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9712-121 (SFD)LICENSED CONTRACTOR DECLARATION (D I 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 Professionals Code, and my -License is in full force and effect. 5 'cense # Lic. Class Exp. Date W.LO 674074 B 7/31/99 c Z /Date Signature of Contractor 0 Pr c OWNER -BUILDER DECLARATION co W W r- I hereby affirm under penalty of perjury that I am exempt from the Contractor's (L 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). V) () I am exempt under Section , B&P.C. for this reason O N Date Signature of Owner rn a Q WORKER'S COMPENSATION DECLARATION C) Q I hereby affirm under penalty of perjury one of the following declarations: •�I—O () 1 have and will maintain a certificate of consent to self -insure for workers' X W LL 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 ) 1 have and will maintain workers' compensation insurance, as required by C;• V S coon 3700 of the Labor Code, for the performance of the work for which this / ci: U0 H permit is issued. My workers' compensation insurance carrier & policy no: are: coZ Carrier Policy No. O STATE FUND 137109597 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 wgrkers' compensation laws of California, and agree that if I should become IDbject to the workers' compensation provisions of Section 3700 of the Labor. ode, 1 shall forthwith comply with those provisions. ate: 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 Ouinta, 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 coytitruction, and hereby authorize representatives of this City to enter upon t e above-mentioned property for inspection purposes. Signature (Owner'/Agent) Date BUILDING PERMIT PERMIT 9712-121 °°"TR°L# _ DATE VALUATION 5260,596.10 LOT 4 TRACT 4Y8 7 7 V 1 p ADDRESS 78-930 VIA CARMEL JOB SITE AP" 646400-004 OWNER CONTRACTOR / DESIGNER / ENGINEER T.D. DESERT DEVELOPMENT SPARKS CONSTRUCTION P.O. BOX 1716 79295 RANCHO LA QUINTA DR. LA QUINTA CA 92253 LA QUINTA CA 92253 (760)771-1941 CBL# 2996 USE OF PERMIT SFD LOT 4, PALACIO PLAN 3 - ART IN PUBLIC PLACES CREDIT OF $401.49 PER AGREEMENT W/ COMM. DEV. DEPT. CUSTOM CONSTRUCTION 3,077.00 SF PORCHIPATIO 550.00 SF GARAGE/CARPORT 693.00 SF ESTIMATED COST OF CONSTRUCTION 260,596.10 PERMIT FEE SUMMARY CONSTRUCTION FEE 101-000418-000 $1,203.00 PLAN CHECK FEE 101-000-439-318 $979.47 MECHANICAL FEE. 101-000-421-000 .$85.50 ELECTRICAL FEE 101-000420-000 $198.06 PLUMBING FEE 101-000-419-000 $193.75 STRONG MOTION FEE - RESID 101-000-241-000 $26.06 GRADING FEE 101-000-423-000 $20.00 INFRASTRUCTURE FEE 225-000-443-342 $5,698.82 ART IN PUBLIC PLACES - RESIC 701-000-255-000 $401.49 ART IN PUBLIC PLACES - RESIT; 701-000-255-000 -$401.49 SUB -TOTAL CONSTRUCTION AND PLAN CHECK $8,806.15 LESS PRE -PAID FEES -$401.49 TOTAL PERMIT FEES DUE NOW $8,404.66 RECEIPT DATE BY DATE FINALED INSPECTOR LICENSED CONTRACTOR DECLARATION U) 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 C14 W Professionals Code, and my License is in full force and effect. M License # Lic. Class Exp. Date I; a� ti /Date Z r- +. ' Signature of Contractor (� 0 r J U C> OWNER -BUILDER DECLARATION HLLI I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the following reason: Z_ ( ) . 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). 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 LO N Date Signature of Owner ON FL Q WORKER'S COMPENSATION DECLARATION C) z I hereby affirm under penalty of perjury one of the following declarations: r F-; '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 C) I have and will maintain workers' compensation insurance, as required by p U LO Q Section 3700 of the Labor Code, for the performance of the work for which this H permit is issued. My workers' compensation insurance carrier & policy no. are: Z Carrier Policy No. ob D .14(V 01,-, i) � "i i4ria d J (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 3subject to the workers' compensation provisions of Section 3700 of the Labor /visions. i}f Code, I shall forthwith comply with those pro J 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 �^Vip & 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 representativesoof this City to enter upon the above mentioned property for inspection purposes. ignature (Owner/Agent) y !� Date—'/S Vic, PERMIT �- # CONTROL # BUILDING PERMIT DATE VALUATIONE ��.;1)(BIJ) LOT }, TRACT S�r�%9 L L 1 jtv ..4 a �B� .�'�5 f�` �. JOB SITE ADDRESS APN43Ef-••���f OWNER CONTRYACTORDESIGNER ENGINEER 'S'PARKSC NS ttCI dON IV,0, BOX 1710 29 J RA NI)AQUI FIX R' , 3_Eitj_1JENIA CA 42 53 I,.A t.)L,tfN'IA ('.A 92253 USE OF PERMIT SSI .t E,ta`! <1 i�i�l,a%(Yll,� ill, �N ,� .• tiit�i' .tfV .t'ltklii..ii' b"L�i:�"L'+.>3 E.1ZE',f�i t C.�.k� ,��,• � . s4tot 44 We, A.trldk -Mt N11' W 1(i AW\4, I*V.144, T. � � °f n 043324)Mt,'ON5TR txf:"['IOe`-I 310"11s 00 «ii' �q C.iI VQFLA U1NNTA 1'tn,?. lfVA` f0 S�tDt#)Sf i�T�..�. i6 a..`:ii ��il t_:.i.��J' RJ.Y' �.�%+44�i •.4 ,��i%�� �F.i `; - .�i)N+�(1�.i�, ., P1': Ii f FEE iiMMxtRY 10'{4WO-418-if O RT .tii3 W,AN(14 Ifjl441)-dW1 318 ',T%C IJAi3ir'AL }f --Z' AAff 1.1211. _000 ISS. 50 l tXIC'i;Rt.c; AL!: ,6,t'. 10 i -1)10-420--%FU S t9.3,06 :MUMBINO YEE Wt-fiiLt T-419-000 SI93.Ts `s 1Tat'3t�i�, A•RC?fit 1N Fro, 1M.510 101 _0lii-741.0(X S't6.mi. f.33i .k.133v"f i 1' a l: 'r Q 1 :D�Q.1�i 'Ol�ll $20 ty) FhL 22540)-443-3442ti: �5;t esu Aa.'i' IN PUBLIC PLAC'FS Ri ,SIL 701-000-255-000 S401 49 ART IN PtlPf Jr fyf, A(TS R1 -i -SW 701 fitN i,lt 54100. A1401.49 SI ria T( -YY V, 4''f lKS-1101('f ON ANO PY,AN e"°EXti?f'.i: kx vlN) I S LESS TOTAL fICH IV1' :fa'<u;04; 01W Now 1. RECEIPT DATE BY DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE I INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs �-�� �� Forms & Footings Z .l _ _;,f Slab Grade 2 ` - Underground Ducts Ducts Return Air _ Steel Combustion Air Roof Deck O.K to Wrap Framing Insulation tel— !� _ G _ _ �� Exhaust Fans F.A.U. Compressor Vents l C 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 -SPAS - BLOCKWALL APPROVALS 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 3= Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection _ z - 3 �G 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 Final Utility Notice (Perm)