9712-0061 (ADDN)54755 Avenida Alvarado
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?, ► ,,‘,4h,.- LICENSED CONTRACTOR DECLARATION
I 11herebffirm:under penaltyof perjurythat I am licensed under provisions of
'-1—, ' *4Chapter 9 (commencing with Section 7000) of Division 3 of the Businessland
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j •.0 Professionals Code, and my License is in full force and effect. R
Lic. Class Exp. Date
O D ch License #
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oOZ •ate -!' Signature -of Contractor
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1— 1:License Law for the following reason: -
CO ( ) 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
593320
i5/50/98
OWNER -BUILDER DECLARATION.
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
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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
NDate Signature of Owner
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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
perforrr at1'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.
avixFit tl e) !'!Ul
(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' compensati.o.Q provisions of Section 3700 of the Labor
Code, I she f awith complywithho 'oI visions.
Date' /WA/ Applicant ' -
Warning: Fail re to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
-thea • Km -mentioned prope • for IAspection purposes.
Signature (Owner/Agent) .- Date 2 5
BUILDING PERMIT
DATE VALUATION ';Z2 317 30 LOT
PERMIT
'1-5t CONTROL t V'
TRACT- , ; , -2 5-
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ADDRESS 44-775 AV 1" NU)A AL VARADO
APN ' 774-I:91:-0 i0
OWNER
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'I' S\Vfi'f & BLANCHE 01.0C KAKI:f
34775 AV1?NfOA ALV.Ai2.ADO ' -
X LA Q[JINTA CA 92253
CONTRACTOR
/ DESIGNER / ENGINEER
'REX AIIAIIRATE,1NC_. '
31639 SHADOW MTN, LN. .
'T'f401JSANI) PALMS CA 92276
(6491' 43-t'i'l l - S"'}1T.$
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USE OF PERMIT ' ,
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ADL iSf'311 Y HALL. AND MASTER, CLOSET, 411 S.F.
• AREA.
ALDED.L.UVibiO
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TRACT CON„ `T.RUC T"fON .111.00
NT.1 SIA ED COSI OF
PktRMIT FEES. 4(MI NI -A1
PX,AN C} PICK :FEE 101-(000-43Q-315
t'`O S'['Ftt, CTiON Ers: )ii!. -f 00-4.J K-0(113
ELECt JCAL FEE 101 -000.420-OM
ELECTRICAL
S [R.ONG MOTION FEE , RESID 101-0OOE 241.-0000
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SUIT-1171rAI, C(.1NST'if.fY :' lON AN)`
LESS
TOTAL PERPiti'r FI+,Es;S
SF
CONSTRUCTION
57.52.10
$7.34.00-
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T'f,AN CHECK
PRE -PAID
!)1i F. NOW
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7.34.ERft-
$29.3
$2.23
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IPAID .
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j MAR 1998 '.'
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CII-OFutQUIN1A
IIIIIIIIIIIIIIIIIIIIIIIII 27
IE
RECEIPT
DA.
B Y /0*"..DATE
FINALED
INSPECTOR
1481.
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Ea
,
Underground Ducts
Forms & Footings
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7
17/ / '
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s/ ! % k
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Ducts
Slab Grade
Retum Air
Combustion Air
_0 1
Steel
1 GII Roof Deck ?/„`
Exhaust Fans
F.A.U.
Compressor
Vents
O.K. to Wrap
1,67Z----
Framing D • 0.7..9¢
Insulation
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
5 ?Ify
i_ at
Exterior Lath 5c26' O4irry.
Diywall - Int. Lath
0/.12:/i
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
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:
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Uinal
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp..Power Pole
Underground Conduit
RoughWiring
Low Voltage Wiring
Fixtures
Fixtures
Main Service
Sub Panels••
Exterior Receptacles
G.F.I.
~—
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
1111111110111111111 28 1
Date 6/7/04
No. 25993
CERTIFICATE OF COMPLIANCE
Desert Sands Unified School District
47950 Dune Palms Road
La Quinta, CA 92253
(760) 771-8515
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BERMUDA DUNES r
(/) RANCHO MIRAGE CDI
{e INDIAN WELLS
Vr PALM DESERT ,y
LA QUINTA
QINDIo V
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Owner Swift Lockard APN # 774-292-030
Address 54-775 Avenida Alverado Jurisdiction La Quinta
City La Quinta Zip 92253 Permit #
Tract # Study Area
Type Residential Addition No. of Units 1
Lot # No. Street S.F.
Unit 1 54775 Avenida Alverado 696 Unit 6
Unit 2 Unit 7
Unit 3 Unit 8
Unit 4 Unit 9
Unit 5 Unit 10
Comments
Lot # No.
Street S.F.
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 (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile
homes. It has been determined that 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
Education Code Section 17620 and Government Code 65995 Et Seq.
in the amount of $2.24 X 696 S.F. or $1,559.04 have been paid for 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/Wells Fargo Bank - Swift Lockard
By Dr. Doris Wilson
Superintendent
Fee collected /exempt
Signature`
Name on the check
on Mc ilvrey
/A4Lilr/i
/
Check No. 0737702435
Telephone 771-0925
Funding Residential
Payment Recd
$1,559.04
$0.00
Overlunder.
NOTICE: Pursuant to Govemment Code Section 66020(d)(1), 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 issued, or from the date on which
those amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier.
NOTICE: This Document NOT VALID if Duplicated
• Embossed Original - Building Department/Applicant Copy - Applicant/Receipt Copy - Accounting