0305-032 (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 ExprtDate y `
606486 D
i
Date„<-+ • � �T 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:
( ) 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).
( ) 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 3,700 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 aP',IND Policy No. 170562440
(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.
Applicant -
Warning: Failure to secure Workers',Compensation coverage is unlawful and
shall subject an employer to cri'Iriinal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemni D
& hold harmless the City of La Quinta, its officers, agents and employee
2. Any permit issued as a result of this application becomes null and void
work is not commenced within 180 days from date of issuance of suc
permit, or cessation of work for 180 days will.subject permit to cancellatio
I certify that I have read this application and state that the above infoation i i
correct. I agree to comply with all City, and State laws relating to the buildin
construction, and hereby authorize representatives of this City to enter upo
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) ' •.Q'- :a •�'"�.1., �f Date* -a?�
BUILDING PERMIT PERMIT
W054521
DATE VALUATION YQ14,1;30.00 LOT CJ TRACTJOB
ADDRESS F43.,:ars t� FAMMAL�.�.a4�'�"'.�el�l'Nl�Fw.J.i7, i OMM,
APN
OWNER
CONTRACTOR/DESIGNER/EN (NEER
s,f. Qt 17INT , i7UWRIS 3 10, U11 C'
£Y' I
50,06 CAUX �•`.�3,°:WMA_RLw `7.5'.R: D I
par tva • r l ' �=rm CA 51264.
PAUL. • 1-WRNGS CA .92264
(760)325-4 7.89 CSIN 61367
USE OF PERMIT
SF • I.�::'P j; 1-01.Am:tn PI RI)PAT i; AYS NUT I:NCLOV—P, Bi,0i - WAL"
!x'004 WIA, 0H. pRWAY APP ZOA.CK 1W04 R Ij' UCTIOW- 70 Pd:, R C`IEC'K
FEE VU r, Tt -j MU1I MPLE bu.S:+7M "K OF SAMZ PLAil TYPE -
TRACT CO)ISTIRUCTIO'A .g1"IJ .Bo IP
4?i:t`iU:t• ll ATIO 45.6E1 St;
0A;itlWfl?,it,"ARPORT 4-0,00 OF
:��I,I fI'J AT � '9 CGSX mill' t.C�l�Ii;+I'T�iJ�"IO
2415$`00.
P��99}�pp ��77'•��
Ce 'NM.' 'Ve.'s•10W .FEE 101. -OCKO-4 I F,-000
PLACE 0-OXX FX$ 0,1149.35
M1 CH.KNE%.4`:.x.1' , 101-U:00-421-000 $47,00
A.'d..W-TRX_A1-T8Y, 3110•6iS
PLUMP111401 YED. ' 1 bl doff.) -41 V-000
�;`!"1wO:ti�' A3{�Tt�itd IST!; • Rir,^!ii I iD2 -£100-2,d I• -0t?Q �I3.�19 :
�'.' -
CiAcS.i') ,'0 FES 101 _00042.11-000. $I:i;f111
rjUVR1. PV.W IMPAZ"1' F—EF
��tf; �3- � T�+ , Cr�1�:Tf til `° ;Oil l� v� 3 PLANC:
S 19.21
JUN 0 2 2003
�
W
CITY OF LA QUINTA /
FINANCE DEPT.
RECEIPT
DATE 4-j'_J
w
BY
/
D F A D INSP R
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings.
Ducts _
Slab Grade
7y
Return Air
Steel
Combustion Air
Roof Deck
i
Exhaust Fans Ilk
O.K. to Wrap
F.A.U.
Framing
Insulation
_
Compressor
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
i
Final
FinalLZ
BLOCKWA
APPROVALS
POO S - 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 AAPPROVAL
Gas Test
lectric 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
Final4
Utility Notice (Gas)
ELECTRICA
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels /
Exterior Receptacles
G.F.I. :
Smoke Detectors'
Temp. Use of Power
Final
Utility Notice (Perm)
4 -
AP O S
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 11/30/0-1
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 nofintended'or offered for
sale (Sec. 7044,'Business & Professionals Code). -
( ')` -1, 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.
( ) I have'and-will" maintairi 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 STATETUND Policy No. `1705624-03
(This section need not be,completed if the permit valuation is for $100.00 or less).
( )' 1 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-subjectto 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 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 attomey's fees.
IMPORTANT'Application is hereby made to the Director of Building and Safety
for a permit subject to they 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 PERMi
0305-032
DATE VALUATION $124,530.00 LOT 9 TRACT 29323
JOB SITE
ADDRESS 79-949 PARKWAY ESPLANADE SOUTH
AP"
609-380-023
OWNER
CONTRACTOR / DESIGNER / EN INEER
LA QUINfA DUNES 350, INC.
CORNERSTONE DEVELOPERS, INC.
5005 CALLE SAN RAPHAEL, SM B-1
5005 CALLE SAN RAPHAEL, SM. B1
PALM SPRINGS CA 92264
PALM SPRINGS CA 92264.
(760)325.4289 CBL4 6867
USE OF PERMIT
SINGLE FAMILY DWELLING
SFD - LOT 9, PLAN -3B •PERMIT DOES;NOT INCLUDE'BLOCK WALLS,
0604 SPA OR DRIVEWAY APPROACH. 75% REDUCTION TO PLAN CHECK
FEE DUE TO MULTIPLE ISSUANCE OF SAME PLAN TYPE: .
TRACT CONSTRUCTION 2,121.00 SF
PORCH/PATIO 45.00 SF
•GARAGEICARPORT 44700 SF
EST]VIATED COST OF CONSTRUCTION
.124530.00
PERMIT FEE SUAD4ARY
CONSTRUCTION FEE 101-000-418-000 $727.00
PLAN CHECK IFEE 101-000-439-318 $149.35
MECHANICAL FEE 101.000.421.000 $47,00
ELECTRICAL: FEE 101-000-420-000 $116.68
PLUMBI"14G FEE 101-000.419=000 $146.75
STRONG MOTION FEE - RESID 101-000-241-000 $12.45
GRADING FEE', 101-000-423-000 X15,00
DEVELOPER IMPACT FEE $2,405.00
SUB -TOTAL CONSTRUCTION AND PLAN CHECK
$3,619.23
LESS PRE -PAID FEES
$0.00
TOTAL PERMIT FEES DUE NOW
$3,61933
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR