0402-017 (SFD)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 -r Exp. Date
783503 }31 C10 MCr,1 11i . yVJ 1/04
!,!Signature of Contractor
OWNER -BUILDER
I hereby affirm under penalty of perjury that Iain 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 MI4MPT Policy No.
(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,.
Irshall 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 proyisioDs.
Date:') �. rAfl .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 Ser..tion 3705
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 purpo
ses. 't
Signature (Owner/Agent) r� - Date's- /0'6'7
Bv'IL )ING PERMIT PERMIT{A
DATE VALUATION Y: " LOT TRACT
22131.640 2 29147-1
JOB SITE
APN
ADDRESS
OWNER
CONTRACTOR /DESIGNER / EN INEER
WE, fsicoPy PM INM i, LLC
I ARM�f i A CONSTRUMTOR INC
tI.00 LMh14nCIZER
CV01Z
IA QUINTA C:.A 9225:3
.L11". Q JJ'IA. CA 92253
(�700)564�4832 CMTA 3237
USE OF PERMIT
blaGIL131 t^if}J.(II. Y DWELJ 0
SPD .. 1X7 f , P1,AN 7. PERMIT DOES NOT INC UDF i3I.ar`iC WALL1%
P004 0RA OR. Ii}itllMAY APPROACH
CUSTOM CONSTRUCT ION 3,632.00 SF
1�OI:Ci UPA.VO 992.00 Sri'
(1ARAGMAR1rOI1.T 826,09 811
ENfAlmr-3 C0&1r OF 4:ORS.11'Rd7MM
312o116.00
�'1�.:I�MIME RIUM'.1flARY
CONSTRUCT1014 IEEE 10) -NO -41 6-000 $1,3$ tit
PT,X'H' CHl3Ca:' RX, 9G1 Ot70 i3 -31 �I,r .c I
MECHANICAL FEE 101.000-471.000 $156.00
ELZCTRICAL TrZZ 101-000-420.000 $211.14
PLUMD1140 FER 101-000.419.000 $174.715
S'1'.CfONQMOTION FEE -!2.'".910 101.000-249-000 $31.23
ORADWO R9 101-000-423-000 $15.ttt1
'1: w—P oPr R rMr%rT .VZV W05.00
PRECISE PLAN 101-000.441.315 $100.06
.ART rH PUBLIC PLACMS • R SIL 270-000-44,-000 0.280.174
FRE I)EP SIT 1011-0001.43q-318 • AVA
vr► �7rir�� ��+ � 1.1-1C1'109AM_P"1W CII-CC1 .
LESS PRE -PATO FhW,
D e
4750100
At IIMMT DA E NOW
��,���
FEB 10 2004
CITY OF I -A QUINTA
FINMICE DEPT.
RECEIPT
DATE
BY
DATE FIN LED
INSPECTfJR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings 3 �$ i
Ducts
Slab Grade
Return Air
Steel _ _ (�°�
Combustion Air
Roof Deck j� �$/p (�y�
Exhaust Fans
O.K.toWrap � /
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 Lath
Drywall - Int. Lath 66, 6
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
Gas Piping
PLUMBING APPROVA S
Gas Test
,qp j
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 Connection
Encapsulation
Gas Piping
Gas Test Z
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit IZ
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)
r Off/02Z10.04...09_:.5.4_. FAX la 002
�..%. STRUCTURAL CONSULTANTS. INC.
---T y AVE. SUITE Z01 -C PALM DESERT. CA. 9ZZ60 f
44--1-DCj_Mnt`_ ERE Fq�( X7601 e36 _T pp{Cf,,-F?.60Y 836-1000
E-MAIL R•FRANE"G@@VEQIZON.NET
r
MAY 25, 2r►n4
SOUTFIEKN'.HTLL§ DEVELOPMENT
84-70 CHANTICLEER DRIVE'
LA (%UINTA, CA. 92253
Attn.: Mit. JIN EVANDELL
Re.: THE SUS AT pFrA- WEg, PT.AN 7, LOT # 2
x"20 SHINECOCK HILLS
Lp QT3INTA;
CA 92253
FOLLOW UP TO WALK THROUGH =1
`JOB jNO.: 4149
DEAR RM
THIS LE_rI'ER ADVISES THAT WE HAVE OBSERVEIJ TFIE STi., ,TUR_AL
REQUTREWfEIRTS-TH'kT-ARPV}SIBl� DURING CONSTRUCTION Kf THE T1ML OF
OUR SITE VISIT.
WE BELIEVE THAT TI'1E AS -BUILT CONSTRUCTION AT THE TINT. OF OUR VISIT IS
INGENERAL CCYNFORMANCE .Wffff0UK:ST]Lt TIiiiAL PbANS AND RELEVANT
EpSp_QNDENCE ISSUED BY OUR OFFICE,
WE70BSE_RVE LTtjE_BUILDING IN ITS FRAMED CONDITXON'PRIOR TO
INSTALLATION OF :DRYWALL AND -STUCCO: WEOBSERVED.-.. VISUAL AND
ACCES
S�E.��CT REQ.UUKEMENTS. (.EXCLUSIONS ITEMS SUCH. AS:
FOOTING SIZE ,FIND REINFORCEMENT, TOP :PLATE SPLICE-Sr,RQOF SHEATHING,
ANr3:•AN'Y-S-TRkPS-ABOVE-"1YFE-R�OF SHEATHING.).
REgpFETFf4LLY SUBMITTED
I
! NICHOLAS F. ABOLT EADEE; PE'
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FX. 8/3p/b8
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CALIF�pN
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