9905-269 (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 tH4 Business and
Professionals Code, and my License IS in lull Yorce an0 effect' ..
License # Lia Class Exp. Wte.i
4074115 P ` 13 ,,trtss0i 1 '
Date %�'C'>- Signature of Contractors ,A,
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.
(' 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:
Cahier Policy No.
C1GN C4T 3534,
(This section nee�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 provis ons.
iDatb-- ,– lam- Applicant t�'14 t )e
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. t
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'.t
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.// ``•
S'gnature (Owner/Agent) re,+ -40 12P 1 '0 a-te
BUILDING PERMIT PERMIT#
DATE. VALUATION LOT !�"5-269 TRACT
V .41l°1'I bTtiil.tEil I.Ei ?=19ii :i
JOB SITE
APN
ADDRESS 7 �7
y AING.• EL�O.ST.REU
79-SN
7699-560-06
OWNER
CONTRACTOR/DESIGNER/ENGINEER
CAPITAL PACIFIC .HOMES INC
CAPITAL PACIFIC HGNIES .INC
4.100 MAC, ARTHUR 'BLVD #400
4.100 MAC ARTHUR BLVD #200
NEWPORT.BEACH CA. 92660
NEWPORTBEACH CA 92860
(949j621-13400 C.BL# 1503
USE OF PERMIT
SFD - PLAN 2C LOT16 - PI -KRAUT DOES NO'P INCLUDE BLOCK. WALLS
O R'POOL.
CUMM M CONSTRUCTION 3,306:00 SF
PORC'H&A:TIO 0290.00 SF
- G ARAMCARPORT 535.00 IF
Ci STIAIATED COSH' OF CONSTRUCTION
272,8811.• 11
P IUf FEE SeJMNLtRY
CONSTRUCTION FES 101.000-418-100 $1,241.50
KA:N C-HISM FEE 101-000-439.318 $1,005.03
NXCHANiCA,L FEE 10I. -M-421-000 $105.00
ELECTRICAL F'lX- 10.9.-0(?D-=120 f100 $183.91.
PLU_MB1N F 1 -9r--000419=000 —$I110;3"T
- ---
S`1 TONG -N-IOT.I:ON FEE, R SID 101-000-241-000 X27.19
G RAIDINC1 Fa 101-000-423-000 $20.00
NfRLAS° RIXTrm.E .FTX 22.5-000-443-342. $6,000.00
,
piRT 1N PuJILIC MACES • 1RESIC 701-010-255-000 &129.70
a
M1d
Sl1B-'i�C' .17AL CONSTRUCTION AND PL:ki CHECK
$9,192.83
.� ! . LESS PRE -PAID I, ES
JUN 0 81999170TAL PERMIT FEES DUE
c
y 10,tl' LA C1��G�i �
d1 0• s /1rt(/.,
RECEIPT
DATE
BYE `
DATE FINALED
fINSPEC OR
);. �
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... . .. tea:.... _ .- ._ . ,:....... .
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 / V
Exhaust Fans
OX to Wrap - f.*_
F.A.U.
Framing — _ (fid
Compressor
Insulation _ 0
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wali Insulation
Condensate Lines
Party Wall Firewall
`Exterior Lath
Drywall - Int. Lath -
Final 7—
BLOCKWALL APPROVALS
Final
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
Encapsulation
Gas Piping
Gas Test
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
Final
Utility Notice (Perm)
COMMENTS: