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0305-025 (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 Date 2t , Signature of Contractor-? ` ' '��''� ^ 1;✓r OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury3 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). 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 perjury one of the following declarations: () I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided fvr, by Section 3700 of the Labor Code, for the performance of the work for wh'idh 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: MUD hiTATE UD Policy No. Y9'JgC:441 (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,L�abor Code, I shall forthwith comply with those provisions. -Date: 4-- Applicant ,-: J. .. 1_ Warning: Failure to secure Workdfs' Compensation coverage is unlawful and shall subject an employer to criral penalties and civil fines up to $100,000, in addition to the cost of compeps6ination, 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 t3 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) i �-, df Date 'S _ "< ' J �? _ 1 BUILDING PERMIT PERMIT#�1''�� DATE VALUATION S 14,15, j1'42„20 LOT 16 TRACT. JOB SITE7 v� i 3<'°.d�.�3rWAX I: &P�,��RAD AE ii Y�.%`IT ADDRESS APN :�- g'•� P.} OWNER CONTRACTOR / DESIGNER / ENGINEER .LA QV14d'1- A!AJTX 3S(, 1.1NIL. C.`0W MM'0 2F DL#V,RLt'31%.iLzLS, T4,J Z. 5005 ^wkUg,°sEi RAPT1,4Jq,S^TR B-1 5005C,AiLLI3AN :RAnVM7..,9,M B 1 1t8fdQIRMJS 1.nfl. 92264 l�PIIA 7YjV3S A _f.v`.A USE OF PERMIT .sF:.: • d iCy ItrL:�lte+ Fi�x� � POOL� SPA 0R. csi�f Py APPROACH P0>PATf.0 53.00 V'r rrWAOU'XPa4i'.isORT 2F 4d ~ i X . ifi:MD CO&Y, Car C0HT11R.Ur_".10Nr t k t ti 10WE 'tii E RUMM AT Y CO MITRUCTION FEE 103 "'0004'! @-ON PLAN CHECK FF'aS MYNIAAXI'Ad11 FEE ra., crmcm. ratsr, 10i-000-11.; (11-000 P1.CFM ft C1 ,. -OW S164,17.1 N TRO'. LOOTiC7id ImEX -1193 ? 101 (.f i3 2.:i.1 -OOP 3l a.34 R ADINO NII 103-000.4 1.3at't O $104 DFVVL.L0PLtR n'M2- A.CT T ;r: $1�4i3S.ttfi ' Mu":ft• (Yr,A1.ty0X10 M.Uf1,10 4 A N D:V; J01 M -[ECS: RECEIPT DATE BY"NA t � NSPECTOR 1 v INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Slab Grade _ Ducts Return Air Steel L41 Combustion Air Roof Deck O.K. to Wrap FramingCompressor _ Exhaust Fans 10-0 A F.A.U. Insulation / Vents Fireplace P.L. Grills TOW v Fireplace T.O. Fans 8 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 Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines Heater Final Water Piping J 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 p — Appliances Final Final Utility Notice (Gas) ELECTRICAL Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles .00 G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) ArPROVAL ` 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 Wih licerised- contractors to construct the project (Sec. 7044„ Business & Professionals Code). () I am exempt under Section B&RC. 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' 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:;vvorkers'. 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. 170562443. (This section need not be completed if the permit valuation.. is for $100.00 or less). O l°certify. that in the performance'd 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 sh°ail'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 theLabor Code, interest:andattomey'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 PERMIT # BUILDING PERMIT 0305-025 DATE VALUATION $145,382.20 LOT 16 TRACT 29323 JOB SITE ADDRESS 79-837 PARKWAY ESPLANADE SOUTH AP" 609-380-023 OWNER CONTRACTOR / DESIGNER / EN (NEER IA. QUINTADUNES 350, INC. CORNERSTONE DEVELOPERS, INC. 5005 CALLE SAN RAPHAEL, SIE. B-1 5005 CALLE SAN RAPHAEL, SIE. B1 PALM SPRINGS CA 92264 PALM SPRINGS CA 92264 (760)325-4289 CBL4 6867 USE OF PERMIT SINGLE FAi gILY D'15V ATG SFD '; LOT 16, PLAN 4YA PERMIT DOES NOT INCLUDE BLOCK WALLS, POOL, SPA OR DRIVEWAY APPROACH �s TRACT,CONSTRUCTION 2,511.00 SF PORCH/PATIO 53.00 SF GARAdE/CARPORT 425.00 SF EST]MATED COST OF CONSTRUCTION 145;382.20 PERMIT FEE SUMMARY. . CONSTRUCTION FEE 101.000-418.000 $800,50 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 .. 1011-000-419.000 $164,75- 164.75STRONG STRONG.-MOTION, MOTION. FEE - RESID 101-000-241-000 $14.54 GRADING FEE . 101-000423-000 $15.00 DEVELOPER IMPACT FEE A40560 SUB -TOTAL CONSTRUCTION AND PLAN 1 -MGIC $4,242.57 LE33 PRE -PATI? FEES $0.00 TOTAL PERMIT FEES DUE NOW $4,242.57 RECEIPT DATE BY DATE FINALED INSPECTOR