0301-190 (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
6064.1 B )1130 0t
Date -? Signature of Contractor -„” ^ _ o•p�
r
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that`j 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.
Z} 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 YU14D Policy No. NMH641-21W
(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: Z, - ✓ 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.
PERM T#
BUILDING PERMIT
0301-1.90
DATE VALUATIONLOT TRACT
JOB SITE
ADDRESS 79- PARKWAY ESPL.f�I� AME SOU, nT
APN 6W-3810-023
OWNER
CONTRACTOR / DESIGNER / EN INEER
1,A Q(.BN'f& DUNES, :350
COkts ERSTOM Z?EVE1,0PERP, INC.
5005 C'Ai.T_E MW RM"I INM� M'R B3
50()5 C~. hi= WAX %t.APHAE f, 93M ,C41
PAI:M SPliNC3S CA 922M
PAIM 181rid NGS CA 9226A
(7 60)32,5-4289 CIBLO 606,7
USE OF PERMIT
:IINGI-E FAMLY DWRIAMIG
7 .
SFT - I.OT 53, PUkN '.XAk PEWIT DOES NOT 114CLUDE 81=K..
''MCT coNs'P uCTION 1.804. o0 1541
PO CH/PAVO 5100 SF
C7.d RACIFXAIiI'ORT 6921.00 ISIS
F91ZVfA:C D CONT OF C:f:iI�i�".�i�'1JM('DN
112,137S) 3
CONSTRUCTION FEE 1e1-0001418.00() $6noo
PLAN ►BECK I+n; 101-000-439-1418 91644.'{0
MEC:i1ANICA1: FEE 101-000-421.000
kt:Li�""f'.f2lCAi, � alb 9 �1l -0<�•� 20-U(3C1 � t f 0. •445
Isl,.ti MEi4 .iT6pL l0l �Ca!IUaA 1'��btAC1 � )�4G.�
,
STA;.CJNO MOTION ME • USI0 101-000-241-000 $)1.2A
ORAADINO FZ'E 101-000-423.800 $15.00
V,fELOPER !MPACT ME
1:.RE DEP081T 101 -OW -4,39-31 9 41000
RM-Mrf,AL t1QMRCll":'3. 0 r ANL') PLAN CHEC *X
$:3,978.61. r:
?.ra sh's° FRE-F'AJD TM! 3
45L0.00 .
/q Q OTALPLIOMTPUMDUENOW
JAN 2 1 2003 ]0
CITY OF LA QUINTA
DFIRT
FINANCE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
TINSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings_
Cp
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
• o C-5 ?
Exhaust Fans
O.K. to Wrap
Q-1 ,D Z)7
F.A.U.
Framing
I
Compressor
Insulation 2
o
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
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
I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
��, 0 3 J
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 i
Appliances
Final
Final
Utility Notice (Gas)–/.Z
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) - 7.0 g,�
COMMENTS:
Torp &p m�E / o,✓!� AA" P" OewP•si�-�c�
•d a S7
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 11/30/0-'
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:
( ) 1, 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).
O .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 .perjucyx, one of the following declarations:
(, )`,06ve 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. 0460011641-2003
(This section need not be completed if the permit valuation is for $160.00 or, less).
O :1.certify that in the performance'of the work for which this permit is issued,
I shall not.employ any 'person in any manner, so to become subject to the
Workers' compensation laws of California,, and agree that if I should become
"subject,to the workers' compensation provisions 6f 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 harmle's.s the City of La Quinta, its officers, -agents and employees.
2. Any permit issued as a result of this application I 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 PERMIT#
0301-190
DATE VALUATION $112,137.90LOT 53 TRACT 29323
JOB
ADDRESS : 79-786 PARKWAY ESPLANADE SOUTH
APN
609-380-023
OWNER
CONTRACTOR / DESIGNER / ENGINEER
LA QUINTA DUNES, 350
CORNERSTONE DEVELOPERS, INC.
5005 CALLE SAN RA.PHAEL., STE. B1
5005 CALLE SAN RAPHAEL, SITE. B1
PALM SPRINGS CA 92264
PALM SPRINGS
CA 92264
(760)325-4289
CB14# 6867
USE OF PERMIT
SINGLE FAMILY:DVIELUNG
SFD - LOT 53, PLAN 1XAR. PERMIT DOES NOT INCLUDE BLOCK
WALLS, POOL SPA OR DRIVEWAY APPROACH
TRACT•CONSTRUCTION 1,806.DD SF.
PORCH/PATIO 53.00 SF
GARAGE/CARPORT 682.00 SF
ESMIATED COST"OF CONSTRUCTION
112,137.90
PERM& FEE'SITADAARY
,
CONSTRUCTION FEE 101.000-418-000 $685.00
PLAN'CHECK FEE 101-000-439-318 $564.30
-
MECHANICAL FEE 101.-000.42.1.000 $47.00
ELECTRICAL FEE' .1011-000-420-000 $110.35
PLUMBING FEE 101.000-41%9-000 $140.75
STRONG MOTION FEE•RESID 101-000-24.1-000 $11.x1
GRADING FEE 101.000.423.000 $15;00
DEVELOPER,IMPACT FEE $2,405.00
FEE DEPOSIT'" 101.000-439.318 $900A0
SUB -TOTAL CONSTRUCTION AND PLAN CHECK
$3,978.61
LESS PRE -PAID FEES
-$500.00
TOTAL PERNIIT FEES DUE NOW
$3,478.61
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR