9806-208 (SFD)(V W
O =) M
I-QLO
W
o Z
Zo0o
JV�
�a
Cn
Z
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 i ,Exp. Date
/"Ojif3y 13 1x31
Signature of Contractor---
OWNER -BUILDER DECLARATION f
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 Policy No.
STATE FUND 035-97-006126
(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,t`at if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
CO,de, I shall forthwith comply with those provisions.
,Pate: �M� Applicant — >'"c �""" %-�-• %'—�
,rte' r �� .-
Warning: Failure to secure Workers' Compn sationcoverage 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.
em'
Signature (Owner/Agent)_
PERMIT# CONTROL"#
BUILDING PERMIT
DATE VALUATION LOT TRACT
�117,864.:u► �, 18, 4�: .
-571, .144 �. .t.
JOB SITe
ADDRESS 57,-443 COIANIAL
PN
761 -UO -026
OWNER
CONTRACTOR/DESIGNER/ENGINEER
N,fCC0k111C-SE0'1C 0P LLC
TP,ANS WEST HO1.;SPNO NIC;
750 R S1 SPI; 3140
78-401 F kl[GMVAY 1.11
SAN DIEGO CA 9'2101
LA QUINTA CA 92253
(760)771-3303 CBL# 4972
USE OF PERMIT
IsF0
:AFD - PH 1, LOT 41, PLAN 2CR. I10MIT DOES NOT .INCLUDE BLOCK
WAI,I.S OR .POOL..
CUSTOM CONSTRUCTION 2,5rZ.00 SF
PORCI-PPATIO 43210) SF
GARAGRICARPOR t` 600.00 SN
1!,S1T1MATLD COST OF CONS1TIi21.iCTJON
217,864.441
PERMIT FEE SUMMMRY
CONSTRUCTION FRX 101-M)-418-000 $1,05^..511
PLAN CHECK* FEE 101-000-439-:318 3861.54
MECHANICAL FEE 101-=421-000 $98.50
f.lj.l CTRICAL FEE 101.000420-000 3159.52
PLUMBING `EE 101-000-419-000 $178.00
STRONG :.M-OTION FEE - RES:1D 101-000-241-000 $21,79
CFRADCNG Frig 101-000-423-000 S2t1.60
WRASTRUC'i'U.R r,M, ' 223-000-443.342 $4,77.67
AIS r 134 PUBLIC PLACES - RESII: 701-000-: SS -000 $2911.66
. .
.TC�p19g
♦
SU13- CC�'1'A,L CONS-FALIC` ION AND PLAN C [ECK
S7,*1tU.1ii
'-"
PR PAID FE UN
$0.00
.LESS
JUL
TOTAL PERMIT FEES nU J�V.O
57,459.18
RECEIPT
DATE
"BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
14 tv
Underground Ducts
Forms & Footings
1 6, VDucts
Slab Grade
_ p - Q
Return Air
Steel
Combustion Air
Roof Deck
-
Exhaust Fans
O.K. to Wrap
q — - -
F.A.U.
Framing
'J-
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
aZ
Drywall - Int. Lath
-
Final
Final 1-2z f
BLOCKWALL APPROVALS
POOLS - SPAS
1 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
Sewer Connection
/-!b -Q�' �..1
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL AP ROVALS
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) �Z
COMMENTS: