9806-247 (SFD)LICENSED CONTRACTOR DECLARATION
I. he'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
b9,71'i t P 1013.1198
Late*' Signature of Contractor
j OWN ER;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 L
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty, of perjury one'of the following declarations.-
(
eclarations:( ) 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.
(� Ihave 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'T'ATE FUND 467-98-0000120
(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.
ate: .. 1r: t% 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.
ig"nature (Owner/Agent)' } 1 t J ^, / '" -(A Date
y
BUILDING PERMIT PERMIT#`-
DATE VALUATION .LOT 9306.2h TRACT
47 T
JOB SITE + ----w�
APN
M
ADDRESS 79-264 CALI:EsWNR StA
604-071.0.07
OWNER
CONTRACTOR/DESIGNER/ENGINEER
OLIPHANT AND WILLIAMS ASSOC., INC.
OL.IPHANT AND WILLIAMS ASSOC., INC,
77-900AVE. OF T -E'S'TATES
77-900 AVE, OF THE STNFES
PALM DESERT CA 92211
,PALM DESERT CA 92211
(160)345-2626 CBL# 2103
USE OF PERMIT
SFD
.SFD -:PH 1, LOT 47, PLAN IB. POINT DOES WCT MC"LUMP LOC'IC
WALLS OR .POOL, PLAN CHECK FEE REDUCED 75?/o FOR MULTIPLE
ISSUANCE OF SAME PLAN TYPE.
TRACT CONSTRUCTION 1,736.00 Sl:
PORCHIPAM 58.00 SIF'
GARAQEICARPORT 495.00 SF
ESTIMATED COST OF CONSTRU,C ION
104,751#0
PERMIT FEE S1U_%f "Y
CONSTRUCTION FEE 101-000-4.18-000 $657.00
PLAN CHECK FEF 10.1-M43.9-318 $140.19
MF.CHt' XIC".AL MT, 101-000421-000 $47.00
EL1rC"1' UCAL FEE 19.1-000.420-000 $128.18
FLUNMING FEE 101-000-4,19-000 $18k75
STRONO'tViOTIONFEE -RESID 101-000-241-000 $10.45
!
ORAD.iNG FEE 101-000463-000 $20A0
�
ilv-FRAS'TRUG""rURE FEE-' -2,25-{100-443-3a2 SZ339,69
PRECISE .PLAN 101-00(Y441-345 $25.00
+ & .AWf 1N PUBIAt PLACES - RESID .701-000-'>S_fi-000 $11.89
w. T
C . r
:.:. tz.�
�Sb&, fAl CONSTRUCTION AND PLAN CHECK
�3,5ii8.123
LE SS PRE -PAID FE
SOA
JUL i�9$
T®B'�iL FERMIT FES DUENOW53,'569
IR
RECEIPT
DATE' y
B� 7
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
OX to Wrap
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
Final
Final
BLOCKWALL APPROVALS
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
—
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
Appliances
(7
/ /Z •
Final
COMMENTS:
Notice (Gas) ���,l�2dZjTOhJ
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 /. . _ _
L