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0105-070 (SFD)LICENSED CONTRACTOR DECLARATION .I %reby 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 160335 � 'w�TM �''f 034U K Date .i Signature of Contract 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' cf perjury one of the following declarations: (..) I have and will .maintain a certificate of consent to self -insure for workers' compensation; asipeovided 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 ,,,Sec It 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. - O�iSail#ti300k2`YS� (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,provis'ot�, of Section 3700 of the Labor Code, I shall forthwith comply .wit h`t. ose ,.visions. moi~ - Date. Applican -�� 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.behajf this application is made.& each person at ' whose request and fo[ 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 1 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 prope rty„joMrlspectidfn�purposes. Signature (Owner/Agent ^"'` -per'✓� Date ^'? BUILDING PERMIT PERMIT” ' M�:�'f^Ci7?� ILLATION LOT TRACT ' DATE VAL p . 14.107.30 39 JOB SIT@ ADDRESS py�q gy p� p� p /yy kgs �yy pyo e7!"ir7Ar.77ii�,-+i.`d.IJ�V��A:P1h .YJi.'7,A 7..Ffr ') rp ` qpig q 1 l�.[••.7.•'IRi�Sai' OWNER CONTRACT( IINEER dV'M1100K DrR.VqJrh ryLIMy A.L3h00', dE 6MPQ W hVLyayJ -5140ANIEMA:4V..1`�'E;NA0 .140AVkXDAFNCMAS GAI► 2 7aA1� (~A 92008 CAR .. AD CA 92008 (,760)804-6866 337 USE OF PERMIT S?V" r LOT 39 K.A14 113 W/C .{'1'A - PERIMUT DOES NOT 11~1C7.UOP, 8.5W, KWAIA .FOUL Oft D DIV WAY APPR0A.:..K CIMOA1 CONSTRUCTION SF 12,501.00 PC7&.CH/P.A.rlo 158.00 SF OAk1AC1f+IC`.A.Fi.1'O RT (S) 1114158-00 F3TftJNrn) i.ONI OF ciongrauM. , ON 2114,107.30 PFf::RI& FUR suh0u1ky CC��S�'3tUC°4'tt7�>rD:z� 141-c1t'1q-1113wCDC►O 51�Cs�2.0Q1� .��., , PLA14 CHECKHM $955,50 Mi CHAN,ICKL F9 101.000-471.000 $111..00 d:L.W_"rJUCA1.. FEW 101-.000-4211• t $133:14 PbliD, arlwo PY-1? 101-CKI0n419-W.)5I".�,A STRt'31F O MO`P10N VEL? - RBSID 101 -0W -W-000 V1.41 ORAL1040 PRS T4I1 1•�d23- a�, DL?VE aiPZn I V- PACT IrEV,SZs90lt)tt _ ;__ AAT 114 k"ODIAC PLACES - PX SNE 701 -OW-255-000 S33 -i'7 cot ' C;"tAP1`bl AND T,$LAN CF.3iEtkiX FD3G 1 U LESS FIRE -PAR.) MS $4,323,07.. $0.00" TH• IMN DUE fq0 J JUN — 2001 CITY OF LA QUINTA FINANCE DEPT RECEIPT DATE BY. DA �I D SPE ;-`.l, OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Slab Grade /f�� Ducts Return Air Steel Roof Deck -�� _ j �� Combustion Air Exhaust Fans O.K. to Wrap�� (� D F.A.U. -A Framing Insulation _ ��J�la G�(/ - -r - - - Compressor Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall _ Exterior Lath- Drtnvall -Int. Lath Final Final POOLS - SPAS BLOCKWALL APPROVALS Steel 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 d�� Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection � i/1/L Encapsulation Gas Piping Gas Test _ Appliances Final COMMENTS: Final -� Utility Notice (Gas) ll�-1 /✓�- 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) a i F— N W p M W V_ 6Z i° ;= d co LIJLLJa U) Z 2 0 R UNt Q a- `rcc laO XWtL mVU O a LO IQ—• Z co 5 �p R 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 J1 Lic. Class Exp. Date 760335 B 03/31/2( 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). ( ) 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. ( ) 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. 035 -1U -p001279 (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. Date: 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, 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 purposes. Signature (Owner/Agent) Date BUILDING PERMIT [DATE VALUATION LOT $214,107.30 1'CMMI I a 39 0105-070 TRACT , 29147-2 JOB SITE APN ADDRESS 57-515 SF•,AITNOLE DRIVE 761-140-015 OWNER CONTRACTOR/DESIGNER/EN (NEER ASHBROOK DEVELOPMENT COMPANY ASHBROOK DEVELOPMENT COMPAI 5140 AVE141DA E1J CINAS 5 ] 40 /AVENIDA ENCINAS CARLSBAD CA 92008 CARLSBAD CA 92008 (760)804-6868 CBLff 3376 USE OF PERMIT SINGLE FAMJI.Y DWELL 1JGr SFD - LOT 39 PLAN IB W/CASITA - PERMIT DOES NOT INCLUDE BLOCKWALL, POOL OR DRIVEWAY APPROACH. CUSTOM COTJSTRUCTION 2,501.00 SF PORCH/PATIO 558.00 SF t1ARAGEICARPORT (SF) 11,858.00 ES11MA'ITD COS'r 01+' CONSTRLICTION 214,10-1 PER ITI; b':EE SU-MNLARY CONSTRUCTION FEE ] Ol -000-418.000 $1,042.00 PLAN CHECK FFE 1U1-U0U-43y-{18 $855.50 MECHANICAL FEE 101-000-421-000 $111,00 ELECTRICAL, FEE 101-000-420-000 $133.14 PLUMBING FEE 101.000.419-000 $19?.75 STRONG MOTION FEE • RESID 101-000-241-000 $21.41 OR_ADINo FEE 101.000.423-000 $20.00 DEVELOPER IMPACT FEE $1,907.00 ART IN PUBLIC PLACES - RESIL 701-000-255-000 $35,27 BLTB-TOTAL CONSTRUCTION AND PLAN' CHECK $4,323.0 LESS PRE -PAID FEES $0.0 TOTAL PERMIT- FEES DTE P?OW $4,323.0 RECEIPT DATE BY DATE FINALED INSPECTOR