9806-254 (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
to t �� ti 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). ' r
E
( ) 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.
his sectiorne d'ho lbe completed if the permit valuation IsRr9$T8M81,
R r5 � t p p $,00.00 6r'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
CAB, I shall forthwith comply with those provisions ,j
,Kate: ~�.I,�/�;� Applicant Ll.5�i %-��.•i
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. ;
�Si nature Owner/A ent Date � t
BUILDING PER IT PERMT#
- 6
DATE VALUATION &9T 98496».254 _, ' TRACT
&138. 6.4{1 54 t 2595:3
JOB SITE
APN
ADDRESS
79-3190 CALLE SONRIS.A
604-071-007
OWNER
CONTRACTOR/DESIGNER/ENGINEER
OLIPHANT AND WILLIAMS ASSOC., INC.
OLIPHANIT AND WILLIAMS ASSOC., INC.
;7-90.0 AVE. OF THE STATES
77 -QW AVE. OF 1.HP, STATES
PALM DESERT CA 92211
PALM DESERT' CA 92211
(760)345.2626 C.BL# 5:2933
-
USE OF PERMIT
U
SFD - PH 1, LOA S4, PLAN 3B (MODEL ,I, PrMZNU D099 NOT. INCLUM
BLOCK, WALLS OR.POOL ,
TRACT CON3TRUCf ION 2.292.00 SF
PORCIVPA.TIO 120.00 3F
GARAMCARPORT 638.00 SF
ESTIMATED COSI' OF CONSTRUCTION'
138.S'�tf. 0
PERMIT FEE 3I1MA/iARY
.. CC)NS1RUGiIONKH 101-000-418-000 $7;6,00
PLAN CRECK FEB 101-000»439315 $661,961.
NWHAL IGALF- X I01-000-421-000 $66.50
ELECI.121CAL FEE 101-000-420.000 $140.48
PLUfkiBING FIX lfl1-0011-40-OW $2.11.50
STRONG NI(YCION :FI - RESID 101-000-24.1-000 $13.86
GRADING FEE 10I.000-42.';-000 $20.00
lNFRASTRIX-MIZE FEE 225.00"3-:442 $3,0$1..61
Phtf3CISE PLAN 101-000-tW1-345 $2:1.00
ART 1N PUBLIC PLACES -'RE-SR 701-000.2.55.400 $96.39
kip
• T
J U L NBafflAL.coNMUCTION FIND PLAN CHECK
$5,103.30
t:. LESS PIKE -PAID FEES
$0.00
Ily, G 6" 1! 1-1i 4
�V T -1l, PERMIT FFF9 DIE NOW
$5,103.30
LA
FEICEIPT
DATEBY
1
DATE FINALED
INSPECTOR
r
r INSPECTION RECORD
OPERATION j
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set BacksUnderground
Ducts
Forms & Footings
I I F1 rz
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
O — — ¢17
Exhaust Fans
O.K. to Wrap
Q -'2p -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 LI /
BLOCKWALL APPROVALS
Final
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
o _,Z _Q 8'
Encapsulation
Gas Piping
Gas Test
c� ,
Appliances
Final
Final
Utility Notice (Gas)
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
oe
Final Z
Utility Notice (Perm)
COMMENTS:
/0lA-� S rLu NJ7 ro-VIZT4_)r
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