0303-318 (CGAR)r
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
1 71/
Date- Signature of Contactor
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).
( ) 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:
Carrier1'>ec,`I! irtild Policy No. 15 131-2002
(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 provisionyof Section 3700 of the, Laboe—
Code, I shall forthwith comply wild tho' e -provisions.
Date: -`%- Applicantf
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 toy the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection,purps-ses �--�
Signature (Own gent) - ` �� , - r f Date / r
BUILDING PERMIT PERMIT #
DATEVALUATION LOT 0303A-3111 TRACT
r`r $6,3WAD
IJOB SITE P
APN
ADDRESS 47-M) WAS 1P1K�''3 ON S e��'
OWNER
CONTRAACTOR/ DESIGNER/ENN61NEEERR
T C
�4Y�Td111 LcalWYL/JMMt7ff LtM.
PO 13 DY, 1.4447
PO BOX 163
111VIV-DRISRAT CA 92260
PALM DEMEIRT CA 9226
(760)346.0745 Cf)L, 6541
USE OF PERMIT
GA"GE G:n2 C..�f CiFi'f
(2) 9'x 18' CAT&OI'C' i PF`YfAMIT DOES NOT =,1x UDP FLI l RICAL
(324 MR)
GARAOMARPORT 321.0 ► fAF'
'7faRiiP T 1.s`I`".i+ 9iixVDAARY
1ILM1 CfIYCK R-11 $58,30
tw0►yS`1`RU 1 ION f+' , 1 U1 v000 415-0100 014.0111
STR<3i7« MOTION FEF„ > C4iV M 100-000-241.000 $1.33
r _
ETCTIO1 f AND PTAK CHEC.TC
$1499 83
D e a IF0) PTM-PATDT'i
$0,00
01 2003 T j I P.Mom' FJ.09N LA Y40W
APR
CITY OF LA QUINTA
FINANCE DEPT.
�7
RECEIPT
DATE?
BYDATE
F A
INSP TOR
RT.
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings 4
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
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
Final
BLOCKWALL APPROVALS
POOLS - SPAS
steel
Set Backs,
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final I I
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
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
Final
Utility Notice (Perm)
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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
306566 B FHC 02/28/2(
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
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 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. 1376131-2002
(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 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) Date
BUILDING PERMIT PERMIT#
DATE VALUATION
56350.40 LOT 0303-318 TRACT
JOB SITE APN
ADDRESS 47-080 WASEMGTON STREET - -
OWNER CONTRACTOR/DESIGNER/EN (NEER
LPI? INC COLIN J MC DERMOTT/MC DERMOTT ENTI
PO BOX 14447 PO BOX 163
PALM! DESERT CA 92260 PALM DESERT CA 92261
(760)346-0745 CBL# 6541
USE OF PERMIT
GARAGE OR CARPORT
(2) 9'x 18' CARPORTS. PERMIT DOES NOT INCLUDE ELECTRICAL.
(324 S.F.)
GARAGE/CARPORT
324.00 SF
ESTIlI+IATED COST OF CONSTRUCTION
PERNIIT FEE SIJAD IARY
PLAN CHECK FEE 101-000-439-318 $58.50
CONSTRUCTION FEE 101-000-418-000 $90.00
STRONG MOTION FEE - COMM 100-000-241-000 $1.33
SUB -TOTAL CONSTRUCTION AND PLAN CHECK
LESS PRE -PAID FEES
TOTAL PERAUT FEES DUE NOW
RECEIPT I DATE I BY I DATE FINALED J INSPECTOR
6,350.40
$149.83
$0.00
$149.83