9806-253 (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
091;1.17 ,r B t 10/31/98
1
/,t, " /r ' .dl Signature of Contractor / r µfm +> • �' %t
�f1 /�f
I t f 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:
J ) 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. '
(This section �ieTeFd hot b�completed if the permit valuation Is OFr180:0olo�"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.
yfte: '• s �� Applicant -,..•�.,./r'.' ,
Warning: Failure to secure Workers' Compe sation 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 4 '°
for a permit subject to the conditions and, restrictions set forth on, his
application. g
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.
Signature (Owner/Agent) -� 3 *' �� r �'.f Date •`f ' ri(
BUILDING PERMIT PERMIT#
y
DATE } VALUATION LOT 9'#0&2.53 TRACT s
$ - - —
$13-4.373.00 53 25+05:
JOB SIT9 11
APN
ADDRESS `
79-37Z CALLS SONRIS.AA
6104-071-007
OWNER
CONTRACTOR / DESIGNER / ENGINEER
OLIP.HANT AND WILLIAMS ,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 92211
(760)345-2-626 CBL# 5203
USE OF PERMIT
c..
u
SF'.D - PH 1, LOT 53, PLAN 2BR (MODEL). PERMfiT DOES NOT
INCLUDE BLOCK WALLS OR FOOT_
TRACT CONSTRUCTION 2,204.00 SF
PORCH/PATIO 150.00 SF
GARAMCARPORT 613.00 SF
CSTII%" ±.D COST OF CONSTRUG FION
134,373.00
PERMIT FEE SUMMARY
C'ONSTRUCTTON.FFE 101-000-118-000 $7762.0ti
PLAN CHECK FEE 101-000-439-3i 8 $646.04
MECHANICAL FEE 101-000-421-00 $53.50
ELECTRICAL f%F..E 101-000-42.0.000 $147.60
PLIJNO3ING F.FE 101.OW419-000 $203.75
STRONG MOTION FEE, - RES 0) 101-000-241.000 $13.414
GRADING FEE 101-000-423-000 $20.00
INFRASTRUCTURE FEE 225-10100-443-2142 $2,978.51
PRECISE PLAN 101-000-141-345 $25.00
ART IN;PUBLIC PLtiCES --RESICi701-000-255-000 535,93
`y�CTB{rMAL
CONSTRUCnON AND PLAN CHECK
$4,935.77
AUL o .,..
LESS P E-PAJ:D IVEES
S0.001
j
rgg ' r TO�AL,a'.1;It:Mrr F r1+;,9 DUE NOW
$4,93.1.77
iECEIPT
DATE _
'8Y'
DATE FINALED
INSPECTOR
q'L
A&
INSPECTION RECORD
OPERATION j
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
I
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
0 - F
Exhaust Fans
O.K to Wrap
_ F v
F.A.U.
Framing
Compressor
Insulation
/- y
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
-
Drywall - Int. Lath
- tB
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
p ;2 3 - $
Encapsulation
Gas Piping
Gas Test
-(
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole F ed
Underground Conduit
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)
COMMENTS:
-{e �'o irt/�u c G/L �I.bTES