0308-048 (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
p X723102 B 1190 �/, r � 9/30/04
Date JP'15 `d%5 Signature of Contractor' /1" °"�`- �t Ux,
r
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
() 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
SeVilon 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 OLD REPUBLIC =11 Policy No. IdiWeloom"A00
(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 I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with��� oseyprovl lo `s.
Date: /r�'lri d'S APPlicant_-�1i/t��.
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, indemnity
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes hull 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
6 the above-mentioned propertyffor inspection ppurposes.
-r Signature (Owner/Agent) t�J�` ��r•j� Date L'j�
BUILDING PERMIT PERMIT#
DATE VALUATION LOT "'•- TRACT "
�c %«} f r jd.�LlY6JVSf 9323
JOB SITE
APN
ADDRESS 43-686 PM2. MAY NSMAN.ADE EA.YF
f -3W O23
OWNER
CONTRACTOR / DESIGNER / EN (NEER
1 RU11M I:COI MS1 OF CXX OlUX4
1 '1;�31��1IL X10 . i " {:li 'tv;�1rUry0#'�11A
76,401 C; zRGETWAY 111
10-401 C 1-UGHW Y 111
LA~Q'U1i'l�aT CA 92253
1,,,AQlW,-A CA 92253
(760)777.0131 CBLO 3434
USE OF PERMIT `
SYD . KDT :3, 4"Zr.AN I t'C.. PE.RMIT DOES NOT NC' WDE BLOCK '4A AJ1L.tin
POOL, SPA OR iSlifV'i�nMAY APPROAOM
TRACT C.ONSTRUC TION 4041.00 SIS
PORC HIDA IO, 53.00 blip
GARAaCJFJ0}I RP0R!P 441190 SF
ES11,1 A*3' .T) C0ST 0YCO.I�S�1.�.�.I�. 10IN
).20a9121.40.
�q
MMARY
CONSTRUCTION FEE 101-000-413-000
PIA1,14 C:HFCIC FEE 101-000-11:9-318
MECHANICAL PEe? 101.000.421.000 M09
Al.irt:T ICt�i,trf?f?; 101-000-420-000
PLUMBING TEE 1.01.000""-419.000 1 imt3,
STR01-10 MOTION FEE - 1I.ES11) 101-000-241,000 $12.03
e3.RAHNO FP,'F- 101-000,423-000 $15.40
ni~ViIAI' ),IMP.Acynz $if IflS.Oli
R3:B lr)'Y I. COWIRU'C=i+7.fiW) )r'.ILAN c"7MCK
T4,062.49
9,11.'-,PlD -
1X3.
S0,00
OryAseFyY 11rS DUF NOW.
lea
S4,062A9
RECEIPT
DATE
13
By 1 D
%
I PECTOR
INSPECTION RECORb
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air—�Q�
V
Steel
_
Combustion Air
Roof Deck
_
Exhaust Fans
O.K. to Wrap
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
J 0r
Final
Final
POOLS - SPAS
BLOCKWALL APPR VALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
I
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
COMMENTS:
Final
Utility Notice (Gas)
✓
ELECTRIC
L APPR V
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)
'
v .1 - v
%e.
REGISTERED INSPECTOR'S WEEKLY REPORT
JON °TANDY
78-194 Elenbrook Ct.
Palm Desert, CA 92211
Office (760) 772-7192
Fax (760) 772-7193
Pager (760) 776-3338
TYPE OF
INSPECTION
PERFORMED
❑ REINFORCED CONCRETE ❑ STRUCT. STEEL ASSEMBLY E-C1c�x
O POST TENSIONED CONCRETE ❑ ASPHALT ❑ OTHER
❑ REINFORCED MASONRY ❑ FIRE PROOFING
JOB LOCATION-�
\
REPORT SEQUENCE NO.
TYPE P FTRUCTUREv
T�
`
PERMIT NO. -
E:1
DATE
DAY OF WEEK
�wl
MAZERIAL`OESCRIPTION C
tin " C (1 SetZI iL
ARCHITECT
INSCTOR
HAS. CHARGED
21
EN INEER
G�oo�
ASSISTANTS
HRS.CHARGED
INSPECTION
DATE
GENERAL
CONTRACTOR
CONTRACTOR•
1-
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wN W Conor
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COPY SENT TO CLIENT O
CONTINUED ON NEXT PAGE O
PAGE OF
CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF Mr
KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE
NOTED I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED
PLANS. SPECIFICATIONS. AND APPLICABLE SECTIONS OF THE
GOVERNING BUILDING LAWS.
'M
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SIG URE OF REGI FERED INSPECTOR
Z 13 IC, O S-y(-1Z1ti-,b1}
DA OF REPORT REGISTER NUMBER
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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
728102 B 1HC 9/30/04
Date 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).
( ) 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, asxequired 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 OLD REPUBLIC INSU Policy No. MWC100843400
(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 I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.
Date: Applicant
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, indemnity
& 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) Date
BUILDING PERMIT PERM T#
DATE VALUATION LOT 0308-048 TRACT
$120,292.40 3 29323.
JOB SITE
APN
ADDRESS 43-686 PARKWAY ESPLANADE EAST
609-380-023
OWNER
CONTRACTOR / DESIGNER / EN (NEER
LENNAR HOMES OF CALIFORNIA
LENNAR HOMES OF CALIFORNIA
78-401 C HIGHWAY l 11
78-401 C HIGHWAY 111
LA QUINTA CA 92253
L.P. QUINTA CA 92253
(760)777.0131 CBL4 3434
USE OF PERMIT
SINGLE FAMILY DWELLING
SFD - LOT 3, PLAN IYC. PERMIT DOES NOT INCLUDE BLOCK WALLS,
POOL, SPA OR DRIVEWAY APPROACH
TRACT CONSTRUCTION 1,041.00 SF
PORCH/PATIO 53.00 SF
GARAGE/CARPORT 447.00 SF
ESTIl"TED COST OF CONSTRUCTION
120,292.40
PER>yIIT FEE SUA4AdARY
CONSTRUCTION FEE 101-000.418-000 $713.00
PLAN CHECK FEE 101-000-439-318 $591.33
MECHANICAL FEE 101.000-421-000 $53.50
ELECTRICAL FEE 101-000-420-000 $113.88
PLUMBING FEE 101.000-419-000 $158.75
STRONG MOTION FEE - RESID 101-000-241-000 $12.03
GRADING FEE 101.000-423-000 $15.00
DEVELOPER IMPACT FEE $7,405.00
SUB -TOTAL CONSTRUCTION AND PLAN CHECK
$4,062.49
LESS PRE -PAID FEES
$0.00
TOTAL PERMrr FEES DUE NOW
$4,062,49
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR