0305-024 (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 k3 11 i3rl4a=
Date ' ' 77Signature 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). C
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Bysiness & 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 ofAfi—q following declarations:
( ) I have and will maintain a certificate of consent;to self -insure for workers'
compensation, as provided.. for by Section 3700 df'the Labor Code, for the
performance of the work for which this permit is issued.
('ti,) I have and will maintain workers' compensation» insurance, as required by
Section 3700 of the Labor Code, for the performanc"! the work for which this
permit is issued. My workers' compensation insurance carrier & policy no. are:
Cartier ,A'dAT1? FUND Policy No. II?0110 "3
(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: 7 . , „ 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' "' �' S
PERMIT #
BUILDING PERMIT
ON)'.5-024
DATE VALUATION e� rf LOT TRACT !y;J 'ZA '
JOB
ADDRESS 79—M e1y.AR�ii�'s�..ir.��sS.'f'y��I�?i.01% SOUTH
7 IF
APN
OWNER
CONTRACTOR / DESIGNER / EN &NEER
LA Q-UPDMA DY1IMS 350, INC.
B -TC.
,5005 C-e�.M SST P-AA'i-iM.., 311? B-1
S W 5 CALLS. MN TRAPM, �M,- B1.
PA112d SPR DIGS CA 92264
1'AI!A SPU,3 G31 CA 92264
('160)325.420 OBL-3 6LI611
USE OryF�PERMIT
��', py [ i{/ 7�(�y{..y y�`�]
A�I.fB`P{�.C.•E, i'•l1dVl2.lJJJi 7Jtl M1111,140
,
3f''o 123T'59, FrJ.AN :3+;.x.. YC,RMIT FUZZ U-1 lr4b.:LLrlJ£; DL .;L4,
Wft%.: A P001., SPA Oil D,RhrMAY ARSHKOACH
`' 1i.r°X`I CONSTRUCTJON 311214* OF
Part.Ol-tMATIQ 45.0,V
0ARASS&CAN.PORT 44. 7,00 SF
_....... .. 7S `L A'i ?'F7 �':`Q°' � f11►' C° 1*Tk 34'C3 ' Ct1�
124.530,110
CON151TRUCTIONFEIrt 103 -OW -418-000
PLAW CHECK FEE 101-004,39-318 1$597,41
N1EMANIVA.L RE 101-t':400.42 , .03003
ELW.I XICALL YU 1015 6640„420-000
PT.z.3m1ii-ao ?QEF 101 a;>f� -419.000 1146,75
�17`ltC1�6f A30'IItYN FRE - IM -11.1 ja"�'1- i(;�(T-241-= $13.44
(JP1 DffiF01 EF 1014,100-4231-000 5'3,00
DWF10IaF. R. IMPACT s°L3d $s dO�.Ot3
StM,TCir.AL.i'01,9f'.�3YRT.1C1'f01VT AND
V,06719
iar>�I.f�>i33ge'ii^,!',�i�ifZ �
"r�1�`Tt$ if. l' i►�6i14Y� ' +�4+."1_ O' :AV
t>Sa1)67,20
RECEIPT
DATE
BYDAT
FINAL
I ECTO
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Slab Grade
MJW
Ducts ✓
Return Air CD
Steel
Combustion Air
Roof Deck
Exhaust Fans
O. K. to Wrap
Framing
Insulation
Compressor
VentsCz 44f
Fireplace P.L.
s
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
i
Final
Final
BLOCKWALL APPR VAS
Pods - PAS
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
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 1-11
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
APPROVALS
L
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 11/3 0/0Z
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).
(` `) -1, as owner"of`ih property," am exclusively coniracting with licensed
contractors to:. construct the. project (Sec. '7044, Business & Professionals'
Code)..
O
1.0m exempt. under Section B&P.C. for this reason
Date Signature of Owner -
WORKER'S COMPENSATION,DECLARATION
l 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.Jor 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 4hat in the performance of the work for which this permit is issued,
1 shall not employ any person .inany manner so as to become subject to the
workers' compensation laws`of California, and agree .that if I should become
subject to the workers' corripensatioWprovisions of Section 3700 of the Labor
Code; I shall`.!.&thwith comply with those provisions.
Date: Applicant -
Warning: Failure to secure Workers'_ Compensation. cove rage is unlawful.and
shall subject an employer to criminal, penalties and civil fines.Up to $100,000, in
addition to the cost of compensation;t6mages'as-provided for in Section 3706
of the Labor Code,: interest and. attorney's fees..
X.
IMPORTANT Application is hereby made to the Director of Building and Safety
for ape rmit '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 PERMIT #.0305-024
DATE VALUATION $124,530.00 LOT 59 TRACT 29323
ADDRESS . 79-882 PARKWAY ESPLANADE SOUTH
APN 609-380-023
OWNER
CONTRACTOR / DESIGNER / ENGINEER
LA QUINTA DUNES 350, INC.
CORNERSTONE DEVELOPERS, INC.
5 005 CALL,E. SAN RAPHAEL, SM. B-1
5 005 CALLE SAN RAPHAEL, SM. B 1
PALM SPRINGS CA 92264
PALM SPRINGS CA 92264
(760)325-4289 CBL4 6867
USE OF PERMIT
-
SIATGLE FAMILY DVIELL1NCT
WALLS, P0014 SPA OR DRIVEWAY APPROACH
.
TRACT. CONSTRUCTION 2,121;00 SF
•PORCH/PATIO:00 4$SF
GARAGEICAR.PORT 447.00 .SF
EgIlMATED'COST OF CONSTRUCTION
124;530.00
PERMIT FEE SUMMARY
CONSTRUCTION. FEE 101-000-418-000 3737.00
PLAN CHECK FEE _ 1'01-000-439-318 $597.41
MECHANICAL FEE 101.=000-421-000 $4700
ELECTRICAL FEE 1011000-420=000 $116.68
PLUMBM_ QiFEE:• 101-000419.000 $146.75`
STRONG MOTION FEE - RESID 101-000-241--000 $12.45
CIRADIN(3 FEE 101.000.423-000 $15;00
DEVELOPER IMPACT FEE $2,405.00
SUB -TOTAL CONSTRUCTION AND PLAN CHECIC
$4,067.29
LESS PRE -PAID FEES
$0,00
TOTAL PERMIT FEES DUE NOW
$4,067.29
RECEIPT
DATE '
BY
DATE FINALED
INSPECTOR