0008-139 (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
,.;
X102'4 r ''+�'`
� 0iA I/2c
a
Date Signature of Contractor*
OWNER -BUILDER DECLARATION ;f
I hereby affirm under penalty of perjury that I am exempt from the Contractor'sr
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).
( ) I, 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 avid 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 S-WfE FUND Policy No. 04f3 NW333
(This section need•not be completed if the.permit valuation is for $100.00 or less).
O I certify that in the performance of the work for which this permit is issued,
r 1 shall not employ any person in any manner-soasto become subject to the
workers' compensation laws of California, and agree that if I should become
subject -to the workers' compensation' provisions off Section -3700 �f the Labor
Code, I shall forthwith comply with those provisions .
Date:'f ,,a Hafts Applicant } f
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 authd-riie��epresentaUves of this City to enter upon
the above-mentioned property for inspection purposes': ,-'�,
4
Signature (Owner/Agent) iDate
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 0008-1.31 TRACT
t, r.r i 2 , t .001 106 29451.11
JOB SITE
ADDRESS 4a 91s wm1
APN
OWNER
CONTRACTOR / DESIGNER / EN (NEER
TU DESW a". FNE.LQ1+'Z,d'f7wr
8 -PARKS C;ONSTRUC1, 10K
ro BOX 1716.
79-295 RANCHO :LEA ( 11114TA DR:
LA Qi€3WTA CA 9225:3
LA, Q LYt 4TA CA 9225:
(76q)771,1941 CDO 2996
USE OF PERMIT
W012 FAMLY DWELIMG
SFD- LC1TA06 PLX.WAi1R - PERMIT liOES NOT INC1,°i,UDe, EL.0..CK';N'AI=1 5
OR P006 7S% PLAN CHECK FEE RK)UC'6ION FOR. MULTIPILt ISSUANCE,'
OF SAME PLAN TYPE
CUSTOM C°ONSTRUCT101t1 3,343,09 sty
PORCH/PATIO 580.06 SF
OA13ACUEWARP0RT (0) M59180
Ira ATED C'osr or COIYs'fiRiTcnoN
2.92,106.00
C014STRUC;TION FEE 101.000.418>090 $1,230,00
PLAN CHECK IEEE $864.23
i 4
ECMHICAL FEF. 101.000421.000 $14930
NLECT4:1C A1.1 i 101=0170-420-0013. $215.04
-f
'Pl,ilMBT.Na ma • 101.000.4196000 $"214
r
STR:ONO MOTIO-H FEE < .RX. -RD 101-000-241=0610 $29.21
£x { 3
ORAD190 FOR 10Im�100-423°000 $206
DF-V1.� QPER IMPACT "M
Ain`t' IN PUBLIC...PLAgt" - AE81001-000.2551.000 $201M7.
PLAN CRN
TA,211.50
uss P;Ci1s-PArD mus
X0.00
T(Yd'1' L PERWr T _ +'-S SUE'` NOW
14,2711 M)
RECEIPT
DATE , J,
BYq t i
DATE FINALED
INSPECTOR
INSPECTION 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
_
9
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
d"
Final
Final
POOLS - SPAS
BLOCKWALYAPIPROVALS
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
_ —6
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
MMENTS:
Final
Utility Notice (Gas)
ELECTRICAL AP ROVALS
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)—��