0005-176 (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 rry;License is in full force and effect.
License # Lic. Class Exp. Date
69.7117 B IRC 131
Date % Signature of Contracto
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).
( ) 1, as owner of the property, am exclusively contracting with licensed
contractors to construct the project -(Sec. 7044, Business & Professionals
Code). '
—O 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
Yd
mance of the work for which this permit is issued.
I have and will maintain, workers' compensation insurance, as required by
n 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 a Policy No.
NTr1.1F k'►Ji�IU 40-49-000010 _
(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 sha. II� f rthwith comply wli thou pr • Islon
Date: /4 a/ Applicant" /��' fy
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 kuilding
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspec .on p rposeV
no- DateSi nature (Owner/A ent!
BUILDING PERMIT PERMIT#
DATE - VALUATION - LOT ' W�& 176 TRACT
JOB SITE
ADDRESS 79410 C:"IX PitkLWfO
APN
C04-381 018
OWNER
CONTRACTOR/DESIGNER/EN (NEER
OUPHANT AN"3a `ATI Al ASSOC., W:
01DHANT.P.ND WM AMS M3OC:`., WC.
7'1-900 AVMM? OF1!1B ai=-9 -
`77-900 AVKW7- OF'M V.&M
PALM.a'7EEEW OA 92211
PALM T1s' lff , CA. 92911
(760)345-2626 - C 4.5203
USE OF PERMIT
MGM I'AIi MY l Vng-i.I3+1•C3
SF -LOT 26 PLAN 3.A/ PERMIT DOES NOTINCLUDE SLOCK WALL OR �
POOLL ALL, OTHER PERMIn REFLECT 75% REDUCTION TO PLAN C RECY �
FEE FOR MULTIPLE ISSUANCF, OF' SAME PLAN TYPE.
TRACT CONSTRUCTION 2129100 SF
FORCHIPATIO 120.00 S1r
RAWCARPURT (SP) 12,304.80
T4:11! 7.'i 3A"I:I?i'li W ll OF CO.N.M. - r] C�"'t_.1:01°JJ
Ic'k'R041T . F`n WA/iNl l RY
CONSTRUCT1OW FEiIZ 101.000.418.000 $"moo
PIAN CHWK FIZE 101-000-439-316 $162.96
MECHANICAL IME 101-0.00;421.000 $66.50
ELECTRICAL FEE 101-000-420-000 $150.45
PLUMBING FEE 101--000.419.000 $169,50
5'1 TORN MOTION FEE • RES11) 101-000-241-000 $13.86
GR-AD940 FEE 101.-000-423-0W $20.00
DEVELOPER IMPACT FLOP $1,907.00'
SM: TOTAL COAT 11ZtTG'' 0 ar AND PLAN C 4W.K
$1,266.20
LT= PRE-PA031-UMS'
$0100
!'600* L ..' T "? XXS`' 810 .KOW
o$3y?6620
AN 12 2001
a `
aiA
RECEIPT
DATE
BY'; r
DATEFINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms &.Footings
1 t4
Ducts
Slab Grade
t
Return Air
Steel
1
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
y
Compressor
Insulation
/
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL A PROVALS
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
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
0
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
/ d
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. 00,
Smoke Detectors —71
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS: