9803-185 (SFD)LICENSED CONTRACTOR DECLARATION
1711 hereby affirm under penalty of perjury that I am licensed under provisions of
F— Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
N W Professionals Code, and my License is in full force and effect.
O =) c) License # Lic. Class Exp. Date
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� ,/ , y o y� "`�.�� ,► � //jam,, (00198o Z r Date Signature of Contractor (—✓
J U coo OWNER -BUILDER DECLARATION
W W I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ ID_ 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
O N Date Signature of Owner
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Q WORKER'S COMPENSATION DECLARATION
IL
C) 2 ZI hereby affirm under penalty of perjury one of the following declarations:
LO Cr
O () 1 have and will maintain a certificate of consent to self -insure for workers'
X W �L- compensation, as•provid'ed 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 I have and will maintain workers' compensation insurance, as required by
O C)Q Section 3700 of the Labor Code, for the performance of the work for which this
fi rn I— permit is issued. My workers' compensation insurance carrier & policy no. are:
v Z Carrier Policy No.
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►�. o STATE FUND 1.230
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(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
3 Code, I shall/fort d comply with tho e jp� Ions.
.tfDate: `�/W, Applicant r //
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
thefabove mentioned property for inspection purposes. ,.Signature
.Signature (Owner/Agent) � Date �/ � f
. BUILDING PERMIT PERMIT# CONTROL#
DATE , VALUATION LOT 98034115 TRACT g
$195,761.90 3
JOB SITE
APN
ADDRESS
50-235 DOi2 AL ST.
769-740-003
OWNER
CONTRACTOR/DESIGNER/ENGINEER
P. T HOMES LLC
Ri':' MVEST IMENTS, IMC.
P.O. BOX 810
1425 E. UNIVERMY DRIVE
LA QUINTA CA 92253
PHOENIX �lZ 85034
(602)257-1656 CBL,# 4990
4
USE OF PERMIT
PLAN 2A - SFO - R3T -rIO11 ES (ai LA (if1INTA F AIRW kYS - 75% PLAN
PA
CHECK REDUCTION APPLIED U
A P
, 0 q 1998
CUSTOM CONSTRi3C...CiC3N ZM9.00 SF
PO.RC14/lPA tTI.O 134.00V., C HT1(®
LA Q U I NT
GARAGEICARPOR T 561.00 SI
WeNTIMATED COST OF C0NSTRUC 11ON
1.95, 64.910
PERMIT FEE SUMMARY
CONSTRUC," 17.0N FEE 101-000-418-OQO yyS,sCi
PLAN CH CK FEE, 101-000-439=318 Sd99.74
1 IECHAN1CAL FW 101-M-42,1-000 598.St1
ELE=RICAL 1+,E 101 -000 -420 -ON $15W.94
P.LUAdBINC,:!:EE 101-04 0.4,1.9-000 • SL56.50
STRUNG NIOTION FEW - RCS1D •101-000-241-080 $1%58
GRADING FEE 101400423-000 $20.00
WRASTRUCTi.ttRF FE 225-000-443-342 $4;3641.61
ART IN PtML1C PLACES - RFSIC; '701.-0001-255.000 $239.41
SUBTOTAL CON5717RUCTION AND PLAN CHECK
$6,224.78
LESS PRE-PAID:iiL'ES
$0.00
TOTAL PERMIT .VEES DUE NONV
-$6,2:23,78
RECEIPT
DATE
BY %
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms 8 Footings
Slab Grade
_ _ _ _
, ��
Ducts
Return Air
Steel
Combustion Air
Roof Deck
_
jQ �j �_ ��
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
v_ �J /
Compressor
Insulation
Vents
Fiteplace P.L.
_ _/
<��`
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
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
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
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
t
t
Final
Utility Notice (Perm)