0301-193 (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
60648,5 B 1 IMMY
Date ' /' / z Signature of Contractor
j.
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. NMI 1641-203
(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 t ose provisions.
,Date: f' E /,. Applicant �- 'P �
r, re �.
Warning: Failure to secure W�orkers' Compensation coverage is unlawful and"
shall subject an employer to`criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth -on. :his
application.
1. Each person upon whose behalf this application is made & each pesonat
Whose request and for whose benefit work is performed under or pursuant.to
any permit issued as a result of this applicaton agrees to, & shall, indemnif
& hold harmless the City of La Quinta, its officers, agents and employees FD
2. Any permit issued as a result of this application becomes null and void
work is not commenced within 180 days from date of issuance of su
permit, or cessation of work for 180 days will subject permit to cancellatio I
I certify that I have read this application and state that the above information is L
correct. I agree to comply with all City, and State laws relating to the build' g
construction, and hereby authorize representatives of this City to enter u
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) r 1. '--' -'� _ Date
BUILDING PERMIT PERMIT#0101,403
DATE VALUATION
Z LOT g{i TRACT'}
JOB SITE
ADDRESS '79 --$Si �KWXRY E SP.t .D%. SC3T II.9
APN w9—M-02-1
OWNER
CONTRACTOR/DESIGNER/EN (NEER
IJkC,-+•1)'iWA.M14F 8, 356
5 00C I16k SAN WH,i UM D i
5005 CA&LE MN 91S P, 1
PALM. SPT2 G'S` CA 92264
PALM 0=14GS CA 92264 '
(760)325-4289 MIX 0617
'
USE OF PERMIT
-
SFD - IST 55, K.,lSN 41,A. PETi.ItR1T DOES NOT INCLUDE BI✓;tCK
WALLA P001SM OR DRIVRMAY M'PTct AMI
TRACT K;t,;NS'1RUCTIOM 4311. DO ST
I•'C11iC1-IlIFl• TIO VY
C ARA.0TUCARPOWY 423,110 101F
KS17MfI:.T1`IM COST OF collWaRTYMON
145=210
I'ARt rFAM 8+1T-D11lAURY,
C UNSTRUCTION FrZ 101-000-438-000 $800.50
PLAN ("HECK ME 101-00"39-31€1
MIrtwlfAIAIC:AL' ?E 101-000-42) $51.9
:
ELECTRICAL FESS 101.000-420-000 S 129. 89
'Z
I'LUM131 O>°im 101-000-4.19.00 s
S'TIF.O3A0 MOTION Fle a R&SID 101'•0e00-241-00
_QRADI140 FEE 101-000.423-006 515,90
DOM01xER. IMP-4Cr F.E.
00
FEE MPOSIT 101-0004 —318M00
K�VA7 J. t,/.�d'iM :..�tl!'.41411VAV .na,:d31I4,aCTI."0�d•1
W+,u4L.
. lk31 PIM-PAIDnMl
._}
45000
t
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�•na
f a
p� ' 1
,iOd.Cbl.e.'�Iudte.S�IxA.i. �d7 �'a��e�.l�P 6�.1�1i4.1tf4
n Now
7
eF��.741.-DP
JA IV 21 1UO3
CITY OF L4
Flfif,4Nr.,r �tlifJjq
RECEIPT
DATE
BY 1
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings '♦
00
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
• 0 6, 5 . ST
Exhaust Fans
O.K. to Wrap
• O �7'r
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
-o si
Drywall - Int. Lath
..3 •a
Final
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
/ • _ • 0 3 157
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
,L,i7.0 3 7
Encapsulation
Gas Piping
Gas Test
Appliances i
Final
COMMENTS:.
79 ��• .�ar� _y �•-r z- Sr
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) -5-7-0a 7
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 11/3.0/01
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:
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:
O I have and Will maintain a; certificate of consent to self -insure for workers'
conipensation,.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 thea performance of the=Work. for which this
permit is issued. My. workers' compensation insurance carrier & policy -no. are:
-Carrier STATE FUND Poky,'No. 04b0011641 2003
(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:
rovisions.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, -dam ages as provided for iri 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 ofthis 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 PERMIT#
0301-193
TRACT
DATE VALUATION $145,382.20 LOT 56 29323
JOB SITE
ADDRESS 79-834 PARKWAY ESPLANADE SOUTH
APN 609-380-023
OWNER
CONTRACTOR / DESIGNER / ENGINEER
I.A QUDITA DUNES, 350
CORNERSTONE DEVELOPERS, INC.
5005' CALLE SAN RAPHAEL, ME, B1
5005 CALLE SAN RAPHAEL, STE, B1
PALM SPRINGS CA 92264
PALM SPRINGS CA 92264
(760)325-4289 CBL4 6867
-
USE OF -PERMIT
SINGLE FAMILY DVNI I JNG
SFD - LOT 56, PLAN 4YA. PERMIT DOES.NOT INCLUDE BLOCK
WALLS, POOL, SPA OR DR1V SWAY APPROACH
TRACT CQNSTRU.CTION 2,511.00 SF
PORCHIPATIO 53.00 SF
GARAGEICARPORT 425,,00 SF
} EST1MA1ED COST OF CONSTRUCTION-
145,382.20
Pld:RNaT FEE'SUMMARY _71
CONSTRUCTION FEE 101-000-418-000 $80p:50
-PLAN CHECK FEE 101-000•-439-318 $659.39
MECHANICAL FEE 101.000-421-000 $53,50
-
ELECTRICAL FEE 101;000-420-000 $129.89
PLUMBING FEE 101.000-419.000 $164,75
,gym
STRONO MOTION FEE • RESID 101.000-241-000 $14.54
GRADING FEE' , , _ 101-000-423-000. $13A0
DEVELOPER IMPACTFE•E $2,405:00
FEE DEPOSIT 101.000.439.318 -$500.00
SUB -TOTAL CONSTRUCTION AND PLAN CHECK
$4,242.57
LESS PRE -PAID FEES
-$500.00
TOTAL PERNITT FEES DUE NOW
$3,742.57
RECEIPT
DATE
BY
DATE FINALED INSPECTOR