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0308-249 (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 BMC{{// 9/3()!04 �� •f"? ` � Signature of Contracto � / '` II// /f/;L . 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. t ( )` I have and will'maintain workers' compensation insurance, as required by Sec ion 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 OLD REPUBLIC IN=Policy No. e�l'�%t�1C9�9S40i3 (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, IS forthith comply with those/provisions../ ,Date: Av d w Applicant �rl,✓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 the above-mentioned property for inspectionpurposes. Signature (Owner/Agent) �1/"/%i�` Date/' %7 `P3 BUILDING PERMIT PERMIT# DATE VALUATION LOT OfS�1�E TRACT .. R. 30521-1 JOB SITE APN ADDRESS r787'u—tl 2 VM FA VIOLA (0'44X42-009 OWNER CONTRACTOR / DESIGNER / ENGINEER LEVOI Alt1. HW" 14 OF (IM IF RKM 1,M4 R VIOW!,'.4 OF CAUT-011 A 7 C€-401 C MDAMY 311 ` 8-40i C :S1~i1;:.>-HW.6,Y 11.1 LA QU119TIA CA '92:25 3 LA Q09M Cis 9225:3 (760)777-0131 allR ' 3434 USE OF PERMIT' r FL3. 14311 25, PLAW lYLit F9JZta11T DO -ES NOT INC.I iM Bf,OCK WA1,IA POM, SPA. %i'FMUCT.1014 O PLAN GHE,CK Ytt DUE TO MLVIPLIE 7SSUA.NC Y, OF.15t Y PLAN TYPE f AV'r (!0N81`A4. q D0x4 2,040.00 OF PO C:illRA IO 4 tM.00 Sr' dAUMU'AiiPORT SE' -E61MMIIJ) COST 4VCOP'fi'UMON ' 1.5911997M YMAST FBR SUNTUARY o' ONSTRUC1`IUN FELE 101-000-418-000 0.00 PLAN CHECK WE. 101-000-439-313 IdNCH-PAIRCA4,FF;E 101.000-421-000 x%1.00 ME:C 3 RICA L P 2(21-OtlO�n's'C-01)Q $135.14 1b1;ddAllt•9. NO FEE 101.000.419.000 '�11�1.019 I T6h7ONO MOTION Fel?j - R:E.SD 101.000-e141-000 E3?43.,'kliN0 101.000-4.23-00 $15.00 Y'91•VEE.EFf'ER F31!lPk1CT FEE $ ,505•i90 EVE12,:71MA?.L W. X STRUtITON AND :.Lal C! HEM $3,840.106 1.7Z3 -PRC—PAIDE MES $0,00 • r•. A � e 1� ,. M1. Pic Now $3;049.76 V 1 t E DEC 5 Or- LA Reil, iA CITYen MOT RECEIP ��.` `•' BY D E FIN INPECT( INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs P Forms & Footings Underground Ducts Ducts Slab Grade Return Air Steel Combustion Air - Roof Deck f _ Exhaust Fans O.K. to Wrap F.A.U. _ _ Framing Compressor NA 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 POOLS - S AS BLOCKWALL APPRO AL steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final Gas Piping PLUMBING APP VALS 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 PRO PALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fbdures Main Service 01 Sub Panels mo 0z Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Of Final Utility Notice (Perm) -Al 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 728102 B HIC 9/30/04 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 OLD REPUBLIC INSU Policy No. MWC100843400 (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: ADDlicant ,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 comperisation, 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. r Signature (Owner/Agent) Date BUILDING PERMIT PERMIT# DATE VALUATION LOT 0308-249 ' TRACT $158,897.60 25 30521-1 JOB SITE APN ADDRESS 78-472 VIA PAVION 604-032-009 OWNER CONTRACTOR / DESIGNER / ENGINEER LENNAR HOMES OF CALIFORNIA - LENNAR HOMES OF CALIFORNIA 78-401 C HIGHWAY 111 78-401 C HIGHWAY 111 LA QUINTA CA 92253 LA QUINTA CA 92253 (760)777-0131 CBL# 3434 USE OF PERMIT SINGLE FAMILY DWELLIA G SFD - LOT 25, PLAN IYCR PERMIT DOES -NOT INCLUDE BLOCK WALLS, P0014 SPA OR DRIVEWAY APPROACH 75 % REDUCTION TO PLAN CHECK FEE DUE TO MULTIPLE ISSUANCE OF SAME PLAN TYPE TRACT CONSTRUCTION 2,640.00 SF PORCH/PATIO 488.00 SF 0ARA0E/CARPORT 462,00 SF ESTIMATED COST OF CONB_TRUCTION 158,897.60 PERMIT FEE SUMMARY CONSTRUCTION FEE 101-000-418.000 $846,00 PLAN CHECK FEE 101-000=439-318 $175.73 MECHANICAL FEE 101-000-421-000 $73.00 . ELECTRICAL FEE 101-000-420-000 $135.14 PLUMBINO FEE 101.000-419.000 $184,00 STRONO MOTION FEE . RESID 101-000-241-000 $15.89 GRADING FEE 101-000-423.000 $15.00 DEVELOPER IMPACT, FEE $7,405.00 SUB -TOTAL CONSTRUCTION AND PLAN CHECK $3,849.76 LESS PRE -PAID FEES $0.00 TOTAL PERAM FEES DUE NOW $3,849.76 RECEIPT DATE BY. DATE FINALED INSPECTOR