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0105-151 (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 e Exp. Date f C Date �' 1�1 ry Signature of Contractor 7 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 3100 ,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 S'eefion 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: Carver . Policy No. (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, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with thosef pirovlsions. Date:r4� i i� •a� t 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 f6r ilh`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 property for inspection purposes. ' ��.Signature (Owner/Agent) Date 1` 13 BUILDING PERMIT - PERMT# DATE VALUATION LOT �� �,� TRACT �j �9ae7�l�J7�.w'YiJ d JOB SITE APN ADDRESS 34-4'25 .��Y.�+'F.�itDA 0.011UX.- � N 774-241E-020 OWNER CONTRACTOR/DESIGNER/EN INEER C\°3MMipCa1"cf1RY110IN TZ I::i?N'MWUR.1 RY L-1C?WS 51370 AAV'i0.�1LDA ITMUDA3, 513"10 d24�..." _NU AX33: h! (TD M I. A (, UINTA CA 192253 LA QUINT'A CA 92233 (7,60)564.1907. (t31.f: 625.E USE OF PERMIT R1Niyj�'y'MLyDW»y q X-4 0 .. SF11- 1MR)AIT DONS NOT INCLUDE BUXK "b3°AT.LM0O1J5P.A OR O1 P41 -MAY .A►PPRIDA H-1gASTRA, TSA,-! 98 c':C+DE TRACT CQy14-5TRUCTICM 11501.x00 SF PORCi�lla,d+XIO 5&00 SF # ,O iCA,i21'O'ftT ( P; 9,074;90 , 5 PT, WOOD FENCR -20;60 LF 'COSvr OF W,.i,I1491A'1`4.�tdAl�,a2.7 �A �'` aa pp,, �yyam�+ ��yyyy� ��/��y,,����yyJL`dY.S.Y1NdR'6JdRD PKLif3i7Y.II+�'J0.'' Cd4.%1Y:iY+/bJ7.S`iY CONSTRUCTION FED 101.000=418.001 $61210 PLAN CHECK 1+`E& 1011 _000_4350 1 P,' MEXHA33XC:A L ME 101.000-421.000 10.00 F1. -F 7TRA(A1. FEF 101-000-420•000 $!.'31.3£x; PLUMBING Fry, 101 -NO -419p000 $110,73 .3T. R.0140 MOT1014 FEE > PM9D 101-000—.241.000 $9.31 ORADIN70 FEE 101.000-423�000 $20,00 1:331VS: 10P1t IMPACT FE -F, p,9iY.? Cts 1pUC109l LAN 10-000.41-34.5 S396.100 -k1:¢&D9POSIT 101-4KMAV39-318 Co.. r SUB-'LMe, 00M. 3`RUMON M,0 11LM CEWX Vj464.31 LL130N4 PRZPAM WO 4250.00 �r+ i MAY 14 2001 REC IPT FI �' ..E QIP BY 4dr DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings/If-0-161— //`_ Iff`(� d1 5� A Ducts Slab Grade Return Air Steel Roof Deck /�`fj s T Combustion Air Exhaust Fans O.K. to Wrap �– - ©c $'j F.A.U. Framing /p� 5 Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath �p Drywall - Int. Lath Final r__ �_�� � �� Final Final POOLS - SPAS BLOCKWAL 1 PPROVALS 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 6/%j� �� 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) ����–� / 57 3;�,i"i..•-,'Y.�i�as r-.� .�.1r.�Wy'�•^'1..:r"-'7sn.:y'-.i.r�i-..-=�wN'�'r�•-?'-'L-,,•✓i...c.�... r..e.l;a�r-�-•.,1...r..�..r.n��a �I�iiNlY.f ;T;:: w.:7...s�-..��/(/� .(//�7n��_..r�...Q, .. /„� �J. �/Z/�. _• .,/.• "'� p at ou&rfij J Building Address Owner Mailing d) Address k.`�,lup`1, Contractor � ca ` 0 tic Address City lZip ITel. State Lic.— ! City & Classif. I �+ V\ Z Cj Lic. # Arch., Engr., �/ ix Designer it Address I Tel. P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 City IZip I State I Lic. # /I ILyyICE+NSED CONTRACTOR'S DECLARATION 'eby affirm thaN1 am ensed under provisions of Chapter 9 (commencing with Section of Divisipq pfyha i�ty@'�ness and Professions Code, and my Iicenskif inyfullfforce Nd 11 !7 r tt s i 1 OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to Its Issuance also requires the applicant for such permit to file a signed statement that he Is licensed pursuant to the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, or that. he Is exempt therefrom, and the basis for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). l: 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, Buisness and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he did not build or improve for the purpose of sale.) I'I I, as owner of the property, am exclusively contracting with licensed contractors to con- struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) 11 1 am exempt under Sec. B. & P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure, or a certificate of Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No. Company r7 Copy is filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) valuation 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. Date Owner NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code.) Lender's Name Lender's Address This is a building permit when properly filled out, signed and validated, and is subject to expiration if work thereunder is suspended for 180 days. I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives -of this city to enter the above- mentioned property for inspection purposes. Signature of applicant Date Mailing Address City, State, Zip APPLICATION ONLY f ' 6, � S - BUILDING: TYPE CONST.�a �t JI`C�OCC. GRP. A.P.Numberq�(� t�� Legal Description (i F �` °�' `' �. `S ' °? VIN l L. (A Project Description Sq. Ft. No. No. Dw. Size Stories Units New;141 Add O O Repair ❑ Demolition ❑ `Alter 4-43S o �c'>�►�crrc-..r� c �c.a . 1-rYLt1SS Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. ' Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL REMARKS ZONE: BY: Minimum Setback Distances: Front Setback fro ter Line Rear Setback fro Prop. ' Side Street Setb f m CenterAne Side Setback fr erty �i�JJfl FINAL DATE SP CTO,tRn Issued by: Da APPlrml Validated by: Validation: FIN A, WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION i Desert Sands Unified School District U 47-950 Dune Palms Road Notice: La Quinta, CA 92253 Document Cannot Be Duplicated 760-771-8515 CERTIFICATE OF COMPLIANCE Date 5/14/01 No. 22013 Jurisdiction Owner Name Tract Construction No, 54-425 Street - Avenida Obregon City La Quinta Zip 92253 Tract # Type of Development Comments Lot # 9 F APN # 774-241-020 La Quinta Permit # 0105-151 Log # Study Area Square Footage 1,501 Single Family Residence No. of Units 1 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.owrier is exempt from paying school fees at this time due to the following reason: EXEMPTION NOT APPLICABLE This certifies that school facility fees imposed pursuant to i Government Code 53080 in the amount of 2.05 X 1,501 or $ 3,077.05 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 By CC/ Union Bank of California- Mark Kellogg Name on the check By Dr. Doris Wilson Superintendent Fee collected /exempted by Signature Paula Ruiz - . i N 0 Payment Receive Check No Telephone 760X333-5390 �, Received $3,077 05'�. 7425307 r( NOTICE: Pursuant of Assembly Bill 3081 (CHAP 549, 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(s) or to another public entity authorized to collect them on the District('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 RC DISTRICT - PLANNING REVIEW FORM This form is to be used by CDD staff for review of single family dwellings in the RC (Cove Residential) District, in order to determine the applicability of compatibility issues or need to require the filing of Master Design Guidelines by the applicant. It shall be transmitted to the Building and Safety Department as your correction list. Please attach additional explanations as necessary. APPLICANT CONTEMPOP.ARY HOMES SITE ADDRESS 54-425 Avenida Obregon APN 774 - 241 - 02b ' BINNO.: �� CASENO.: 2001-449 LEGAL: LOT 9 BLOCK 265 UNIT S.C.@V.L.Q. CHECKED BY: Stan Sawa DATE: Inform the assigned Building plan checker upon your assignment to this case. The CDD Executive Secretary maintains a log book to track applications and assign case numbers. REQUIRED ITEM Y N COMMENT/CORRECTION Compatibility Review \1► Case logged and number assigned Verify legal and APN information Consistent with MDG on file (as.aptplicable MDG filing required (5 filings since 9/3/98) Consistency with street/surrounding area: Colors Materials Architecture v Other Requirements:r nils , ANS e Certificate -,of Occupancy :0,�. City of La Quinta � Ag Building and Safety Department. �`fMoTM° This Certificate issued pursuant to the requirements of Section 109 of the Uniform Building Code, certifying that, at the time of issuance, this structure was in compliance with the various ordinances of the City regulating building construction or use. For the following: BUILDING ADDRESS: Use Classification: SINGLE FAMILY DWELLING Occupancy Group: R-3, U-1 Type of Const Owner of Building: CONTEMPORARY HOMES Building Official 54-425 AVENIDA OBREGON Bldg. Permit No.: 0105-151 ction: VN Land Use Zone: RC Address: 51-370 AVENIDA BERMUDAS City: LA QUINTA CA 92253 By: KIRK KIRKLAND Date: JANUARY 8, 2002 POST IN A.CONSPIC000S PLACE