9806-213 (SFD)04
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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
/701030 B
t0ate - ���^�Signature of Contractor
OWNER -BUILDER DECLARATION' j
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 6wner 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.
S'1':,TE FUND 1333-97-0001236
(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 provisions4of Section 3700 of the Labor
Code, I s�all�fortwith comply with those provisions
vDate:"O/� i/r' Applicant
;ti 4 z� rt'y--•
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Warning: Failure to secure Workers' Compens/'tion'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.propertyinspectourposes.np
,,Signature (Owner/Agent)' ��-!`" Date/
f
BUILDINGPERMIT PERMITN °°NTR°`"
DATE VALUATION LOT. 9806-213 TRACT
7 A. 9
art 8,aaa.7n i16, ,
JOB SITE�t
ADDRESS
57-363 -COLONIAL.
.
APN
,. 761490-026
OWNER
CONTRACTOR/DESIGNER/ENGINEER
MCCONOC-SEMOP LLC
TRANS WEST HOUSLNG f N C
730 B ST STI:? 3140
",8-401 F HIGHWAY 111
SAN MGGO CA 92101
LA c?ii A CA 92253
(760j'171-3363 CBI,# 4972
USE OF PERMIT
SFD - FH i., LOT 46, PLAN 1A. PERMIT DOES NOT INCLUDE 13LOC`K
WALLS OR POOL,
�.UVOM CONSTRUCTION 2,203.00 SF
PORCHIPATIO 403.00 SF .
GARAGLYCARPOR.T 566.00 SF
EsTuN1A"rr-,..o C08T OF CtAj*1S i MU(!T .ON
189,13 3.711
PERMIT FEE SUMMARY
CONSTRUCTTON FEE, 10.1-000-418-000
'PLAN CHECK FM 101-000-439-318 S'.72.95
M1;.:CHANIC:AL nX 101-000-421-000 $60.00
ELECTR_tC.AL FAE 10.1-000-420-000 $145.93
PLUiv B NG FEF, 101-00-419-000 V%.do
STRONG A1OVON FEE' - RFS1D . 101-000-241-000 $.18.81
GRADING I"F 101-000-423-000 $20,00
iWRASTRUCTURE FEE 225-000-443-342 $4„1.10.91
ART 1'N PUF LIC PLACES - RESfI: 701-000-255-000 57.20.33
m.
'
SUB -'I'. -D1 :L CONSTRUCT10N AND PLAN CHECK
,- LESS PRE -PAID FEES
$6,465.93
$0.00
h.
JUL 14 TOTAL PERMIT FEES DUENO`Y
$6,665.93
RECEIPT
DATE k
BY
E FINALED
INSPECTOR
is
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
�a-Underground
Ducts
Forms & Footings
Ducts
Slab Grade
Q - - 8
Return Air
Steel
Combustion Air
Roof Deck
_ _
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
-g
Compressor
Insulation
D - (—
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
d - 57 -Q
Final
Final '
BLOCKWALL APPROV S
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
Water Piping
Z. .
Heater Final
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Sewer Connection
// -i ¢ s/ T
Pool Cover
Encapsulation
Final
COMMENTS:
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underaround Conduit
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
TemD. Use of Power
Final _
Wity Notice (Perm)