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0005-268 (AR)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 �k Exp. Date Kate 684857 B:mac 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, br 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 CA IN'17&WITY MS Policy No. N2037273E (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 w -kers' compensation laws of California, and agree that if I should become s bject to the workers' compensation,.provisions of Section 3700 of the Labor JDate: de,Jl_shall forthwith comply with'..th�o,5e provision '+ `� 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 City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon th, above-mentioned prop erty for. sp ct,ion purpo, esu y Ignature: '(Owner/Agent) a Date PERMIT# BUILDING PERMIT.:. DATE VALUATION '- - LOT - TRACT.. , JOB SITE i � a�;, APN ' ADDRESS 9 769-501-031 OWNER 'asp;; •t,`'. MIM WADE HAlvIPTY3N 54.880 R1VBU LLA QUU.117A CA 92253 USE OF PERMIT IiNI1JJ1't YW, ADI3IilC`5W ATTACHED DUES T HOUSE, 333 S.F. Ct3STOM CONSTRUCTION CONTRACTOR / DESIGNER / ENGINEER 0 . 79>?-0DRM 1—k QPINTA CA. 92 5s C160)175-7933 CHI,#- 3, 12 333.00 SF E5°.�1Vl.A:ul) COST Of,' C:0,1N"iJCS#orm PMZWr BTT SUMMARY PLAN CHECK FEE �01.000.439-318 1148,03 COINS'PRUCTION FEE 101-000-418-000 $258.50 MECHANICAL FEE 101.000.421-000. $33.00 EIe.t?.C'I.'RICA.L, FEE 101-000-4:0-000 $41A0 PLiiMBINO ME 101.000-419.000 $4.55 STRDJ40 MOTION IEE - REBID 101-000-241-000 $2.59 GRA 11NO FEE 101.000.423-000 31.+ 00 7� .r SM-TM'AL CONSIMUC79710N AWD P fid• CRVCK $563.52 IMS PkE-PAID FLO33 $1100 T91A PEIM!'r MO DlWE NOW ' $563.52 RECEIPT DATE BY' 7 DATE FINAL b\ INSPECTO \ INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings 1A Ducts Slab Grade Return Air Steel Combustion Air Roof Deck Exhaust Fans O.K. to Wrap F.A.U. Framing Compressor Insulation b Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath pa Final 77 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 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) COMMENTS: a i0 ' Bin. B ' a City of, La � _Quinta •��.. Safe •Division"' �-' •' 'Building 8L• ty - - .. P.O. Box 1504 ;•� - ' d - 78-495 Calle Tampico ' P.eirnkLa Quints, CA 92253'' ` • ` • ;. Building Permit Application,and'Tracking Sheet Owner's Name: Project Address: ' Address: • A. P. Number: City,ST. Zip: ` •Le¢al Description: y� Telephone: Contractor: _ ` tjCc, - Project Description: Address: l US Citv.ST. Zip: duk � -ti.? Telephone: -q,,' © State Lic. Arch..`Ener:. Denigtier X , Address: {, Y , Cin•. ST. Zip: U = •�•'� Telephone: 28" P ctonTYPe, Occupanc)r C0 nstru - - _ Alter _ Rea, . Demo New. do tYP e circle one�Ad p State Lic. - #Stones: !, ;tl Units: Name of Contact Person: _ Sq. Ft: �y � - ted Value of Project: Q� • _ Telephone ' Contact Person: �::.:•}}i::::::::::: n?t}Y?:G:•i.....::::::::: "G'C< w::::•.?::?::;riii:::;:;r::: � i • •{.:': - vvy •{:::::{.}{;:xrr^...O. ;Yi <:}i}i rii�i:4:.:+.:...:. ... ......... ....... ....::::..::. �..:D.IQ•....E1.�.::::::. •?}>sY•:•}{ -.: .:......:•:x:>i::::::::.•. AP... 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Wade Hampton No. 54-880 Street�em City La Quinta Tract # Lot # APN # 769-501-031 La Quints Permit #0005-268 Log # zip 92253 Study Area Square Footage 333 Type of Development Residential Addition No. of Units 1 Comments 333 sq. ft. attached Guest House. At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patiostwalkways, 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 333 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 By N/A - Bob Edwards Telll:pbone 760-775-7933 Name on the checky By Dr. Doris Wilson =' Superintendent - Fee collected /exemptel by Mary Ann L. Boda Exempt `{ Wqo' ` 71 , 4, Signature Check No. N/A NOTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1998) 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 peril 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 Distric('s)(s) behalf, whichever is Wier. Collector: Attach a copy of county or city plan check application form to dfptC h copy for all waivers. Embossed Original- Building Dept /Applicant Copy - Applicant/Receipt Copy - Accounting 1 FA,;. Pan, Apr.. A c�5 �, FP1 F1 it -1 Ur -11 iF HAMPTON _ > PGA WEST - 0 RBID'EWMAL ASSOCIATION, INC: r1, : .;.•�,� i., _/�%r '..t'1 ,�. /' 1 �.`� /% e > .f�..� tipr'i1 i2' 2000 Wade i�: Nancv Hammon — La 4uinta; CA 92253 --- RE: .54490 Riviera Dear Mr. and Mrs. Hampton: Tha•a e YDS or submitrin t},e uee, i� roq! dd z .. v,., v Jvu, �rvvv 1�1v1V•1Q 1GSitirlll:G. 3 L S Mr. Dnn Aiinlnh Ort-hitec__r (`nm.... !' � ;«��1! c apyroveu uic P'A"•1111114ry Pjans. Prior to tiluSl Or, Smisiteci or adhered to. 1) Please submit 4 complete sets of finalized plans. 2) please show the elevation of the new entry gate. 3) Please submit examples of snlr�rn material of n��:v ad!i�tinn. a) Thele 3rQ .2TT3 gtlnn .F1!?.inS �ro,��.�c �f.. britt -the arra resnonsible foo mn—in'n an , if nono._ Please 1?�! adkrleatiy ?'ter o1e't.,..a1 tt.i. 1. -jag vti:^uii`.1:uG11 must. be reported to the Home ' U'%�° iers Ast wiaiion. R you nave any questions reaardingthis matter, please feel free to contact me 1 ai 771-1134 extension 15. i SincereL� �/ � 4. i juara Operations Manager cc. Architectural Committte- p0. Boy 1060: LP 07linyP �,. ."a; .4,.tCrhc;^a ?604; i 1-"3d1GJ4 ri-v� ioV-Il1-5'IL5