9806-250 (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 Ucense is in full force and effect.
License # Lic. Class Exp. Date
6971 A -7 9 10/311%
ate �?���i 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.
()d 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.
STATE FLr9D' 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: A , y ` Applicant `� ,11 � f , � i 5
y 7 r• s- �., K Z ;, ,sem �,+Y
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 Saferty��
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 ifs,
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. f /
Zature (Owner/Agent) ' <r ' � � Date +`' /
BUILDING PERMIT PERMT" _ qq
9806.25!!
DATE VALUATION LOT t` TRACT
,$134,373.00 50 _ = 25953 - _-
JOB SITE ' 0
ADDRESS 79-318 SONR SA
APN
604-071-007
CAL- LE ,
OWNER
CONTRACTOR/DESIGNER/ENGINEER
OLIPHANT AND %IL.LLAMS ASSOC., INC.
OLIPHANT.AND WILLIAMS ASSOC., INC,
77-900 AVE. OF THE STATES
77-900 AVE. OF THE STATES
PALM DESERT CA 92211
PALM DESERT CA 9221.1
(760)345-2626 CBL# 5603
USE OF PERMIT
SFD
SI'D - PH 1, LOT 50, PLAN 2A. PS. INU DOES NOT INCLUDE HLC.�t•`K
:WALLS OR POOL. PLAN CHECK FEE REDUCED 75% FOR, MULTIPLE
ISSUANCE OF SAME PLAN TYPE.
TRACT CONSTRUCTION 2,2(9.00 SF
PORCHYPATIO 150.00 SF
GARAGE/CARPORT 648.00 SF
ESTIN i'D COST OF CONSTRUCTION
1344,373.€ 0
PERMIT .FEE SUMMARY
CONSY'Ri7CTION FEE 101-000-4,18-000 &762,00
PLAN CHECK FEE 101-000-439-318 sibi.51
.
MECHANICAL FFA 101-000-4121-000 $53.50
ELECTRICAL FEE l{}1=000-420-000 5147:50
PLUMING FEE 101-000-4.19-000 $203.75
STRONG 14iO`:[:ION FEE - RE -SID 101-00U-241-000 $13"441
GRADING 101-000423-000 $20-00
INFRASTRUCTURE FEE 22_3— -443-342 52, 78.51
PRECISE PLAN `? MI -1100 -iii -'345 6?i.00
ARF IN l'LT13LIC PLACE - RES k-'70 1000-255-000 $85.93
y
SUB= cc 1`Ai, CONSTRUCTION ANIS PL.A,.N CHECK
$4,451.24
LESS 'PkE-PAID FEES
$0.00
YOTAL PERM. [ FEES DUE NOW
$4,451,24
' •},ped.' y*• y _ ,
apt
RECEIPT
DATE
BY
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
O.K. to Wra
_
F.A.U.
Framing
�, (o -Q
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 APPROVPiS
POOLS - SPAS
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
—
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
p _ -
Encapsulation
Gas Piping
Gas Test
Appliances
/
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final 444494
Utility Notice (Perm)
COMMENTS: