9807-254 (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
,47366 � 40t00
ate ✓i7� Signature of Contract
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).
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
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 Policy No. .
(This sectio'nj eeCo4rno)Vbef' o'hWp eted if the permit valuation is fo $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' -co mpensation provisions of Section 3700 of the Labor
C9de, I shall forthwith comply with those provisions.
(date: % �;b Applicants
Warning: Failure to secureWorkers Compensation coverage is unlawful and
shall subject an employerto tcriminal 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 propeQ11-1-14411
for inspection purposes.
t O /A ent)/ d Date � 1A
�igna ure ( wner g
BUILDING PERMIT PERMIT #
DATE VALUATION LOT "07-254 TRACT
$M%1.10 36 285452,
JOB Sli-0 I
APN
ADDRESS
77-3701/2 WSTA FLORA
631-380-072
OWNER CONTRACTOR/DESIGNER/ENGINEER
IASL DUERT RESORTS, P.JC. ILSL LAND 11 CORPORATION
ao-140 "PGA BLVD' 55-920 PSA BLVD'
LA Q INTA CA � 92253 LA QUINTA CA' 922,53
1,760)57406 CBL# 5323
USE OF PERMIT
P -LAN 1 - SFP - P1r ,fl 'T?bFS NOT INC"1, UDP'HL(-)C.K W ALI, OR .Pt.)OL. .
LA QttINT.A RESORT HOME,. PHA -58 Y. "$2 +0.00 PLAN C[€(eC#:;
WSTOM COINS':C UCTION 93.9;00 SE'
POR,MPAT O 245:00 SF
GARAGEICAKPOtt r 1, l90.0c1 SF
ronamA'CFm COST OF CONS`t°RUC T ION1 "
99,341.111
PERI1UT ECE SUMMARY
CONS` 1RUC7f0N FIT, 101•4WO-41.8-000 $bV,50
PLAN CtRECK FEE 101-000-439-:318 $530.81
;�tEC:t1AN1CAi.1"� 101-t30p-421-014! X53.50
ELEMWAL flE 101-000- 20-)00 $104.99
PL.[Ji 48ING >E` tib 101400-4:19-000 *6,00
SmONG pie otJ RE RESID 101.000-241-000 $9.93
101-000-423-000 $20.00
IAfkftrl4's12.1r(;Tuftfz:N ty 2 J-000-443-'42, $2:1.41.86
rT,.I Mposrr 4 l o.a X000 -A39-3111 4250,0 ►
,3
SLM-TOTAL CONSTRUCT ON AND PLAN CHECK
$3,656,65
LESS P1t .-PAID ]PUTS
4250.00
TOTALL .P,ERIF IT FEES DUE- NOW
S ,406.65
� a
3 ,
RECEIPT
DATE
BY
DTE FINALED
'� -1(0-9q
INSPECTOR
INSPECTION RECORD
OPERATION j
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
Vents
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
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)
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)