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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 2)GI' 3-0 .B 1./31/39
Date f%
Signature of Contractof -
f% J OWNER -BUILDER DECLARATION �r
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.
(V) 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:
Cartier Policy No.
S T.XrE I7 WIM 1) 35.9? -M1 1230
(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 Californie, 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 those provisions.
✓Date: -?'/�>:� 0 Applicant--- ,' ``. _ 14 -
Warning: Failure to secure Workers' Compensation°coverage is unlawful and
shall subject an employer to criminal penalties and
civ III 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 putposes.
.ySignature (Owner/Agent) Date
_ r r
BUILDING PERMIT PERMIT# CONTROL#
_1
9t 9101- 11a°
DATE VALUATION LOT - -) TRACT e
$2;50,795.211 i l 118
-7 /,A kto
JOB SIT 1 I
APN
ADDRESS 57-01 COLONIAL
761-U0.026
OWNER
CONTRACTOR/DESIGNER/ENGINEER
N14CCOMIC-SE0KTI)P LLC
T1tANS NVEST HOUSING✓ INC
750 B ST STE 3140
7it-401 F HIGHWAY 111
SAN DIEGO Cry 92101
LA QUINTA CA 92253
(760)77t-3363 CBL# 4972
USE OF PERMIT
8FD - P€I 1. LOT 43, PLAN 3CE2., PEP IIT DOES NOT INCLUIDF BUCK.
WALLS OR POOL',, PLAN CHECK FFE? .RFDIICED BY 754•* FOR NIULT'IPLEi
ISSUANCE OF SANIE PLAN TYPE:.
CUS'1'0?v1 CONS' RIXTION 3,013.00 SF
PORC`Eid'1'ATIO 325.00 SF
0ARAGWC.ARPORT 600.00 SF
&STIMA'i'.E D MST OV CONSTRUCTION
151D,'"?5.411
PERMIT FEE SUMMARY
CONS TRIJCTION FEET 101-M-418-000 i-000 S 1, i6i8mo
PLAN CR CK FEE 101-000-439-315 $2.39.50
NIECHAN.ICAL'FEE 101-000-421-000 SI,24-00
EL C'.CRICAS.1.113 i01-100-420-000 $174.96
PLWAING FEE, 101-000-419-000 $1V2.50
STRONG MOTION FM - RESID 101-000-241.000 S25.05
GRADING IEE 101-000423-000 520.00
1NFRAS`iRU(MIRE FFA? 225 -OW -443-342 55,545.64
ART INPUBLIC.PLACFS-RF",°1C 701-000-255-000 $376.99
SUB -TOTAL CONMUCRON AND PLAN CHE(:1`'
$7,8uo.0
1 WSsS PRE -PAID FEES
60.01!
_/
TOTAL , PERMIT FEES DUE NOW
$7,866-67
JUL 14 ',,-S3;�3 yy
- — - - - 4 A. x'
RECEIPT
DATE 1BY" '•
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE 7
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
7 QDucts
Slab Grade
- 8
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
-
Drywall - Int. Lath
p -$ =
Final
Final Z sz
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
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
��� f1- �—
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas) a ;'
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
t
2 �
Final _
Utility Notice (Perm) z-
COMMENTS:
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