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0008-286 (SFD)LICENSED CONTRACTOR DECLARATION U) I I hereby affirm under penalty of perjury that I am licensed under provisions of J- Chapter 9 (commencing with Section 7000) of Division 3 of the Business and 04 W Professionals Code, and my License is in full force and effect. O M License # Lic. Class Exp. Date Lu � Q � rZ oZr-- Date . 1 r r e)Signature.of Contract CO 0-� _J F- CD o OWNER -BUILDER DECLARATION W W I hereby affirm under penalty of perjury that I am exempt from the Contractor's ~ a 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). N .• ^ ( ) I, as owner of the property, am .exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business & Professionals - Code). , c'') () I am exempt under Section B&P.C. for this reason LO N Date Signature of Owner ON 0) U Q 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. l have and will maintain workers' compensation insurance, as required by Sec on -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. ZURICH -AM- ;RICAN WCO22096.03 (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 shII forthwith comply*with`thos—e pr—ovlsioris. ; Date: f?7t�7.t �r^'�lAPPlicant et --...r ., .- 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 persorrupon 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-meentioned.property for Inspe -tlo purposes. / / f Signature' (Owner/Agent)�+�°,...,.- a Datev?/ -7�f BUILDING PERMIT PERMIT -_#-_+_�-- DATE f: VALUATION LOT TRACT JOB SITEI • APN 3 ADDRESS OWNER CONTRACTOR/DESIGNER/EN (NEER r Y - 228() • AFJ)LOYT Max, NiJSym .50 220() VYdB:iWL0 Wa:s1.v%.v ro Ai-W.'..I.F 150 4 CORONA. CA. 91120 COBCOMA CA 91720 (909279.4000 CSIR 5761 USE OF PERMIT CFD-LOT59 PLAN 301"'1.PERMIT DOES NOT INCLUDE BLOCK WALL OR POOL'? % PLANCHECK FBI, R9DVCT1tJkd FOR MULTIPLF ISSUANCE OF f' ZME PLAN TYPR CUSTOM CONSTRUCTION 3,213.00 SF PORCHIPA 110 533:00 SF 0ARA0FJcAR.PO.RT (SF) 6,584:80 EFMXM cost OF CONSTRUCTION 20,140-80 CONSTRUCTION FER 1.01.000 418-000, $1,324.011 PLAN CHECK FEE B $250,93 'MECHANICAL FEE 101 «000.421.000 $118.00 LqZCTRICAIL:FRR 101-000-+420.000 $1'7.3.79 PLUMBING FEE 101.000-419.000 $198.50 STRO1,10 INIOTION Imo. • RE -SID 101-000-241,-000 316.61 y a • �� {: t -` O11,ADI1140 FRE 101.000-423.000 $20,00 114FR&STRUCTUR, M 225-300-4443-342 $1,907.00 ART 1N. PUBLIC PLACES .. R.ESIr 701.000-255-000 3165;37 •� �=- OUW-TO'IAT,. CONSTRUCTION AND i•'i.n,W CFWO-'. $4,084.20 LEW PPE�FAM i $a 00 4&rA.L 1 • MMU FUS DDE NUW K04.20 RECEIPT DATE BY < DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS ' Set Backs 9 4 Underground Ducts Forms & Footings Q Ducts Slab Grade / D 0ReturnAir Steel Combustion Air Roof Deck Exhaust Fans O.K. to Wrap / F.A.U. Framing e4m— A Compressor Insulation / p Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath p/ Drywall - Int. Lath Final Final �( _ BLOCKWALL APPROVALS steel POOLS - SPAS Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final I Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines �-I —" Heater Final Water Piping 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 Final _ Utility Notice (Gas) 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) COMMENTS: LL7-7,�jt44, 5447, fW.X I 06,rt�fcate. ppancy Occ .� a City of La Quinta 5 Building .and Safety Department This Certificate issued pursuant to the requirements of Section 109 of the Uniform Building Code, certifying that, at the time of issuance, this structure was in compliance with the various ordinances of the City regulating building construction or use. For the following: BUILDING ADDRESS: 0008.-286 Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0008-286 Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL Owner of Building: CENTEX HOMES Address: 2280 WARDLOW CIR, STE 150 City: CORONA, CA., 91720 �b By: RICHARD K. KIRKLAND Date: 7/3/01 Building Official POST IN A CONSPICUOUS PLACE