9807-245 (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
741786-6 13 4/30/00
bto ,C/ „-`f Signature of Contractotr�— � f
OWNER -BUILDER DECLARATION �f
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).
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
SeL'tion 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 Policy No.
LRA g..9 i;s1�iT rC=R 1AJc`6- if406506
(This section nee not be completed if the permit valuation is for X100.00 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
C�d'e;'I shall'forthwith comply with�h se provisions.. -
Date: f' Applicant
1/
Warning: Failure to secure Workers' Compensation coverage. Is unlawful and
shall subject an employer to cr, ip;tinal 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 permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each personat
Whose request and for whose benefit work is performed under or•pursuankto
any permit issued as a result of this applicaton agrees to, & shall, ihdemni f
& 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
theabove-mentionedproperty for inspection purposes.
tgnature (Owner/Agent) ' 1 1'4 Date
-1171
BUILDING PERMIT PERMITN
DATE r VALUATION LOT 9807.24S TRACT
$132,49'2.70 X1.1 28545-2
JOB SITE (" % Z)
APN
ADDRESS 1
77-418'"STA FLORA
631 -380 -072 -
OWNER CONTRACTOR / DESIGNER / ENGINEER
T:.SL DESERT PLUMS, IN& KSL LAND U CO.RTORATIt3N
MA 40 PGA BLVD . ' 35-920 RGA. '81,t O
LA QUTNTA C.A. 92253 LA QUiNTA CA .92.253
(7b0j56ii-716ti C.BL# 5323
USE OF PERMIT
PLAN 2t1- SF@-- PEn-1111 DOES NOT INCLUDE CSLOCK WAIL OR P001-
rs°fo PY AN CHECK fi=JC ION APPLIED. LA QU.tN A RtI;:iAR r umm,
1414 Aq F
l
CUSTOM CONSTRUCTION TION 1,674.00 Si'.
PORC` I PATIO 1-:57..00 SF
I ' 'IXIA'L'.ED C08,T Or, t".`Q S'9`RUC"1-100
132,492.70
PERMIT FEE.s,U1!'r11VtARY
CONSTRUCTION FEE 10:14000-418-000 $7.55.00
PLAN CHECK FEE. 101-900-439-3.18 $160.21
,NIECHANIQAL &'E" l e:1-000-421-000 $9 ,Sff
EL.E01RJC A i.I FE6 l it l -0130-420-000
PLUN18ING FEF 101-000-41.9-000 cl 11 �0
S'i:RONOMOTi3ONFIFE RE,SIl2 101000.241.000 31z?S
101400423-000 2e.0i3
f:f IALA`,kRU01UR2: FEE 115-n0(i-/143-3'12 $2.I►i ..ft)
AR:Y' 01'Nl:fBur- PLk,-E5 R S}1» 701-000-255-0013 $t11.2i
t.
K
bf SUB -TML CONS"a'RUCTION AND PLAN CHECK
$4,3g67,88
ES C
F F• .. 1 BLESS ./RI2 1PMID i 1. S
TOTAL F'E+ RMIT FEE-l'S DUE NOW
$4,367,88
RECEIPT
DATE
BY /�A•t-
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 71
Exhaust Fans
O.K to Wrap
F.A.U.
FramingCompressor
Insulation —
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath �—
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground PI . 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
Gas Piping
Encapsulation
Gas Test - Z
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 17— 77
Utility Notice (Perm) — -
COMMENTS: