0205-039 (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.
r6icense # Lic. Class Exp. Date
✓JJ67V Buie /30/02
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&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 STATE FUND Policy No. 07152
(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 provision's 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, 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" -
DATE VALUATION 07,822.70 LOT 35 0205-039TRACT
30125-1
JOB SITE APN
ADDRESS 507070 PALENCIA COURT 1 773-022-021
OWNER
SEDONA HOMES, INC .
77-564 COUNTRY CLUB DRIVE SUITE 137
PALIVI DESERT CA 92211
USE OF PERMIT
SINGLE FAlvvnY DWELLING
CONTRACTOR / DESIGNER / ENGINEER
SUNROSE CORPORATION
77.645A COUNTRY CLUB DRIVE SUITE 15
PALM DESERT CA 92260
(760)772-8224 CBL4 1137
SFD - LOT 35 PLAN 2R. PERMiIT DOES NOT INCLUDE BLOCK WALLS,
POO" SPA OR DRIVEWAY APPROACH.
CUSTOM( CONSTRUCTION 2,480.00 SF
PORCH/PATIO 123.00 SF
GARAGE/CARPORT 663.00 SF
ESTEVIATED COST OF CONSTRUCTION
PERA4IT FEE S'UMARARY
CONSTRUCTION FEE
101-000-418-000
$1,017.50
PLAN CHECK FEE
101-000-439-318
$829.40
MECHANICAL FEE
101-000.421-000
$109.00
ELECTRICAL FEE
101-000-420-000
$133.56
PLUMBING} FEE
101-000-419-000
$165.00
STRONO MOTION FEE - RESID
101-000-2$1-000
$20.78
GRADI-NG FEE
101.000-423-000
$20.00
DEVELOPER IMPACT FEE
$4907.00
ART IN PUBLIC PLACES - RESIL 270-000-445-000
$19.56
SUB -TOTAL CONSTRUCTION AND PLAN CHECK
LESS PRE -PAID FEES
TOTAL PERMIT FEES DUE NOW
RECEIPT I DATE I BY I DATE FINALED J INSPECTOR
207,822.70
$4,221.80
$0.00
$4,221.80
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & FootingsZ -_Z7
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck / _ ;P _3
Exhaust Fans
O.K. to Wrap -
F.A.U.
Framing
Compressor
Insulation - -
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Party Wall Firewall
Condensate Lines Of
Exterior Lath
Drywall -Int. Lath
Final
_
Final
BLOCKWALL APPROVALS
POOLS -SPAS
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/ 3Plumbing
Plumbing Top Out
Final
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection 2 - - 2
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final ✓
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring?j
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm) gI coo
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