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0403-267 (RC)0 LO X m t'J a: L0 O,'N U0 CL �Z Q HO JJ. QU UQ L� VZ cb 5 r, O 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 # Lc. Class Exp. Date 648681 B 01/31/2( 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: ( ) 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).. ( ) 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business & Professionals Code). O 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. 04600992602 (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 is 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 ls.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 rthis 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# 0403-267 DATE O VALUATION n oom LOT TRACT JOB SITE APN - ADDRESS DUNE PALMS DIL - - OWNER ^' CONTRACTOR / DESIGNER / EN (NEER MARK RUELMM RAMGER PALM DESERT CA 92211 (760)200-4625 CBL# 2416 USE OF PERMIT COIAhMCL4L REMODEL MODIFACTION , RELOCATION OF ELECTRICAL CLOSET. 2001 CBC. CONTRACT AMOUNT 1,600.00 L3 ESTIIdATED COST OF CONSTRUCTION 1,600.00 PE>IallM FEE SUhDSARY CONSTRUCTION FEE 101-000-418-000 537.00 PLAN CHECK_ FEE 101-000-439-318 ELECTRICAL FEE 101-000-420-000 :15.00 STRONG -MOTION FEE• COMM :100-000-241-000 $.50 ART IN PUBLIC PLACES - COMi 270-000-445-000 $8.00 SUB=TOTAL CONSTRUCTION AND PIAN CHECK $90.71 LS33 PRE -PAID FEES $0.00 TOTAL PERMIT FEES DUE NOW $90.71 RECEIPT DATE, BY DATE FlNALED' SPECTOR 7 LICENSED CONTRACTOR DECLARATION CO I hereby affirm under penalty of perjury that I am licensed under provisions of H Chapter 9 (commencing with Section 7000) of Division 3 of the Business and 04 W Professionals Code, and my License is in full force and effect. p ch License # Lic. Class Exp. Date o Z ti /bat 1�� ,gnature of Contractor'—T+-`, (� . (D 0. — J OWNER -BUILDER DECLARATION WLU I hereby affirm under penalty of perjury that I am exempt from the Contractor's N 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), c'')() I am exempt under Section B&P.C. for this reason N Date Signature of Owner rn CL Z WORKER'S COMPENSATION DECLARATION Cc I hereby affirm under penalty of perjury one of the following declarations: A p () 1 have and will maintain a certificate of consent to self -insure for workers' K W C= compensation, as provided for by Section 3700 of the Labor Code, for the nJ Q performance of the work for which this permit is issued. Q U ( ) I have and will maintain workers' compensation insurance, as required by ] U Q Section 3700 of the Labor Code, for the performance of the work for which this L F— permit is issued. My workers' compensation insurance carrier & policy no. are: co :3 TATE TATE FU Nt, Policy No. 04600492602 �C3 g (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 all forth ith compllyy'with-those provisions, ,.Dat( `� sARplicant� _ ` „� ,r � ,�� r I 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. r Signature (6.wne4g"),e li BUILDING PERMIT PERMIT# fW(Y3 )h / DATEVALUATION LOT TRACT JOB SITE APN ADDRESS 46-5{)5 DUNY' -A AI NIS DX OWNER " CONTRACTOR / DESIGNER / EN (NEER :klAt lvl DESP's C/60)200-4625 C 1.4 2416 USE OF PERMIT 010'1. MERCfA,7. !iWUDW 10001FrA.C? ION , FIFIV-)CATION OF EL11:C IOCA], CL OSLFT, 1.001 L'HC. C OOTI AC 'I' AMOUNT LO PWRI'AffIFF1.Is° 11RT 1IM 1VR_ 1'. (:0143TRUC's ICW 3ER 101'•fif10- 18-000 I°LAA.N CHf.;r::K F13E 101-000-4:3-0-318 $30.21 JKLECTRICtil, M 101.000.420-C1Ct) $15100 S 0 $.54 RE01 P.k'i IN FIJI: UP? MACE'S - CON9 27(p.-•000-445•000 s�,alt fthkM 181004 CITY OF LA QUINTA FINANCE DEPT. SM -TOTAL ("0P*8 F 0MIX—lig :� )1) PLAN CtIECiK 1 LXXX, PRE -PAS FES $0,00 'll, 'A� P� 0;r��T J►'V1F;w, D UE .1 OW mss. 1 RECEIPT DATE_ BY T DAT INSP T 3 INSPECTM RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings 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 Wali Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath Final FinalPOOLS-SPAS owl 8" BLOCKWALL API 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 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) COMMENTS: Jf X X °n a/f %..1Lr V1 1.0 %4ul11Ld Building BE Safety Mision 040 P.O. Box 1504, 78-495 Cape Tamplcb-t7 La Quinta, CA 92253 - (760) 777-70.12 Building Permit Application and Tracking Sheet Permit Project Address: ' .,O ONaer s Name: A. P..Nnmber: Legal Description: Contractor. 5 Address: Cit}. ST: Zip: FTelephone: a ,'t y Address;, 7 - j� : �r ��• / 1�17 City, ST, Zip: `j T/l `P—.. LODF° _ Teh:phone: � u - •=- =� = - _ • L . fit. State Lic. 0: City'Lic. S' ' '! i`�21/1"e G Des%Q✓�/ Arch.. Engr-D�gnc w - r ^ . �e- -e.G Address: -7.5_bA City. ST. Zip: 1 I Telephone-7�© 3� j t?' 3 `� :.: " _ State Lia Name of Contact Person: D Construction Type: Occupancy: /�J . (circle one): New Add'n Alter Repair Sq. Ft:: Stories:_, —,--- M Units: Telephone p of Contact Person: - Nimated Valueof,Project: APPLICANT: DO NOT WRITE BELOW THIS UNE a Submittal •i Req'd Recd TRACKING 1.P.ERMIT FEES 2-. Plan Sets Plan Check submitted Iters .Amount Structural Cdcs. Reviewed, ready for corrections ,% Z3 Plan Check Deposit Trans Cain. Called Contact Person 7,17,Y Pian Cheek Balance v 3 Energy Calot. Plans ticked up Construction Flood plain plan Plans resubmitted 6 Mechanical Grading plan V Review, madyfor correetionsronot 3/1 Electrical ` S Subeootaetor last Called Contact Person Plumbing Grant Deed Plans picked up S.AI.i. H.O.A. Approval Plans resubmitted Grading INHOUSE:- Review, ready for usue 3 Developer Impact Fee Planning Approval ra CalledContact Person 3 % A.LP.P. . O Pub. Wks Appr Date of permit issue b School Fees Taal Permit Feeshm 71 °n a/f