0106-360 (SFD)LICENSED CONTRACTORbiCLARATION
I hereby affirm under penalty of perjury that I arrlicensed 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 ,/Exp. Date
Date * 4. Signature of Contractor
OWNER -BUILDER DECLARATIONVt
1 hereby affirm under penalty of perjury that I dm exempt from the Contractforsa
License Law for the following reason:
( ) 1, as owner of the property, or myjemployees with wages astheir sole
compensation, will do the work, and the structure is not intended or°roffered 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 Policy No.
aa9'%°P�•;�t1�3;C� 21�A�•�3fI�115'�'3
(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" s to become subject to the
workers' compensation laws of California, ancl`agree th if I should become
subject to the workers' compensation provisions of Sec ' n 3700 of the Labor
C09,J"Shall forthwith comply with tt ose provisions.
IDflte: Applicant
/,>
Warning: Failure to secure Workerslff"Compens. for pF4tLgr•.agesls;unlawf�u nd
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 Sectiqn 3706
of the Labor Code, interest anclAttorney'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
1 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 epresentLives of this -City to enter upon
theabove-mentioned property for inspection 2rposes.r'
Signature (Owner/Agent) ���✓"?�'�` � �y = "'"Date-
BUILDING PERMIT PERMIT#
DATE VALUATION LOT TRACT „
ZLK 7%
JOB ITE
ADDRESS
APN
.�J.�•-�1'�;�. ��,f�'}��a'�3..�►�`�.L.���F�
`fie �,�-���.•-
�WNER
CONTRACTOR/ / EN (NEER
LENDE, EIRES, WC.
:a.E%TDEL VIMURM! ,WC,
"3 .{3 e lEtJ s iYzt'rE Z r%N15
51.370 AVEN10ABEU.1k1UDM, RUB2, RM-:
LA; QL2XTA. L..A 92253
L& Q1W.M. t:.A 92253
Q60)564.1866 Offi:;r $59
USE OF PERMIT
Sl Pkv <..,Ii9a?:OTAL I.112M.MIT TO SYD I'A.;t;MIT 010a 198 • AD).)K) 95 St VI*
IN WJkI fSk SED.C,'OW AND, WING k M- M. M1Rd'f`!G CONSTRUCTION, 8
R.W1erII:T,3.b' PPf?0V9D PLAN- 6MV01
A;%?Dt'I`MA 93,09 OF
VYMATIM) COST ON' COMTRUM011f
IalAH C:3ii`.�X FEE, 101-GC0439-11,8 51.3.69
C"ON;aTRI.aGTION FES 701000.13-18_000 t.otr
MS)NOWAT-1014 M EMID 101.000-M.000 s 3
`It:71., i10.L'+➢ 115 D PJ,.4'liPl CHECK
011 34. V?
LESS PRE.Pfiz) Flal-FIS
$0,00
JUN 2 7 2001
I
CITY OF LA QUINTA
FINANCF DEPT
GEIPT r //,
BY./
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
/�/Q�
5�
Ducts
Slab Grade
Return Air
Steel
Combustion Air
_
Roof Deck
O.K. to Wrap s9/� .�0/ ST
_
—1��
_
S
Exhaust Fans
F.A.U.
Framing
o (
g�
Compressor
Insulation
5 T
Vents
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
_
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
I
Gas Piping
PLUMBING APPROVALS
Gas Test
Waste Lines
-$ j'
Electric Final
Heater Final
Heater
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Coriduit
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)
_3,ov
,��✓
,-Bin #
City of La Quin W
Building &r Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address: 51-�j NexJ-7a-Z()A-
Owner's Name: 2f - P—Lc—k�)I-w
A. P. Number: -7-7 S f b. c) c)
Address: Poo,
Legal Description: LOrT e—
City, ST, Zip: &4!2u(,tJ
bsorr—,�— /C50,��&K--e
Address: T>,o , 2-�� 45-0
,CitN,,ST, Zip: 610,(PJ1ATM
... . . ......... ,.::..::.:Contractor:
—Telephone: ec4- 193
Project Description: 1,AJ C
LJ A _ S /,�r K)
Telephone:
.................
..... :::::.. "..O
............
....... ......
Aor>e� Ib 64 VV5
State Lic.#:
City Lic. #:j
ViJ 'D
Arch.. Engr., Designer:
Address:
City, ST, Zip:
..... ... ....
............
Telephone: ........
State Lic. #:
Name of Contact Person: L,
14 C,),t
Construction Type: OccupancN•
Projec t type (circle oney. New Add'n Alter Repair Demo
Sq. Ft.: ores: —F#
I # St Units:i
Telephone # of Contact Person: 15(0.+- 18(0(p
—
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs,.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cales.
2.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
2
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2"' Review, ready for co rrectio
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A.Approval
Plans resubmitted
Grading
IN HOUSE:-
Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
MARM PUAI)
fro low JUV(51W
Total Permit Fees
Desert Sands Unified School District
r 47-950 Dune Palms Road
.Notice: La Quinta, CA 92253' -
Document Cannot Be Duplicated. .760-771-9515
CERTIFICATE OF COMPLIANCE '
Date 6/27/01 APN# 773-151-006
No. 22179 Jurisdiction. ; La Quinta L
Owner NameLendel Ventures, Inc.
.Permit # 0 106-3 60
No. 51-861 Street Avenida Montezuma Log #
City La Quinta zip 92253 Study Area ,
Tract # BLK 28 Lot # 6 Square Footage '95 ,
Type of Development New Residential Addition No. of Units, 1
Comments
0
SFD Permit 0102-198 - Added 95 sq. ft. during.construction.
r
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:
Add. of Sq. Ft. to New Construction
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of
2.05 X 95 or $ 194.75 the property listed above and that building.
permits and/or Certificates of Occupancy for this square footage in this proposed project may nomPbe issued
Fees Paid By CC / Valley Independent Bank - A. P. LinchTelephone 760-564-1866
Name on the check;
By' Dr. Doris Wilson -`
Superintendent -
Fee collected /exemp d by Annette Barlow Payment Received' $194.75
Check No. 247557
Signature
t
OTICE: 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
Dove 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 Districts) or to another public entity authorized to
Alect them on the District('s)(s') behalf, whichever is earlier.
K�
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