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9806-215 (SFD)LICENSED CONTRACTOR DECLARATION In I hereby affirm under penalty of perjury that I am licensed under provisions of I— Chapter 9 (commencing with Section 7000) of Division 3 of the Business and cel W Professionals Code, and my License is in full force and effect. M License # Lic. Class Exp. Date Z � `v ate �� ' Signature of Contractor coo O r " ~ I.— coo x OWNER -BUILDER DECLARATION/ Ha I hereby affirm under penalty of perjury that I am exempt from'the Contractor's License Law for the following reason: Z_ ( ) 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). co () I am exempt under Section B&P.C. for this reason N Date Signature of Owner O N rn d Q WORKER'S COMPENSATION DECLARATION C) Z I hereby affirm under penalty'of perjury one of the following declarations: LO O () 1 have and will maintain a certificate of consent to self insure for workers' X W compensation; as provided for by Section 3700 of the Labor Code, for the O J Q performance of the work for which this permit is issued. m Q U (x) I have and will maintain workers' compensation insurance, as required by O Q Section 3700 of the Labor Code, for the performance of the work for which this Z permit is issued. My workers' compensation insurance carrier & policy no. are: Carrier Policy No. CL O .1vilAT'E FUkM) 035-97.0001235 (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, fo h6th comply with those„provisions:^-w '”' "" iDate: 7Z.1arl.,19' `Applicant Warning Failure to secure Workers4Compensation coverage is unlawful and shall subject ari 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 !V 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 represeniativ}es of this City to enter upon -the above-mentioned property for inspection pu.,rposeS..-..•- 0 Y5ignature (Owner/Agent) � �" "-Date �� BUILDINGPERMIT PERMIT# CONTROL# 9F1116.215 DATE "7 J VALUATION LOT -�` _ TRACT / 1 I�(C �2�t►,7�5.'211 .fits i;_S.L, x ! ff JOB SITb APN ADDRESS r- 5.�-6D1 tlN"fCRLAChiI1V 761,4190-026 OWNER CONTRACTOR/DESIGNER/ENGINEER MCCONIIC-S.EOK.TOP LLC v 'rRAN'S WEST HOUSING INC 14so .A ST M. 3140 78-441 F HIGHWAY to 1. SAN .DIEGO CA 92101 LA QUCNTA CA 92253 7t 0 rt-33� CBS,# 4972 USE OF PERMIT ISM SFD - PH 1, LaC 48PLAN 319R, 1PF. UMIT DOES NOT INCLUDE BLOCK' WAI, LS OR POOL. PLAN C14?,C K FEE RE©UCIED BY 7.5016 FOP, MLTI.T.IPLE ISSMANCE OF SAME PLANTYPM;. .t COST OM CONSTRUCTION 3,013.00 S PORCKMATTO 325.00 SP . GARAQWCARPM 600.100 SF ES t`UMM ED CaWf Oft CONSTRUCTION 2511,7".ZdJ PEttMIT IFEE SUMMARY CONSTRU(7t'I.ON FEB 10.1-tlttli-4.1.8-000 $t,If�8.00 1''I -AN CHECK FEE 101-000-439-315 S.239.50 MECHANICAL FEE 101-000-421-000 5121.00 ELECTRICAL FEE 101-000-420-000 PLI[, 1Bl11G.FFE 101-000-419.000 STRONG MOTION FE - MID 101-000241-000 szs.oa GRADING FEr '101-000-423-000 $Moo 1Md RASTRU`C°t`itliF F E 225-000-443-:342 55,545.64 ART 1N PUBLIC PLACES - RESM 701-000-"s5-000 ga • a>s t'Or �IBZIXMALCONSTRUCTION AND PLAN CHECK LESS PRE-PIUID FEES $7,%-%.67 $0.(10 J U L 14 1999 TOTAL PERMUT 1+ EE:N DUE NOW S7.S66.67 RECEIPT DATE BV' m DATE FINALED INSPECTOR 4 OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs/ e; G Underground Ducts Forms & Footings �' -0 Ducts Slab Grade V --/p -cej Return Air Steel Combustion Air Roof Deck qp Exhaust Fans O.K. to Wrap . Z Q F.A.U. Framing - Compressor Insulation _ Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath Final 4a BLOCKWALL APPROVA S Final 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 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 Sewer Connection �8 -�Q Pool Cover Encapsulation Gas Piping Gas Test Appliances Final COMMENTS: Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wining Low Voftage Wiring. Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final /f tlhtRy Notice (Penn) /(T/� .�VA�