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0111-195 (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 674074,/ F BMICMM Date., t�` �.F Signature of Contractor e,•, e 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: O 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: Cartier a ��ia'��",'#�i,IND Policy No. 046-0073XI (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//worl�2rs'. compensatio�n,prov sons of Section"370 of the Labor Code, I shaYorthwith'comply with those provisions. 'Date:.,- Is, i ! ' Applicant ( > -� 1. Warning Failure to secure Workers' Compensation coverage is unlawful an shall subject an employer to criminal penalties and civil fines up to $100 000, ins addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT. Application is hereby made to the Director.of Building and Safety for a permit. subject to the conditions and restrictions set forth on his application. • , 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to. any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work 'is not commenced within 180 days from date of issuance of such permit; or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to -enter ,upon •the above-mentioned property'for inspection1purposes. a' Signature (Owner/Agent) �~ Dat BUILDING PERMIT PERMIT# DATE VALUATION LOT �• TRACT rt �y fy �9 / 29457-2 { } JOB SITE APN ADDRESS OWNER CONTRACTOR I DESIGNER /EN NR � i✓ •1.J .r:+.QLlp.Apa.n ,�tlFJyl'4x4�.JalfCt dpYtd1�+ �� WAM§ CJVMik"rty4N, y�3I30�:?i"I,679-Z93I2A.YaCH07.Ar2,,.r3! 1TADR, LA QT fIIYTA CA 92153 1A (,)U 'rA C 92233 (160)771.1947 QlMif 2996 USE OF PERMIT 307) IXYP 29 PLAN MMR. P.i�'.�J1IT 170F3 IJo l3 PICTXDF 8 r,; ` AJ..,Ls, P00,L�S PA OR. OP,It!'$?'4VJ°,YAPP4ZOACH C'i5B'I OM CONSTIZIJC ION 4,243.00 2F PGIFZ,CH PATIO 52.2.00 ISF QAkAMC'Ars, ORT 710.100 SP 1;37DWED C'CD1r'I' OF CIONSTRZIC ON 35L136&?,0 CONSTRUCTION FEE 101-000-438-000 sl,sn�,o K.K0 Ma:d'"M FEE 101-000-439318 9309i?3 %,A Ir'f.,Y'rZlCAL M9 I01400-420-000 tilos. K3. 1,00 PTM 101-.000-419.000 $203,00 STIZON.O LAOTIa IKE - RESID 101 400-241-000 $35.14 MADllrIV .4fU 1011.000.423--000 110.00 O�.IM,:3-,Ox+.ER, 2 '.ACT Fig: $1,907.00 ART YN PUBLIC PLAM;X - tdESK 2"+0-000P-44$5-f{iiI SO;3iF?.47 sum-P&M PLAN CEHYC $4,759.M S I' ti $0.00 p7o- w�p•p�p• n �yy� ggfyy�� • L.'�.ti•C2.E.6 .ieA.F.d:t.Lft.i.'d�rTo2'i+.3,A d7OYY e7"3g fi"iia RECEIPT DATE BY DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs j � Underground Ducts Forms & Footings "/� Ducts 3 Slab Grade Return Air _ Steel _/ — Combustion Air Roof Deck Exhaust Fans O.K. to Wrap F.A.U. Framing 3 Compressor Insulation - !� _ Vents _ �s Fireplace P.L. _ _ Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Eiderior Lath Drywall - Int. LathJ�. Z cSzCJ� Final I Final 7-7' '-az I / 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 Waste Lines %Z 2 !� / Electric Final Heater Final Water Piping - _ ",! Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral _ _ / �Z Z�/y� �G� Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test _ Appliances _ Final - COMMENTS: Final�jy , Utility Notice (Gas) (_ / _ ELECTRICAL APPROVALS Temp. Power Pole ,Q 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) - 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 k Lic. Class Exp. Date 674074 B HIC 07/31/2( 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: ( ) 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. .046-0007338 (This section need not be completed if the permit valuation is fog $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 " LOT 0111-195 TRACT $351,388.30 28 29457-2 JOB SITE ADDRESS 49-321 VISTA MIRASOL APN 649 IOD -002 OWNER CONTRACTOR / DESIGNER / EN (NEER TD DESERT DEVELOPMENT SPARKS CONSTRUCTION PO BOX 1716 79-295 RANCHO LA QUINTA DR LA QUINTA CA 92233 LA QUINTA CA 92253 (760)771-1941 CBL# 2996 USE OF PERMIT SINGLE FAMILY DWELLIld(3 SFD - LOT 28 PLAN MSR PERMIT DOES NOT INCLUDE BLOCK WALLS, POOL, SPA OR DRIVEWAY APPROACH CUSTOM CONSTRUCTION 4,243.00 SF PORCHIPATIO 522.00 SF GARAGE/CARPORT 710.00 SF ESTIMATED COST OF CONSTRUCTION 351,3W.30 PERM ' FEE 9Uhfl IARY CONSTRUCTION FEE 101-000-418-000 11,321.50 PLAN CHECK FEE 101-000-439-318 $308.73 MECHANICAL FEE 101-000-421-000 $136.50 ELECTRICAL FEE 101-000-420-000 $246.71 PLUMBINO FEE 101.000-419.000 f205.00 STRONG MOTION FEE - RESID 101-000-241-000 $35.14 GRADING FEE 101-000-423-000 SZ0.00 DEVELOPER IMPACT FEE . $1,907.00 ART IN PUBLIC PLACES - RESIE 270-000-445-000 $378.47 S SUB -TOTAL CONSTRUCTION AND PLAN CHECK $4,759.05 LESS PRE -PAID FEES $0.00 TOTAL PERAW FEES DUE NOW 54,759.05 RECEIPT DATE BY DATE FINALED INSPECTOR ..� Certificate, -ofOccUanc*y p City _ of La Quanta Building'and Safety.Departm6nt OF This Certificate issued pursuant to the requirements of Section 109 of the Uniform Building Code, - certifying, that; at the time of issuance, this'structure was in _compliance with thervarious ordinances . of the City regulating building construction or use. For the- fol%wing': ' BUILDING ADDRESS: 49-321 VISTA MIRASOL Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.:, 0111-195 Occupancy Group: R=3' r Type of Construction: VN Land Use Zone: R -L Owner of Building: TD DESERT. DEVELOPMEMT -Address: PO BOX 1716 r ,City: LAQUINTA CA. 92253 r By: GARY SHOWALTER Date: 07 -18 -02 -- Building Official `POST IN A CONSPICUOUS PLACE