0305-023 (SFD)%. JIM I nm%, I Wrf UCL LAKAI IUN
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 11/301102.1
Date Signature of Contractor
OWNER -BUILDER DECLARATION
1 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 theproject (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 "wilt 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.iis 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).
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 t(` becor ie 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, 1. 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
per 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..1 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#
DATE VALUATION LOT Q3Q5-023
$136,342.00 58 TRACT 29323
oDRESS 79-865 PARKWAY ESPLANADE SOUTH
rAPN
609-380-023
OWNER
CONTRACTOR /DESIGNER / EN INEER
LA QUINTA DUNES 350, INC.
CORNERSTONE DEVELOPERS, INC.
5005 CALLE SAN RAPHAEL, SM. B.1
5005 CAI.LE SAID RA,PHAEL, SM. BI
PALM SPRINGS CA 92264
PALM SPRINGS CA 92264
(760)325.4289 CBL# 6867
USE OF PERMIT
.SINGLE FAMILY DWELLING
SFD - LAT 58, PLAN 2YB. PERMIT DOES NOT INCLUDE BLOCK
WALLS, POOL, SPA OR DR1VE*AY APPROACH
TRACT. CONSTRUCTION 2,349.00 SF
PORCH/PATIO 45.00 SF
GARA(tE/CARPORT 418.00 .SF
ESTDIIATED COST OF CONSTRUCTION
136•,342.00
PFRA7ITT FEE suhu jARY
CONSTRUCTION PEE 101-000.418-000 $769,60
PLAN CHECK FEE 101-000-439-3.18 $632.29
MECHANICAL'FEE 101-000-421-000 $47.00
ELECTRICAL FEE 101-000-420-000 $124.08
PLUMBING FEE 101.000-419.000 $158.75
STRONQ MOTION FEE . RESID 101-000-241-000 $13.63
GRADING FEE 101-000-423-000 $1500
.
DEVELOPER IMPACT FEE. $2,405:00
SUB -TOTAL CONSTRUCTION AND PLAN CHECK
$4,164.75
LESS PRE -PAID FEES
$0.00
TOTAL PERAUT FEES DUE NOW
$41164.75
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
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
6015486 B 1 /3 0, Ov
Date 2-1 ' ' �� 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.
G�) 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 '. GTATE M101 Policy No. !"%614.-W,
(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: - �' c' a Applicant t �. sions.._� o'
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer ty iminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicafon agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and Hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
.Signature (Owner/Agent) %'-- - 1 Date '� • ' "'"
BUILDING PERMIT PERMIT
DATE j VALUATIONS ;�� LOT v "� TRACTJOB
SITE
ADDRESS 79-W FASNIPWmY UPTA,iUDE 149GUM
APN
OWNER
CONTRACTOR / DESIGNER / EN (NEER
5005 E &LE 3M RA1MAU.,; �KrR .13.• I
5005 CAI.;i..A :'lit �cAt?A:tA,.i`�., ERIi, N � Y
k'163'..M 9PP. KGq CA 92264.
N.ALM apr'ewa CIIA. 9=64
(180j�65-4�8 ;7stb £:w?
'
USE OF PERMIT
.eras..Ear rtis.lp4�.4 1i.K 4
WALLA J100 e'APA. Oft DRIVEWAY APPROACH
TRACT 21349.Op SI
.Cy�ONSTRUCTION
'PiZil:.i`$�1�ATIO 45.010 Sly
'
SY
LN"T:i�iaE TKID COSIT OF CiNISMU41i:10N
MO.'£' bSkTZ SUMMARY
K".OMI3'RUCT103 FRE I0im0;110-419-00,$ `1'969.Ofl
PLAN CHUCK FEE 18
MECHANICAL #RR l0 1 -E300 4711.0011)
rAIMIMUCAL, FM I W _W& 4710-000 0m,
C'LlMV-114411TIFF '101-t7 -419VP1
ST,R-04, 1U .NAO'€IOW P'SH • JZWmoll) 10 l -000-34) -000 E1 �.ii3
OlZA1711W FU
DZV ELGOT�'.:lR. FH11PACT 77M, ��,4fDS.f10
hu ,,, 4MAL Mk+UIBIAL P11 D 111111 Aa 97.1w, 1.1 CK
$4, 164.7 5
LUZ" 'ER&r:AID RIPS
SU,GtCP
RECEIPT
DATE
D FI
SPE
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS `
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
17
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F .U.
FramingCompressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wail Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
.�qJ
Drywall - Int. Lath
i®
Fina
Final
BLOCKWALL APPROVALS
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
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
Final
Utility Notice (Gas)
ELECTRICAL
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
FixturesAJ-
Main Service
Sub Panels
Exterior Receptacles.
G. F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Penn)
JU
APPROVALS
IV
VIC
COMMENTS: