL FEE
101-000.421=000
1102.60
ELECTRICAL FEE
101=000-420-000
:139.80
PLUMBING FEE
101-000-419-000
$172,26
STRONG MOTION PER - RESID
101-000-241=000
121.65
QRADwo FEE
101-000-423.000
315.00
DEVELOPER IMPACT. FEE .
$2,405.00
ART IN PUBLIC PLACES - RESIT 270-000445-000
$66.37
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 Ouinta, 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.
• RECEIPT
Signature (Owner/Agent)
Date
SOB -TOTAL CONSTRUCTION AND PLAN CHECK
LESS PRE -PAID FEES
TOTAL PERMIT FEES DUE NOW
0
226,549.50
$4,886.27
$0.00
- $4,886.27
DATE I BY I DATE FINALED I INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms 8 Footings
Ducts
Slab Grade
Return Air
Steel
2 .. 6
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
2 _ . 3
F.A.U. f 1.07
Framing
_ 3 _
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
Final
Final = --
BLOCKWALL APPROVALS
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Band Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines _
-L�,
Heater Final
Water Piping
Plumbing Top Out
Plumbing Final
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
J '
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring z-1,3—?1
Low Voltage Wiring
Fixtures _
Main Service
Sub Panels IV
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final - —3
Utility Notice (Perm) - -�
COMMENTS:
-