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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
70-10)9 F3 1-1€31/99
ate � Signature.of Cont a for
OWNER -BUILDER DECLAR- N
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.
( y) 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.
S'1'A1'F FUND 035-97-0001235
(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 th'at�if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
C�ode, I_sall forthwith comply with those provisions_..-� -
vbate: Applicant
Warning: Failure to secure Workers' Compen ation 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 pro-p-eyrt-�y-fo—r-inspection purposes.
(ignature (Owner/Agent) _"""^ """ ^• Date'���-'
J
BUILDINGPERMIT PERMIT# CONTROL#
DATE VALUATION LOT ' s�-� TRACT
7;(�, 5
71i5hg,
JOB SITE
APN
ADDRESS 57-457 COLONIAL
761-4WO26
OWNER
CONTRACTOR/DESIGNER/ENGINEER
MCCOMIC-SEOK.'TOP LLC
TRANS AVETr HOUSING INC
750 B ST STE 3140
78-401 F HIGWAY 111
SAN .DIEGO CA 92101
`LA. QUiNTA CA 922.53
(760)7..71-3363 CUL" 4972
USE OF PERMIT
SF1')
SFD - Pfd 1, LOT 42, PIAN 3A. PEWIT DOES NOT INCLUDE BLOCK
WALLS OR POM:,
CUSTOM CO1q8TR11CT10N 3,013.00 SFr
PORCMI)A'TIO 325.01) SF .
GARAGF/CA•RPORT 600100V
€S't'i11 Xf ED COS T OF CONS1'i RUC",t ION
2511" 5:5.20
PERMIT FEE SUMMARY
CONSTRUCTION FEE 101.-000-418-000 511168,00
PLAN CWVK FEE 101-000-439-318 $957.99
I ECHANICA1,FEE 101-000-421-000 5124.00
ELFC11t1CAL .FEE 101-000-420-000 5174.96
PLUkIRING FEE 101-000-419-000 $1.91-150
STRONG! MOTIONFEE - RESID 101-000-241-000 V5.08
GRADING FEE 101-000-423-000 $20.00
INFRASTRUCTURE FEE 22.5-000-443-342 55,545.64
t ART IN PUBLIC PLACES - RESr1, 701-000.255;000 $376.99
OP - t'
71 �i +
-- Suii�,.rOTA.L CONa CRUCT'IOl`4 AND PLAN CHECK
th4��S35.1 is
USS PRE -PA1131' FFES
olUL ? f
TOTAL PERMIT FEES nilE NOAV
X8,585.16 .
RECEIPT
DATE f
BY'
DATE FINALED i
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
/�? /n�
Underground Ducts
Forms & Footings
7 i7
Ducts
Slab Grade
=3 - Q
Return Air
Steel
Combustion Air
Roof Deck
3 -q
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
��8�
1
Compressor
Insulation
- -9 9
s. _
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
z
POOLS - SPAS
BLOCKWALL PP OVALS
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
��_� fi . ��
Encapsulation
Gas Piping
Gas Test
7/
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas) _727/-,
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)