9905-124 (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.
License # Lic. Class ; Exp. Date
01084 1 rs
pale .`ZA 166 Signature of Contractor. C
V / p ✓
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.
(1 have and will maintain workers' compensation insurance, as required by
Sg6)on 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 Policy No.
(This section1n �tl otttiPcompleted if the permit valuation ilio"P 1&A 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 thosprovisions. r
Date- JZ�%T7�_ /r��Applicant -+
tiWarning: 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 fo inspection p'rpose
ignature (Owner/Agent) /' w AP 1,64 Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOTTRACT
06/10/199 $120,647.40 4 � 2390-4
JOB SITE
APN
ADDRESS -
- 7&440 PARKIIRWK COORT
604-040-021
OWNER CONTRACTOR / DESIGNER / ENGINEER
INC:O HOXI.FS CORP. INCO .HOMES CORN'.
1282 W. ARPLOW NQS Y 1282 W, ARRCAV HWY
UPLAND' CA 91^85 UPLAND CA 9I7135
(909)981-8989 CBL# 3318
USE OF PERMIT
LY'A-�.q�. 3
�a 1V•J M. -- .1 Yl .i.t �. VY I:r. M.L..2Y O ,
SF D - PUW 4.211-3,, LOT d, ,. PM iT DOES NOT INCLUDE BLOCK
WALLS OR ;POOL.13LM CHECK PORTION OF FEF REDUCED 750% FOR
T-qlt r I Q •IAN AA . t A D!
`t kACT tyaxSTRUCTm 2,008.00 SF
- 1aORCI3/.PAT1.0 14.00 SF
GA.RACTIV(;AItPORT 583.00 Sly
I! S•1 IMATE'D COSI" ON' C ONSTRUC 17ION
120 47,40
PERMIT FEE M.-IMNIARY
CCi'Ivs`tRUurm FEE 101.008418-000 $713.00
P1., N`CHECKFEiE 101-000439-318 $1471
MECHAN1C.AL I& 101-000421-000 $47.00
lr ,ECt`IUCAL FFX- .101-000420-000 $130.44
PLUMBING FEE 101-000-419-000 $1.48.00
STRONG 2ViOTION`f`rEE -RE SfD 1.01-000-241-000 $.12.05
GRADING FBE. 101..-000-423-000 $20.06
1Ni°.12A`'1�i1iC`.1't11tF�1`21:% `225-000•-1143-3421 $2,710.38
ARTIN IN PL113IAC PLACES - REM,701-000-255.000 $51.62
c,
' ^
V
-AL CONSTRUC -ON AND PLAN C:HE;CK
-x,3,980.29
,% LASS PRE-.P.MD FEISS
PA0T
5V
%0.06
JUIN 10 1999
TOTAL PERMIT FEES DUE NOW
$3.980.29
•_a1 N 3 OF LA QUs'N T a
RECEIPT
DATE
By i(/1
DATE FINALED ._
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
`Underground. Ducts
Forms & Footings
f 9
Ducts
Slab Grade
AReturn
Air
Steel
Combustion Air
Roof Deck
. _
Exhaust Fans
O.K to Wrap
_ dol
F.A.U.
Framing
— /.&
Compressor
Insulation
b --j _
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
j
Drywall - Int. Lath
Final
Final
- -
POOLS - SPAS
BLOCKWALL
APPROVALS
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
Pool Cover
Sewer Connection
q
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
r.
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
Temp. Use of Power
Final
Utility Notice (Perm)