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0305-028 (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 606A86 Fa 1 i J. 01 Date Signature of Contractor 1, 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). t ( ) 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 'TATE FUN.:D Policy No. 170 624-0.1 (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: <: - a Applicant , � c..;,•� _. � Warning: Failure to secure Woocers' Compensation coverage is unlawful and shall subject an employer to crifninal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his application. 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessatiori of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspection purposes. -Signature (Owner/Agent) ' f <: • - Date PERMIT # BUILDING PERMITgf v DATE VALUATIONv1 7�;�J 2�9^ Ib LOT ,j TRACT ZfJ'M JOB SITE ADDRESS 7A".9I�wE14�ii�1Y�a?lZ�w�4'da APN OWNER CONTRACTOR / DESIGNER / EN (NEER 3 S(D 1140..fi2A f� r`- "CONZ' 0*:i� f f f✓�'Ej t f3,, it d':.". 5005 C, I E NAN RMI-TA0,3TKE B-1 P -M PAL. I ° SIPIU1V `.3L: C.tp �,. 92264 PP.s.,ibl. SM1,1.10"31 CIA 14264 USE OF PERMIT 2119-3Rf eD W91I.M0 `.4 —1 .....L?'.' S S, !'1,F1Pv :a}#9a.�silL] . 'KIOU 5"i iJtl :S +;,- o'd.AiLLA P004 30A OR OItI'VsT.WAY APPRICt ,CH YM 90114"ZY C'C$Nul'rRU��"'itOA! F11"? i T1- ON -4.1k-000 ��l�a::F:: ��• a :� � --�rts;.4.:� �-� f � ;ii>�.'f.If7 NISCkY Ai.•4ICA1. IMF +/)� 1 ` OOfL� �Ai�(t�-0�}0�0� 47�7,13f� 101-'00-420,000 e L.9 "i 1VC , L. i'U 2V: •:•.^i �T�O':N d+6^"V►fV r I A I MD. NO FRE 19.00.0 L"1 3 m , ;:i o 2A k -f7fiU vYi.24 C •RAC414.0 FOR ��;��..�,►�•.�c �c��r�;;r�'�'s2ttii�.a�� pia c�-�:�:�c� ��Yd� ��a.sy .. Ims PCtlu _P.Nsi3':TF* $0,00 i P i ��CQ• RECEIPT DATE. BY DAIS 9 INSPECTOR /- Loo, � ,, INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade I yV Return Air Steel Combustion Air Roof Deck Exhaust Fans OX to Wrap Framing Insulation J .- F.A.U. 141) A Ila I Compressor Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath22 C Final Final BLOCKWALL PROVAL 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 PP OVALS 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 0 Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test Appliances. Final Final Utility Notice (Gas) In) Avu- ELECTRICA!LV Temp. Power Pole / Underground Conduit Rough Wiring Low Voltage Wiring Fixtures Main Service Sub Panels 1A Y) iefof Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) COMMENTS: 4. 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 N Lic. Class Exp. Date 606486 B 1113 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). ( ) I,- as°owner. of the property, 'am`exclusively contracting with licensed contractorsto 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 herebyaffirm under penalty of.perjury.one of.the following declarations: . () 1 have and will ;maintain a certificate of consent to self -insure for workers' compensation, as -provided for -by Section 3700 of the Labor. Code, Ior'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. 1763624-03. (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�forwhich 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,'! 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 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 #0305-028 0305-028 DATE VALUATION $138,376.50 LOT 13 TRACT 29323 ADDRESS 79-885 PARKWAY ESPLANADE SOUTH APN 609-380-023 OWNER CONTRACTOR / DESIGNER / EN INEER LA QUINTA DUNES 350, INC. CORNERSTONE DEVELOPERS, INC. 5005 CALLE SAN RAPHAEL, STE, B-1 5()05 CALLE SAN RAPHAEL, ME, B1 PALM SPRINGS CA 92264 PALM SPRINGS CA 92264 (760)325-4289 CB1,4 6867 USE OF PERMIT SINGLE FAMILY DWELLING SFD - LOT 13, PLAN 3A/casite. PERMIT DOES NOT INCLUDE BLOCK WALLS, POOL SPA OR DRIVEWAY APPROACH TRACT CONSTRUCTION 2,376.00 SF PORCHIPATIO 45.00 SF GARAGE/CARPORT 447,00 SF ESTIMATED._ COST OF: CONSTRUCTION 138,37650 PERMIT FEE SlThDJARY CONSTRUCTION FEE 101.000418-000 $776,00 PLAN CHECK FEE 101-000-4.397318 $645.87 MECHANICAL FEE 101.000.421.000 STI, 50 ELECTRICAL FEE 101-000-420-000 $125.60 PLUMBING FEE 101-000.419-000, $166.00 STRONO MOTION FEE - RESID 101-000-241-000 $13.84 GRADING FEE 101-000.423-000 $15.00 DEVELOPEI2'IMPACT FEE $2,405.00 SUB -TOTAL CONSTRUCTION AND PLAN CHECK $4,219.81 LESS PRE -PAID FEES $0.00 TOTAL PERAUT FEES DUE NOW $4,219.81 RECEIPT DATE BY DATE FINALED INSPECTOR