0006-131 (AR)LICENSED CONTRACTOR DECLARATION
I hereby affirm. under penalty of perjury that I am licensed under provisions of
'Chaptor. 9 (commencing with.Section 7000) of Division 3 of the Business and
Professionals Code, and my License is in full force a d eff, t.
License # ' Lic. Class Exp. to
5113024 I3 05/31/15
Date h _ /��d 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 STATg FUN,) ' Policy No. . 1344132-07
(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
wor rs' compensation laws of Califorrpia, and agree that if I should become
suct to the workers' compensation r visions of Section 3700 of the Labor
Code, I shall forthwith comply with os provisions. r
ate: ?� 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 *1 rdf tate laws relating to the building
const ri�
ction, and hereby authoee ey tatives of this City to enter upon
the bove-mentioned propert/,f6r i s ect/on purposes.
ignature (Owner/Agent `�-/� Date " -77-6
l
0013UILDING PERMIT PERMIT#
DATE VALUATION LOT OD06- 31
TRACT
Ibl�,.'�0.410
JOB SITE
APN
ADDRESS 5 9 4:)(
754)82
OWNER
CONTRACTOR/DESIGNER/EN INEER
FRW P R COOT
s .
1CM`d mal L. C0NSMICI10M
80.519 OAI TM
72847 SKYWARD WAY
LA QWNTA CA 92233
PALM DESIE 2T
CA
9261
(160)346-8071
3169
USE OF PERMIT
MIDENITIAL AMMON
AW31TICYN TO BEDROOM- 200 SQ. FT.
CUSTOM CONSTRUCTION 200.00 O
E1311 TE.D COSI' Olr COrTS'I1tTJCI`A0414
151MR D
7PRRhTrI' F+ E SM104ARY r
AI.AAN CHECK TEE 101.000.439-318 5111.1:?
CONSTRUCTION FEE 101-000-118-000 $171.00
� '7
MECHANICAL FEE 101-000-421-000 $23,00
V
XLFCTRIOAL FEE 1.01-000-420-000 $21.73
STRONGMO'TIONFEE- RESI.D 101.000 -?x41.000 $I•a6
'-
� •��
ORADING FEE 101.000.423.000
"
SL R -TI >I AL COAiMLTMTOR AND PLAH CMCK
$346.46
LESS PRE -PAID 1W.9
$0,00
T07At M Mff M.6 DULC NOW
,4fi
A
RECEIPT
DATE
BY/
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
` BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings 1.
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
OX to Wrap _
Framing D �S�lSD
F.A.U.
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
BLOCKWALL APPROVALS
POOLS - SPAS
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)
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)
Notice:
Document Cannot Be Duplicated
Date 6/19/00
No. 20562
Owner NameFred Prescott
Desert Sands Unified School District
47-950 Dune Palms Road
La Quinta, CA 92253
760-771-8515
CERTIFICATE OF COMPLIANCE
APN # 775-082-009
Jurisdiction La Quinta
Permit # 0006-131
N 80-519 Street. Oak-- ��
;�_ R
city La Quinta zip 92253
Study Area
Tract # Lot # Square Footage 200
Type of Development Residential Addition No. of Units 1
Comments
sq. ft. Bedroom Addition.
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered
patios/walkways, residential additions under 500 square feet, detached accessory structures or replacement mobilehomes. It
has been determined the above-named owner is exempt from paying school fees at this time due to the following reason:
Residential Addition 500 Sq Feet or Less
EXEMPT
This certifies that school facility fees imposed pursuant to
Government Code 53080 in the amount of
0.00 X 200 or $ 0.00
the property listed above and that building
permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued
Fees Paid B N/A - Fred Prescott .
Y
` 0 ' .
Telep6oete �,; 760-347-4007
Name on the check
By Dr. Doris Wilson
s �
•13
Superintendent
4i$6
Fee collected /exempted by Mary Ann L. Boda
Exempt f4' -
I h _A
Check No. N/A
Signature
NOTICE: Pursuant of Assembly Bili 3081 (CHAP 649, STATS. 1996) this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified
above will begin to run from the date on which the building or installation permit for this project is sssued or on which they are paid to the District(a) or to another public entity authorized to
collect them on the Dlstdd('s)(s') behalf, whichever is earlier.
Collector: Attach a copy of county or city plan check application form to district copy for all waivers.
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting
fN
PGA WEST
RESIDENTIAL ASSOCIATION, INC.
May 23, 2000
Fred Prescott
80-519 Oak Tree
La Quinta, CA 92253
Dear Mr. Prescott:
Mr, Don Adolph, Architectural Committee Chairman, has approved your request for a room addition
at your 80-519 Oak Tree residence.. Upon completion please submit the enclosed Notice of
Completion form to this office.
Please note that the contractor's name, license number, and proof of Insurance and Worker's
Compensation must still be submitted to this office.
We reserve the right to make a final inspection of this change to make sure that it matches the
original request. An approval is based only on the aesthetics of your proposed plan and should not
be taken as any certification as to the construction worthiness or structural integrity of the proposed
change.
Please note that any electrical wiring exposed during construction must be reported to the H.O.A.
We appreciate your cooperation in submitting this request for approval. If I may be of further
assistance, please contact me at the HOA office, (760) 771-1234 extension 15.
Sincerely,
Kelly McGalliard
Operations Manager
cc: Architectural Committee
Enclosure
P.O. Box 1060, La Quinta, California 82253, Telephone 760-771-1234 FAX 760-771-5125