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0306-488 (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 606486 B l 1130!0;e Date ��? Signature of Contractor OWNER -BUILDER ffDECLARA ON I hereby affirm under penalty of perjurylfhat 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). 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: Carver 187:,17? FIMD' Policy No. 1705624-03 (This section need not be completed if the permit valuation is for $100.00 or, less). O 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 3ZO0 of the Labor Code, I shall forthwith comply with those provisions. Date:r•'_') - , 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. r 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. > Signature (Owner/Agent) -P _ ' �� Date 1�• X�-n r� 5 BUILDING PERMIT PERMIT" DATE VALUATION ae , u`�a� LOT j TRACT 2.932-3 3 JOB ADDRESS^ APN �1'lS(r1..ti•�4, OWNER CONTRACTOR/6 EN INFER Q"Lr•(��'yA,lphs.�`JWp� 9,1. i' 3'".A 1) �'ti .�J;.' ��a'jt��?,��i].!-`1y��p�.'..mk�:e�gy l�,�a qLA y+p• g 1��7i11:'AC1�aLn��q Fp ai'iL�,rrLq''��I [�� 05 �.r��RYY•.1rril1.��iitS�•ti}�,B8S�I.iI.4� e`:.f'Lfi71Ly�S�yy�/6�f(�II)�lt.�v. S� � 733i//+`.�\yyI ;� ��r�1�/JI;;.��ttsY��.hTT�.i (('qq. 11. t•'-d'�1.L.W.l S:sC'!`,S.l� tTS _ 1..1'1: .922,64 qq5��,r PALM Rl%'J�c.L.+1ris CA• . 92 4 4 . 680 .USE OF PERMIT T €) •3 -XPi 3:0:6:: a, Z7. 11 ;0 POW .V-;Y.a4.. .� 'I!iSi/f, lb —0-5- .•,3 L fav hd,• r -.l /+.✓�.�K. r s tC r S tF � Y• 1 0 Y ��f'ra,J.�s'�� '�%1�, wa3.�i� r:G :: �lli.��.E1,'�-��' ai��''.1�•..�iGH TR&CT C0h48 `.ftUC r 100 x,27 S Oo OF ^y Pt,iCiiir'P1i? 't3.Al() Sd` C'iAILA(MCA1 01IR p FRIMINTsT"FZiE SURRMa3 cr:`V SC I 31TRt. C TI ON 011" . .40 3 .w0.;'118.00o PL,At,N CHEX'.K WX 1fi':a f7�C? Y�:s6° 3'dlt ' �s�417 ; MRCIL"MAL FEE 101>000_4;j1.000 !'r'.LIK"TR; IALFEE it)<••/3s11.�.�-(1140 �td� �l3 01.000-41 S�-000 S146.75 ; ,:;TROWQ MOVON FE*.:.Ptt; ID CW1:11;."'o PEP IO �ty�0v�i�3�t�0i? 1N.(1(s 1P:IIR IRR-PACIY-�o,,�ICiS, f?;2 17 R, DR:TI(Ally Yrs . -4.49--318 _920100 SUP, U ?'Ja,,kT ti-]ETIP:.0-K $4,14151 AUG 112003 CITY OF LA QUINTA FINANCE DEPT RECEIPT DATE_ BY •' DAT IN [}i^ TO nCSPEC i INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts / Slab Grade - Return Air Steel c — 3 Combustion Air Roof Deck Exhaust Fans 00 O.K. to Wrap F.A.U. Framing �. Compressor Insulation Vents Fireplace P.L. Fireplace T.O. Grills Fans 8 Controls / Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath /Final Final BLOCKWALL APPROVALS steel POOLS - SPAS Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final Gas Piping PLUMBING APP OVAL Gas Test Electric Final Waste Lines er 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: _ " 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 606486 B 11 /30/02 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, 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 STATE FUND Policy No. 1705624-03 (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, 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) Date BUILDING PERMIT PERMi 0306-488 DATE VALUATION $135,4.00 LOT 6 TRACT 29323-1 JOB SITE ADDRESS 43-770 PARKWAY ESPLANADI+� APN 609-380-023 OWNER CONTRACTOR/DESIGNER/ENGINEER LA QUNTA DUNES 350 CORNERSTONE DEVELOPERS, INC. 5 005 CALLE RAPHAEL, SIE. B1 5 005 CALLE SAN RAPHAEL, STE, B1 PALM SPRINGS CA 92264 PALM SPRINGS CA 92264 (760)325-4289 CBL# 6867 USE OF PERMIT SINGLE FAMILY DWEL1JNG aPLJ - LIJI ou rL.tUl -ULCI . rGR1Vl11 LJULI.7 lIV A I. WALLS, POOL, SPA OR DRIVEWAY APPROACH TRACT CONSTRUCTION 1,225.00 SF PORCH/PATIO 53.00 SF GARAGE/CARPORT 711.00 SF ESTIMATED COST OF CONSTRUCTION PERMIT FEE SU30AARY CONSTRUCTION FEE 101.000-418-000 $765.50 PLAN CHECK FEE 101-000-439-318 $627.17 MECHANICAL FEE 101.000.421.000 547.00 ELECTRICAL FEE 101-000-420-000 $125.60 PLUMBING FEE 101.000.419-000 $146.75 STRONG MOTION FEE - RESID 101•-000-241-000 $13.55 GRADING FEE 101.000-423.000 $15.00 DEVELOPER IMPACT FEE $2,405.00 FEE DEPOSIT 101-000-439.318 4250.00 SUB -TOTAL CONSTRUCTION AND PLAN CHECK LESS PRE -PAID FEES TOTAL PERMIT FEES DITE NOW I RECEIPT ' I DATE I BY I DATE FINALED I INSPECTOR 135,458.00 $4,145.57 -$250.00 $3,895.57