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0305-029 (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 3N Signature of Contractor OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that 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 provided1f6r by" Section 3700 of the Labor Code, for the performance of the work forrwhich 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 workerscompensation insurance carrier & policy no. are: Carrier STATE K:ND Policy No. IV, 161440 (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 Ofithe Labor Code, I shall forthwith comply with thoseprovision_ (,f ,.Date: :^ } Applicant l� y Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his application. 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspection purposes. Signature (Owner/Agent)' 1 /- f. r` — --� f Date PERMIT # PERMIT .BUILDING (S-VA9 DATE VALUATION TQ L t v. TRACT .' JOB SITED ADD ESS... A g—%�n Iti'. .lrNr�Y SPLANWDF 3 s APN OWNER CONTRACTOR / DESIGNER / ENGINEER : py,1%�;O'�t:,�. L( rlt�(>:6t♦A,i/:�8u�.M-011,1E.,'D`[1��.�rryC��C^�I"�ERS,,alagC. /'��gji/1•��.,pp��::ii�$t{��fk,�.io`{; x� 500s� C:A.11Ld� ae%;. '%.l.\Yy:�4s i+��.i'•:L7 h? .'1 F•:1 506,5 i-k7)Jd.A6:•!iI6 14 Y. 46�P.1.�I7.��_, SM. .1.4E PALM dPRDAis CA 9226A, ALM SPRTOM CA 92`'264 ��?�f1�32J••-�}`LE1� �Y �d fAWtk 7 USE O��F11 PE//R..MITyy. ►7J.1 :0.T., _a•..5�`1cviLLr 7. .(_i La .i .Y.at.Q.dl.V l7 VVA.1..U.« P00(4 SPA, OR Di1NXW44,Y .f;PP R0A.CH, 15% REDUC".` IOYN TO F11.1.101 o H:Ir� . PE P.:f '.out •r0 StULTIE't'i E "ssu,'17110E• C7F 'A1.me PL." '-,rom `1.1is1Ca r,�sai�a�:�l"ftfSCT1C>:Pi �,Fat.,r��''� Ff.;11iC1'?!%ykv.,P:v.�,OI! .i2.1 ��t.l`d:.1q�:�I::S•;".:":?Z.Y"('f:ta.i •5d�,'a`1� i`SP 4 : E��.,ry��p,A H�•y1 ,{•� ,.gyp• r`' �L �•t y�+�`'y .I:ig6�71 MK�e.� WOF �wt�iyy STl."��7J�.� 011 1.O.,Je .7{JMraa"V qq��yypp,� ��yq�L��ery pPp;`t may. q v SA6dL?JME ,L EES. 9W_Try.6.AirtA1Z 0X`NS't":2" C1310N 1111— tl, 101 -00041 V-000 diiilU•' �t! PLAN C'HIPr-K MS 10 .000-439-31 E WCki.ESNI.CALFEIT, '101 CX11 -.871-(0()Q $53. so 101 ` 000-420--(Jl~1fl 1 x.69 Krum' 'BIND TIUR 101 -000-419,000 57KON13 M TICi'e4 F81. = Ft.&RD I01- Ori -24l -000 GRAf7li<il3 F"FF, S.1$A Dk-VZL.•Oi`V,`-%IPJI Y' i °' tTf:E AL CONIS'j`l;=UCTTSLYK AND F']L.AN C TTFM,: 1XIM KIT., P.601) FEES V�a r:a wx k' s. D. E r, 31'v RECEIPT DATE — BY p INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs j Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck ! Exhaust Fans OX to Wrap 1 F.A.U. Framing _ Compressor Insulation_ Vents Fireplace P.L. Grills Fireplace T.O. I Fans & Controls Party Wall Insulation Condensate Unes Party Wall Firewall Exterior Lath i Drywall - Int. Lath f } I Final Final i BLOCKWALL APPROVALS P061 S -SPAS steel Set Backs 1 Electric Bond Footings i Main Drain Bond Beam Approval to Cover I Equipment Location ', 1 Underground Electric I Underground Pibg. Test Final i Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines i Heater Final Water Piping } Plumbing Final Plumbing Top Out _ Equipment Enclosure Shower Pans 1 O.K for Finish Plaster Sewer Lateral I Pool Cover Sewer Connection40 Encapsulation Gas Piping 1 Gas Test I Appliances i Final }COMMENTS: i Final } Utility Notice (Gas) ELECTRICA AP V L Temp. Power Pole Underground Conduit Rough Wiring 1 Low Voltage Wiring Fixtures Main Service 1 ol Sub Panels Exterior Receptacles , G.F.I. lo ZcT Smoke Detectors Temp. Use of Power Final } Utility Notice (Perm) vjf 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 11/30/01 Date ISignature 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). 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 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. 1705624 03 (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: Applicant ' Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject arf 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. T. 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 0305-029 DATE VALUATION $145,382-20 LOT 12 TRACT 29323 ADDRESS 79-901 PARKWAY ESPLANADE SOUTH APN 609-380-023 OWNER CONTRACTOR / DESIGNER / ENGINEER LA QUINTADUNES 350, INC. CORNERSTONE DEVELOPERS, INC. 5005 CALLE SAN RAPHAEL, STE, B-1 5005 CALLE SAN RAPHAEL, STE, BI PALM SPRINGS CA 92264 PALM SPRINGS CA 92264 (760)325-4289 CBL4 6867 USE OF PERMIT SINGLE FAMILY DAG 5FD • 13, ..LOT WALLS, 0004.SPA: OR DRIVEWAY APPROACH, 75%. REDUCTION TO PLAN CHECK FEE -DUE TOMULTIPLE ISSUANCE OF SANTE PLAN TYPE TRACT CONSTRUCTION 2,511.00 SF PCACHIPAT10 53.00 SF GARAGVCARPORT 425,00 SF ESTIMATED COST OF CONSTRUCTION 145,382.20 PERAM FEE SUMMARY . CONSTRUCTION FEE 101-000-418.000 $800.50 PLAN CHECK FEE 101-000-439-318 $164:81 MECHANICAL FEE 101-000.421-000 $53,50 ELECTRICAL FEE 101-000.-420-000 $129.89 PLUMBING FEE 101.000419-000 $164,75 STRONO'MOTION FEE- RESID 101-000-241-000 $14.54 GRADING FEE 101-000-423-000 $1500 DEVELOPER IMPACT FEE $2,405.00 SUB -TOTAL CONSTRUCTION AND PLAN CHECK $3,748.03 LESS PRE -PAID FEES 40100 TOTAL PFIZT*M FEES DUE NOW $3,748.03 RECEIPT DATE BY DATE FINALED INSPECTOR