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9808-023 (SFD)', LICENSED CONTRACTOR DECLARATION r I hereby affirm under penalty of perjury that I am licensed under provisions of t� F -t Chapter 9 (commencing with Section 7000) of Division 3 of the Business and I C4 Professionals Code, and my License is in full force and effect. ' O c?) License # Lic. Class Exp. Date CiLLJ 489234 13 12il- VW) OlDate �/� �� Signature of Contractor i� � tp OWNER -BUILDER DECLARATION ;J UJ r- I hereby affirm under penalty of perjury that I am exempt from the Contractor's ~ t1 License Law for the following reason: Z_ ( ) 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 perfo ance of the work for which this permit is issued. . ( 7have 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'L'ATE1 D Elf355.97 (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 Section 3700 of the Labor Code, I shall forthwith comply with those provisions. ' late: E041/9.(1 Applicant Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his application. 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnity & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within -180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspection purposes. .,Signature (Owner/Agent)�Q - ✓ � �=' Date r/jolkd CONTROL# BUILDING -PERMIT = ��y ,. DATE f VALUATION �, ���� ��I LOT �j-tg� TRACT LTS-9 ® : OJ 6�' JOB SITE'{ ADDRESS 4'3.: 9F .IPXAAIA (t (3i.{1dl APN tta�?A-lii31��41�3 OWNER CONTRA(C�TOR /))DESIGNER' yyrr pp ji3��}}vy 't`I1r t.'..li..lii'1e�u ' ORM' 7T/ (E''��N11..GINEER (. �rj� ((.,. ASSOC. r\�::i,lSK �V,T...I.r1.1.NNBE1'1OUR \11 ASSOC. 78-61 .5 NAPLFS DR 79615 .NAPLE,S .DRIVE. LA 1,>1JINI'A. CA 92.253 LA C,11AN'1'.A C.A. 92253 (700M24,122 CB11-9 18.5$ USE OF PERMIT S'INGI -,6 FAMILY 1.11HL,7 .11Vi 4V 91T►. PLAN 5AP, LOT 916. PF,ft,�!I.t'1' DOES NOT INCLUDE FsLO(. I, WAIL , p R ki OK K)OL. PLAN CHECK t. FE:E Rt DUC EL) 7%0/o F4 ?R MULTIPLE I3SU/u'aV—E O SAME PLAN, TYPE. 4' r` TRACT trONS170=0111 i,4 W.V1/ ,Jl' •. PORC.k1fPA110 160.00 SIF GARAOE/CAfd 1atT 449,00 SF , N'f1A'Ita"ff. D COST OF CUNSTRUCTION 141,243,40 CC3Na'P.[2'UC'CIC)N .N£ 101-000-418-000 1�r: AN `"93CK FE, 10 1-000-439-31 fz ,4WEC iANIC..A.L FEE t01-0:00 4121-000 $50.00 a L.EC'rRiC;AL 1•� 101-000-127.0.000 $141.48 'PLU. MBINO FEE lot -M-419-000 $140.75 MONoNtOT1{31dMI .. -RESID 100-000.241-1430 $14..12 GRADING E 11E 10.1 -0p00 -4? -1-000 $20.00 KFRAS'1'`RUC"I ORE FEE -,215-000-443-342 S -A,130.21 AR.`f' IN PUBLIC PL ACES - RESTfr 701-00f3-255-000 $103.12 SL R-R—YrAL. CON S"rr:.i.f+,-110N AND PLAN CHEaCKt 6 LESS PRE -PAID: EES $O.W r TOTAL PERMIT FEY'NS DU F NONY S4159.'.t6 RECEIPT DATE BY DATE FINALED INSPECTOR BILA. t i6 Qgp INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs _ Underground Ducts Forms & Footings � Ducts Slab Grade Q' Return Air Steel Combustion Air Roof Deck /� Y Exhaust Fans O.K to Wrap _ /,Z - 7—q X F.A.U. Framing 2 —/br_ jr Compressor Insulation Z —3-Q— Vents Fireplace P.L. Grills Fireplace T.O. Fans & Control Party Wall Insulation Condensate Lin Party Wall Firewall Exterior Lath Drywall - Int. Lath Final Final VPOOLS - SPAS BLOCKWALL APPROVAI S 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 Co ion Encapsulation Gas Piping Gas Test Appliances Final COMMENTS: Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Furfures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) 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 4882M B IV31199 Date 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)., -( -).'[,,as owner'of°the''property,"am'ezclusively contracting with`licensed contractors to: construct -the project (Sec. 7044, Business'& Professionals Code),.. O I'am exempt under Section B&P.C. for this reason Date Signature of Owner WORKER'S COMPENSATIOWDECLARATION I hereby affirm under penalty of perjury, ones of. the following declarations: O I have andwillmaintain•a certificate ofconsent 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 . msurancey, as'requt,ed by '`Section'•3700 of'.the 1-46or Code, for the performance:of the*work for which this permit is issued. My= Workers,. compensation insurance "carrier 8 policy no. are: `Gainer Policy No. . . STATEFUND 626335=97 (This section need not be completed if the permit valuation Is for-$1o0.wor less). O I certify that in the perfo'mance of the Work.for which this permit is issued, I shall not employ any person in any It so as to become subjectAo the workers' compensation laws:•of California, and agree that if;l should become, subject.to the workers' compensatiom,provisions of Section 3700`of the'Labor Code, I shall forthwith comply with those,provisions. Date: Applicant Warning: Failure oto secure Workers Compensation 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 fora 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 off ioers;:agents and employees. 2. Any permit issued as a result of this application becomes null and void if work isnot 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. Signature (Owner/Agent) Date 0iL Alc PERMIT# —---CONTR,O�L# BUILDING PERMIT n DATE VALUATION $141,248.40 LOT 16 TRACT 29 V v JOB SITEADDRESS 43`•590 PARMA'COURT TAPN 609080-013 OWNER CONTRACTOR/DESIGNER/ENGINEER THE EXCHANGE GROUP ROGER SNELLENBERGER & ASSOC. 78415 NAPLES DR 78615 NAPLES DRIVE LA QUAVTA CA 92,253 LA QUINTA CA 92253 (760)772-0222 CBL# 1858 USE OF PERMIT ' SINGLE FAMILY DWELLING SFD; PLAN SAR, LOT #10, PERMIT DOES NOT -INCLUDE -BLOCK WAILS OR°POOL PLAN. CHE(ZC FIE RBDVCi® 79% FOR MULTIPLE ISSUANCE PF ,SAME'PLAN;TYPE, TRACT CONSTRUCTION 2.400.00: SF PORCH/PATIO. 160.00SF GAkAIIJARPORT 449:00 SF ESTIMATED COST,OF.CONSTRUcnON 141,248.40 PERMITFEE SUMMARY CONSTRUCTION FFE 101-000=418-000 3786:50 PIAN Ci ECK FEE 101-000-439-318 ' 3161.98 IANICAL FEE 101-000-421-000' 360.00 ELECTRICAL FFE - 101-000=420-000 ., 5141.48 ' 4 PLUMBING FER 101-000419-000 $14035 STRONG MOTION FEE - RESED -101-000=241=000 314':12 aRADINO FEE .'- 101.=000 `423-000 320.00. INFRASTRUCTURE FEE 225-000-443-342 33:130.21 ART IN PUBLIC PLACES - RESM 701-000-255-000 5103:12: SUB -'ICTAL CONSTRUCTION AND PLAN CHECK $4,558.16 LESS PRE -PAID FEES $0.00 TOTAL PERMIT FEES DUE NOW $4,548.16 RECEIPT DATE BY DATE FINALED INSPECTOR "