9905-267 (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
Protesslonals Uode, and My License is in full fuice and effeul.
License # Lic. Class Exp. Date
- 540745 8__ Signature of Contractor VIA
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 i - Cl 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 fob 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.
et t
(This sectio
GN �A not be completed if the permit valuation is fP 110�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,. -,J
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 persoda"t,-
whose request and for whose benefit work is performed under or, pursue into
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. 1
` ignature (Owner/Agent)v"�'... �.��1/ /)oria• p� C �y
V
i BUILDING PERMIT PERMIT
DATE VALUATION LOT, 9911267 TRACT
6. 14 2489013
JOB SITE
APN
ADDRESS 79-870' ANGELOS'fRr,, lr t
769-5,60-414
OWNER CONTRACTOR/DESIGNER/ENGINEER
CAPITAL PACIFIC HOMES INC CAPITAL PACIFIC HOSIES INvC
4100 MAC, ARTHUR BLVD 0200 4100 MAC Al2 INUR BLVD 4200
NEWPOU BEACH CA 92660 NEWPORT BEACH CA, 52660
(949)622; 8400 CBT.# 1503
USE OF PERMIT
SOK-It Y': f? U1,
SIM - PLAN 4C LOT14., - PEWIT DOES NWt BLOCK. UTAL LS
OR POOL, .
Al
CUS ON1 CC3NyTRUCTION ,7 -;,rt10:00 Si•'
P01WWATIO .. 205.00. SF
GARAG&CARPORT 581,00 :517
USTIMIA'1".IP.,D COST Of. WINSTRUC RON
3133,123.40
P'ERMl 1 FE, E SUROI kRY
CONSTRUCTION 3:F,F 101-000-418-000 $1,353,50
PLAN C.WCK, FR. 10.1-000439:318 $1,008.00
1y.1C.CRANICAL FE,F.. 101-400-1121-000 $111.. 50
ELW'.rR1CAL ME 10.1-000420-040
---PL 371 - - -101-5500=J:i OO ---421060.,
-
S T1 0NL G N1O'TI0N FEE - "-SfD 101-000-241-000 $30.31
c3RtW.[NC, FER x,101.-000423-000 $20.00
.
INFRA&MUC'3`t)RE. ME 225-M-443-342 U.000.00
.ART IN PUBLIC PLACES - RUSIC 701-000-255-000
x � �
SUB -TOTAL CONSTRUC' 10N AND PLAN CHECK
$9,530.9
A i nOTAL
PERMT F.E. DUE NOW
$9153049
- JUN 0 81999
RECEIPT
�I
A 5--gg � pp
fl'- 6L.6 � � �
�B `.j
DATE FINALED
INSPECTOR
9
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
r- l _
Underground Ducts
Forms & Footings
-
Ducts
Slab Grade
l -
Return Air
Steel
Combustion Air
Roof Deck
_ d _
Exhaust Fans
O.K to Wrap
F.A.U.
FramingCompressor
,
Insulation
_ ou
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final L
Final
POOLS - SPAS
BLOCKWALL
APPROVALS
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
- — C
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
ot 04
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
5-7
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
Final
Utility Notice (Perm)