0008-132 (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 Expo ate
6/74074 � t
Date €t. 4/10 Signature of Contractor
"",-1
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).
( ) 1, as owner' of the property, am exclusively contracting -with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code). y
() I am exempt under Section B&P.C. for this reason
Date Signature of Owner i
WORKER'S COMPENSATION DECLARATION
I hereby affirm under'pe41ty 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 ,l y 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. No.
$TATE Ftrl°11� 04�i-DOp 3s3
(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 dNagree that .if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall fotthwith comply with%"those provisions,
Date: ��l�i�t Applicant—/
Warning: Failure to secure Workers''-Csompensation coverage is unlawfbl 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 auth rize repres ntatiives of this City to enter upon
the above-mentioned property for inspection) purposes.
Signature (Owner/Qgent )4_ - ' Date ` /y
BUILDING-. PERMIT PERMIT#
DATE / VALUATION - LOT ..' TRACT
+'r? 10T� 99 2947-I
JOB SITE' °
APN
ADDRESS 49, s vfsrA .S'J%18. tL.A
64.1919.00AW
OWNER
CONTRACTOR / DESIGNER / EN (NEER
''D Dmi-•F-T I)R'MOPIO F-. AT
,S:PARTUS CON"n%Li3an014
PO BOX 1716
79.295 RANCHO. 1A t Vft4'I.ADR
XA QUT;~i'rA CA 92253
I.A QUA° A CA 92253
(160)771.1941 CBLA` 2996
USE OF PERMIT
SINGLU FAMILY i VnU2.NG
SFD* IDT:99 PLA1 :M3.11- PERMITIVES NW 1NC1.11100 8LOCI,'"b?IAP,,LS OR'
P006 75% NLAN.Ck='K FEE REDUC` 11614 t)OR MULTIPLE ISSUANCE OF
SAME PLAN T'IF'F.
CUSTOM CONSTRUCTION 4,24:1;0.0 SF
POP,CWP.ATIO 532.00 SIP
O�ACIUC.,�12PC31t'P �S� 13eS►i 0, Q0
COST OF C0.14FfR IU,C.n0N
{ 1„ .36
r 3p/ +y ��'/,� [�t�j��'��*�yEST`.[R.t�ATF)
�I�.�i1V3.0 di � .i[+r :i V 17.tiD'p a` �2Y
CON,ST.RUCYION I°"FSI; 101.010-418.000 $1,521,50
PLAN. CHECK FEW.
WCHANIMI, FEE 101.000.431-0100 l3b.50
'
EL'W-TWAL M% $246,11
°� Y
.101-000-420-000
PLUMBING ME 101 r000 -419y000 $205.00
STROW NIOTIO N FES: • RMID 101-000-2411-000 $35.I4
GRADING FEE 101-000-42 1-000 $20.Q0
DEVELOPER IMPACT 1*LE
ART IN PUBLIC PLACES RESIZ 701'•000.235-,000 W/3,47
4o pi
Silk-T13mC0149 UCIT'adAF'ANDPI"Ci t.,.CT"..
$4,759.713
L.VZS PR'E PMD1
$0.00
TOTAL 111"?W.Ows DIVE 1400
SA., M05
RECEIPT
DATE I '
BY
DATE FINALED ,
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING. APPROVALS
MECHANICAL APPROVALS
Set Backs
�
v_
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
. d
F.A.U.
Framing
_�
6
Compressor
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
FinalrP�PaROVALS
_
POOLS - SPAS
BLOCKWA
L
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
COMMENTS:
Final
Utility Notice (Gas)
ELECTRIC
L 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)