9806-211 (SFD)IC/) -
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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 EX TDate
70 03,E-1'�li
Zate �!? EB Signature of Contractor
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.
(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.
STAJE FUND 0.35-97-0001236
(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 S cti on 3700 of the Labor
Code, I s II forthwith comply with_those provision
✓Date: �� 1 Applicant
r/ 1 ,, i
Warning: Failure to secure Worker`s' Compensation overage 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 pu'rposes:- " f
tSignature ;(Owner/Agent) ,' - +' ""''✓rte•-� Date 4
PERMIT# CONTROL# -
BUILDING PERMIT
8 11 -.0
647
DATE VALUATION LOT .�-TRACT
- c $2.17,864.40} ;.,. , f 1
JOB SITE°
APN
ADDRESS ,,+)-51'5 COLONIAL
761-4911-126
OWNER
CONTRACTOR/DESIGNER/ENGINEER
MCC0tv11C-SEOKT0P LLC
TRANS 4VFST HOUSING INC
750 B ST STE 3110
78-401. F H:1C1:klWAY l'l l
SAN DIEGO CA 1.02101
Lek QUINCA CA. 92253
(1160)771-33153 CBL# 4972
USE OF PERMIT
SF'I)
SFD - 141 1, LOT 44, PLAN 2A., PEIWIT 60PS NOT INCLUDE BLOCK,
WALLS OR POOL, PLAN CHECK FEF .RFI?UCED BY 7,r/a FORAAXTIPLE
ISSUANCE OF SAME PLAN TYPE.
CLISTOMCONS'TRUCTION b,572.00 SF
I%il'k�GIfi0PA'.t"ICi 132,00 SF .
OARAGEICARPORT 600.00 5F
&ST t.t ATED C()2V1' OF CONS' RUC1•.10N
2173804.411
PERMIT EEE SUMMARY .
CONSTRUCTION • U,, E, 101E-000-115-000 S1,052.50
PLAN CHECK FEE 101-000-439-318 $21.5.39
NIECHAMC.AL 'FEE 101-00042I-000 $95.50
ELECTRICAL FEE 101,•000-420-400 X159,52
PLI'.7 IBING FesT, 101 -OW -419-000 S111%.00
S9 RONQ MOTION FEE - "RLSl'D 101-000-241-000 $21.79
GRADING FEE 101.000-123-.000 $20.00
INFRIA.S,CRLJCT1JRfi FEE 225-000.4.43-342 S4,772-67
ART .IN PUBLIC PLACES -.RESM 701-000-255-000 529:1.66
GCin1TR%IfifilEA.hIfliF.CI
1,1rS5 iii -PAIDI FEES
, S0.00
TOTi%J, PM.TT FEES DUE NONV
JUL 1 0 ER
$6,813.03
RECEIPT `'; _
DATE 4;BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs_
�q �TO
Underground Ducts
Forms 8 Footings
/� ' / 7
Ducts
Slab Grade ;
8 —
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
1i
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 Lath17_01,0rl
Drywall - Int, Lath
Final
Final
L z — r
POOLS - SPAS
BLOCKWALL
AP ROVALS
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
�n�//)
�7Z `� OF
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
_ _
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
%
Final
COMMENTS:
Final
Utility Notice (Gas) l Q.ol-
ELECTRICAL AP ROVALS
Temp. Power Pole
Underground Conduit ='
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
.G.F.1.
Smoke Detectors
Temp. Use of Power
Final _
Utility Notice (Perm) �