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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 # r. Lic. Class Exp. Date
2538i
Signature of Contractor
%1/98
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
perfo ance 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.
;T V1'1? FOND :.".:,ofe -Sr;
(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 oe°California, and agree that if I should become
subject to the workers' compensation provisions`of Section 3700 of the•L,abor
Code,,...I sh II fort With comply with those pr visiofis. C'
Date CkApplicant :)%
yi "
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
theiabove-mentioned property for inspection purposes.
Signature (Owner/Agent) Date
BUILDING PERMIT PERMITkCONTROL-# : i
!NI) itq�
DATE VALUATION s04, S27 70 LOT • TRACT 6900
JOB SITE
ADDRESS 54.010 AVENIJ)A. ALVAR 1
APN
OWNER
CONTRACTOR / DESIGNER / ENGINEER
DAVID ROSS MILLED(,
170 S'iReNI( f
.PACIFIC TRADES
P.O..130X 722
S OCEANSIDE CA 92054
r,A QU1N't'A. . CA 9225:1
(6I9)5M-0273 C13L!1 1955
USE OF PERMIT
f%!
�®
•
• SPD - PERMIT uGAS NOT .j1 Ci. U0E 131.0C`K WALLS OR POOL I e
7199,0
7x1•, T t RUC ION ( r
1. Sc ACT CONSTRUCTION iLiY 1,.�:t i int SF
POWIt/PAiIO 1 .00 SF 1
_ 7 ��� - I®
' 7
OARAUWCA1t.PORT 492 .00 SF t
BLOCK WAL1. (BMX) 2)..6.50
$ FT. WOOD FENCE 200.011 LF
f
i1)7.Il
' ESTIMATED COST OFCONSTRUCTION
3�?s;5u
PERMIT FEE SUMMARY
, 41'
t:'t7T+iSINucCt)NFEE 101 -000 -4)R -00f) SSu4.Y.1
PttN111 (.1111 C1•1 EtTs IQ) -000.439..318 s1.9 ►.:4
MECHANICAL 1'143' - 101.000-421-000 SS3.50
ill.#:CI't UCAi,1. E 101-000-420-000 $1::22.10
PLLiM(3.tt'OFEE 101-000-419-000 Sl:t.'fa
a't'Rr: w; s•,gOT1c 1N VF - REST() t01 -{N)(1-.'341-0013 cH pit
COIA1 INO VII: 101-000-.1?3-0O0 $24).(xi
INFRA., I&ti tURE FEE 225-0(0-443='42 $1,91.8412
PRECISE PLAN 101-000-411.345 $25.0t)
t ,A.14 CIa)= K. FEF 101-000-439-318 -R29-1,011
•
SUB -TOTAL CONSTRUCTION AND KAN CHECK
$1,;%61 76
L. S:1 PRE -PAID FEE`.
4250.70
TOTAL PERMIT FEES DUE NOW
SJ,I,L3,76
IIIIIIIIIIIIIIIIIIIIIIIII 57
1IE
4
RECEIPT
DATE
BY
DIE Fly', 12
INSPECTOR
INSPECTION RECORD
• . OPERATION
DATE
INSPECTOR
OPERATIONDATE
INSPECTOR
BUILDING APPROVAL,,MECHANICAL
Ducts
Ducts
APPROVALS
Set Backs
9j 9 APUnderground
------
Forms & Footings�8
Slab Grade
��/�
j .0Combustion
Retum Air
Air
Steel
Roof Deck
rii
P
Exhaust Fans
F.A.U.
O.K to Wrap
Framing ayi�
/ �.
Compressor
Insulation
,
Vents
Fireplace P.L.
Grills _
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath/
'Mr',�
Drywall - Int. Lath
•
I _ /
�®
Final
POOLS
- SPAS
Final
711�Z11
`7
BLOCKWALL APPROVALS
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
3 "
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
1
f
0177#
i
Pool Cover
Encapsulation
Sewer Connection.
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
'
.
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Vottage Wiring
Fixtures
Main Service •
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
C
C.
/1/1/1--A
78
Final
Utility Notice (Perm)
Desert Sands Unified School District
Notice: 82-879 Highway 111
Indio, CA 92201
Document Cannot Be Duplicated 619-775-3500
CERTIFICATE OF COMPLIANCE
Date 2/27/98
No. 16682
Owner NameDavid Ross Miller
I
IE
II
APN # 774-203-001
Jurisdiction La Quinta
No. 54010
City La Quinta
Tract #
Street Avenida Alvarado
Lot #
II
61
Permit #
Log #
Zip 92253 Study Area
Type of Development Single Family Residence
Comments
Square Footage 1393
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 owner 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 Government Code 53080
1.93 X 1,393 or $ 2,688.49
in the amount of
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/Capital Bank of North County/David Ross Miller
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Rosita Jones
Signature
Telephone 564-0273
Payment Received $2,688.49
Check No. 052364
NOTICE: Pursuant of As :mbly 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 wrl 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