9607-095 (SFD)LIGE NSEDCONTRACTOR DECLARATION
HI 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
N W Professionals Code, and my License is in full force and effect.
O Z) M License # Lic. Class Exp. Date
6/30/07
Z �
Date � Signature of Contractor..
M OWNER -BUILDER DECLARATION_
UJI LU I hereby affirm under.penalty,of perjury that I am exempt from the Contractor's
~ U) License Law for the following reason:,
Z_ ( ) 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).
�
O I am exempt under Section B&P.C. for this reason' '
N Date el�_111�` 4 Signature of Owner �= � �- .% •
O.N
d Q WORKER'S COMPENSATION DECLARATION
C:) <'LO cc I hereby affirm under penalty of perjury 'one of the following declarations:
Hp ( ) I have and will maintain a certificate of consent to self -insure for workers'
X UJ compensation, as provided for by Section 3700 of the Labor Code, for the
mJ Q performance of the work for which this permit is issued.
Q U ( ) I have and will maintain workers' compensation insurance, as required by
p U Q Section 3700 of the Labor Code, for the performance of the work for, which this
Il rn H permit is issued. My workers' compensation insurance. carrier. & policy -no. are:
Z Carrier GULDEN KA01.1.Policy No.
Cb ()
J (This section *need not be completed if the permit valuation is for $100:1)0 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 those provisions.
Date: 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 applicator 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.
. � ; �Date
Signature (Owner/Agent)'%�-..1.rn''' �'��.-Y_-•--r
PERMIT# CONTROL#BUILDING PERMIT
96071-095
4 0 51
DATE 9113/9, 6. VALUATION $114.5,W2,10 LOT! TRACT "
JOB SITE:. 53499 AVENIDA MO.INTE?;U1 NIA
APN �i�to3�+�s
ADDRESS
OWNER
CONTRACTOR / DESIGNER / ENGINEER
-1100 : �:c�x:a a.:t .tION
S �''27, 7 A.VEN11. A D: I.A.L .
_SUN
/2-850 SOME.".R.D.
F,A. (1UKTA. CA. 9226.3
PA.lA OF ER•t` CA, 92260
619.3462940 Cf.11Y 11.37,
USE OF PERMIT nS.
•y.
6y 14i1�It'F' 1NtfL11iJF S' 2W F::V or e, .ANI) m Lv a A' IbiJV;GN1ZYW.ALI.. POOL PERA•UT 1110 BE
t. ITAITWO rvEll''AI't,A'+UlY.
f3tAt;t,'w`Cthf f`:T'iih .f°fc3N 2,1(17.W 31,,
m 't''ORCIIJNVIC) 940.00 81
tAAiitA0fi'CAIZ,*C)RX s30.9f) 5r
4 FT. WALL 16.00 L
0i 114 C, WALL 290.40 TX
RNMAIATED COST Of. CONSTRUCTION'
PURA4:1 T F:UE NiJMMAFZV
r,;� lfd 1 F21►C' I`r.C1N 1"w!s i s1 F -if(3(�-fit fi 4t)tF $900-59.
0
4Li(J.00
R4i�(.HAN10AL �' l O F iUfltf�4?.1-(}13C? S92.ft4i
�
f~'F Jrt�`f`;ZI(.At:'£!?,: l�1! Ott ?2( (N30i4R,t3
i
]PLUAIRING 1.174 101-0,00•410-000 $173.75
CY*.)
SWAN
r --i
GFt MNG F'FE . " . 101-000-471.000 .$20.0,0
Q( �
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(EJiRA.`. TRUCTF11RE,47.I 2'15 -W -44,t ll, -.1471 S2
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IH)�tgiyyl�c<'I�SSC,yy�'L;A1c4
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kt: B -TIM AL C.'ONtiS'TRIJCItl WAND PLAN Cfic,CK
�d,'tiT3.29
;ESS P.M-13;AID .F%� S.
... 4250.00
'((Y.AL,PERt4HT.FE.+ ' DUE`(Vi_W
$4,50.24 =.:
RECEIPT
DATE
BY
DATEFINALED.
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap /
F.A.U.
Framing z
Compressor
Insulation 3
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 7Z
POOLS-SPAS
BLOCKWALL APPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Til/ /
Equipment Location
vb iw r t�L
Underground Electric
Underground Pibg. 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:.
/vii/ `�
/01,fd
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)
Desert Sands Unified School District
Notice: 82-879 Highway 111
Document Cannot Be Duplicated Indio, CA 92201619-775-3500
CERTIFICATE OF COMPLIANCE
Date 9/12/96
No. 14840
APN # 774-033-005
Jurisdiction La Quinta
Owner Name SUnrose Corp.
No. 53-298 Street Avenida Montezuma
City La Quinta Zip 92253
Tract #
Lot #
Type of Development Single Family Residence
Comments
Permit #
Log #
Study Area 111
Square Footage 2107
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
in the amount of 1.84 x 2,107 or $3,876.88
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/First Bank/Sunrose Corp. Telephone 1346-5239
Name on the check _
By Dr. Carol McGrew
Administrator in Charge
Fee collected /exempted by Pauline Pearson Payment Received $3,876.88
Check No. 35649
Aignature
Coli lector: 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
COACHELLA VALLEY WATER DISTRICT
CASH RECEIPT DETAIL N!
Received From: A I N v f
Address: `�--^ ~r47y)/0 t`t.
Account Nolo71 23 0.0 Lots) ;.'I
Service Address
Vm eter(s)
�U X/
wr aervice(s)
❑ Backflow(s)
❑ House Laterals)
❑ DetectorCheck(s)
❑ Meter Surcharge
J;?'6a'nitation Capacity Charge
❑ W.S.B.F.C.
❑ Temporary Construction Meter
❑ Turn on Charge
❑ Uncollected Account - Name
❑ Inspection Fee - Tract -
Fee -
❑ Plan Check Fees Water I Sewer -
Tract -
❑ Bond Payment - A.D. - Bond
Assmt.
❑ Customer Deposit
❑ Other
0
/ ar.a
TOTAL $
Remarks: J2 7r \ t —Uy— 1 \ C.wl/VI/ _4�;/
aQ0_,P,y to:
Cash Water Service
Check l Z
Money Cashier
Order CVWD-438 (11189)