9806-252 (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 Exp. Date
Zat,
tti971i, Signature of Contractor'' I
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.
(v1 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 E'[iP4D 467.9$-000120
(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 Ikshould become
subject to the workers' compensation provisions 6f Section 3700 of the Labor
C64 I shall forthwith comply with those provisions. r0 ,,
!Date: '-t f.," f' %� Applicant—"
pplicant +
and
i7 .j f. .�. FJ `. r-.. _
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $1 00 ;000N.
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 k
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'i6
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. 3 ,
p rr,,ignature (Owner/Agent) +�'� t -.r I �.'�' Date
-
PERMIT PERMT#- -
BUILDING
I 1.9biQ6-»�3•
DATE / VALUATION $104,75,780 LOT 52._'. TRACT 25953
�,
JOB SITEy� g g�LE �t
ADDRESS 9-354 CALSON41,15.4
APN
604-071-007
OWNER
CONTRACTOR / DESIGNER / ENGINEER
OLIPHANT AND WILL 1A S.ASSOC., INC.
OLIPHANTANI) WILLIAMS ASSOC., [N`C.
77-900 AVE. GF THE STATES
777-900 AVE. OF THE S"PATES•
PAU1.DESERT CA 92211
PAX DESERT CA, 92.211
(760)345.2626 CBL.# 5203
USE OF PERMIT
S:FU
SF'D - PFI i, LOT S2, PLAN 1 A tNIODF.L). PERMIT DOES 140T INCLUDE
BLOCK WALLS OR POOL.
uAC'r CONSTRUCTION 1,736.00 SF
PORCRPATIO x8.00 SF
GARAGFJCARPOR.T 496.00 SF
ESTIMA'T'ED COST OF CONSTRUCTION
104.,757.80
PERMIT FEE Su iVtt A"Y
- CONSTRUCTIONF'EE 101 -000 -418 -Ott $6157.00
PLAN MEC% PEE .101-000-439-318 $580.74
MECHANICAL .FEE 101-000421-000 $47.00
UEC1`R1CAL RM .101-000420-000 $129.18
PLUM3E31No FEE 101-000-419-W0 $188.75
STRONG hIOTION FEE'- ItESID 101-000-241-000 $10:48
GEAWNG }fid 101-000-423-000 ^0.00
dNl'iiASMUCTURE"FEE 2125-000-443-•312 V,339.69
I'REC.iS1. PL+ AN ;# 101-000-1{4,1 X45 S25.ti0
ART IN PUBLIC PL.A.CES - RES+IC 701.000-255-000 $11.89
AI a
> iJ -T� AL CONSTRUCTION AND PLAN CHECK
$3,98813
r .. LESS PRL: -PAID FSES
$0,00
JUL 0 9 1990
��
TOT: ., PERAUT FEES DUE NOW
S3,998.73
4:
L
YRECEIPT
DATEBY
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
lo - 7 _
Exhaust Fans
0. K. to Wrap
p - _
F.A.U.
Framing
- i' S
Compressor
Insulation
/ - 2
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
001 INFinal
Final
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg, 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
_ Q
Encapsulation
Gas Piping
Gas Test
Appliances
APAIoW
_ Z --QY
Final
Final /
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole 49 Fr Is
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
1,4
Final
Utility Notice (Perm)
COMMENTS: