SFD (0306-184)53125 Avenida Martinez
0306-184
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 Exp. Date
Date 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, 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,contract pg with licensed
co-ntractors to construct the ,project (Sec. 704Y4!' Bus ss & Professionals
Code). /' !
() I am exempt,uppnder Section B&P.C. for this'reason
Date 'l 4' /J .7. Signature of Owner r" ".r° i `
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty sof, 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.
(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' compensation provisibris of Section 3700 of the Labor
CCoode;,l shall'forthwith comply with those provisions.
.'eih:;' r3 ` Applicant — -e4f'+ ..
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalf'ies 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. ;=-"a`
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, ,ill City,` and 1 Stateilaws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) Date
PERMIT PERMITp
.-,,...-,--BUILDING
DATE VALUATION LOTi i } TRACT
f k _3 4d2 !a.1fi'a d6 ?; i;ix_ $ltfi
JOB SITE.
APN
ADDRESS
V44 "_5 AMM70A
_74-061-018
OWNER
CONTRACTOR / DESIGNER / ENGINEER
C WH
+ j;},ry r' y ' fir/ q, ..
. ; 4` ,
,irr9.l Q%ia✓'1TA ` 31 9"11111113
USE OF PERMIT
1670 `fr. S P72 PI?IL,-t< IT .E10E,S NOT INC.'UUM r, SPw'3C;.rW'AD.,L, PCIGI.1:${'A
OR I31.2fVEWAY .OPROACifi
TRACT M43T UC x ION 11930.0 Or"
110RCHiPATIO ' 11117.00 .S1''
C,iA1`IAODCA1fPORT 540A U1`
( v ; + • g .'Y; "1.' xi
A'4ET 9EYM I11RS.'d. ,
C4, >; 1019100-.1.;! 8 0 P
'LAV CHCc' K FFE..,
FEE DEPOSIT -S-M.0
Ar; ?'1.A .fl fFC. .9. `.+.'.. :1t51•6)C: r' 9 CI !j:50,G !
:FILE :TRIC%L.I; E 11111-00-420-000 S121104
PLU1t B 4 0 F', E 19-000
S'n ROM MOTIO41 Mi3... n,.M31D '10 1 , 4100-141 000
f:?2-U(:%r'-f'G? -•£fUCi
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10110 IE-PAID z ,:,
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.
D
SEF.0 4: 2003
CITY OF LA QUINTA
FINANCE DEPT. • _
RECEIPTDATE
BY
DAT FIN ED
INSPECTO
INSPECT16WRECORo
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/2-
4
F.A.U.
'Framing
0
Compressor
Insulation.p
"Z
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wail Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final — �-
BLOCKWALL APPROVALS
POOLS -SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
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
—L
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:
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 $2.14 X 1,820 S.F. or $3,894.80 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 OC/Wells Fargo - Christine Harris Check No. 0737703927
Name on the check Telephone 760/777.1419
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Sharon McGilvrey Payment Recd go.00
$3,894.80 Over/Under
Signature
NOTICE: Pursuant to Government 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
CERTIFICATE OF COMPLIANCE
Desert Sands Unified School District
47950 Dune Palms Road.
¢ BERMUDA DUNES r'
Date
9/4/03
La Quinta CA 92253
RAN CJ
No.
24912
(760) 771-8515
INDIAN Eti
AN WELLS
S
LM DESERT
.y P LA QUINTA
^, ,y
INDIO J
O .Y
Owner
Christine Hams
APN #
774-061-018
Address
77480 Loma Vista
Jurisdiction
La Quinta
City
La Quinta Zip 92253
Permit #
0306-184
Tract #
BLK 208
Study Area
Type
Single Family Residence
No. of Units
1
Lot # No. Street
S.F. Lot # No.
Street S.F.
Unit 1 6
53125 Avenida Martinez 1820 Unit 6
Unit 2
Unit 7
Unit 3
Unit 8
Unit 4
Unit 9
Unit 5
Unit 10
Comments
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 $2.14 X 1,820 S.F. or $3,894.80 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 OC/Wells Fargo - Christine Harris Check No. 0737703927
Name on the check Telephone 760/777.1419
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Sharon McGilvrey Payment Recd go.00
$3,894.80 Over/Under
Signature
NOTICE: Pursuant to Government Code Section 66020(d)(1), this will serve to notify you that the 90 -day approval period in which you may protest the fees or
other payment identified above will begin to run from the date on which the building or installation permit for this project is issued, or from the date on which
those amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier.
NOTICE: This Document NOT VALID if Duplicated
Embossed Original - Building Department/Applicant Copy - Applicant/Receipt Copy - Accounting
CITY OF LA QUINTA SUB -CONTRACTOR LI$T
JOB ADDRESS 53-1-D54 PERMIT NUMBER D304- /94 _ OWNER .
This form shall be osted on the 'ob with the Buildin Ins ection Card at all times in a conspicuous lace. OnlyBUILDER
on this job. Any changes to this list must be a persons appearing on this list or their employees are authorized to work
approved by the Building Division prior to commencement of work. Failure to comply will result in a stoppage of work and/or the voidance
of building permit. For each applicable trade, all information requested below must be completed by applicant. "On File" is not an acceptable response.
Trade / Classification Contractor State Contractor's License
Workers Compensation Insurance City Business License
Company Name Classification License Number Exp. Date Carrier Name
9• (xxxxxx) (xx/xr./xx) (e.g. State Fund, CalCom) Policy Number Exp. Date License Number Exp. Date
(e. A, B, C-8) p (Format Varies) (xx/xx/xx) (xxxx) (xx/xx/xx)
EARTHWORK (C-12)/b!Q hd f /) 'v 3 i c
/ f9 `S
CONCRETE (C-8) 2
P -79 19 /F A". cJ
FRAMING (C-5) LUQ /
5' / 7
3
STRUCT. STEEL (C-5 1) '
MASONRY (C-29)
PLUMBING (C-36)
LATH, PLASTER (C-35)
DRYWALL (C-9)
HVAC (C-20)
ELECTRICAL (C-10)
ROOFING (C-39)
SHEET METAL (C-43)
FLOORING (C-15)
GLAZING (C-17)
INSULATION (C-2)
SEWAGE DISP. (C-42)
PAINTING (C-33)
CERAMIC TILE (C-54)
CABINETS (C-6)
FENCING (C-13)
LANDSCAPING (C-27)
POOL (C-53)
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Certifica te_: of Odcupancy
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41
IncasouTm -
wex
G OF w ; . 9► Y Building & Safety Department f
This Certificate is issued pursuant to the requirements of Section 109 of Fthe California Building
Code, certifying- that, at the time of issuance, this structure- was .in -compliance with the
provisions of the Building Code and the various ordinances of the City regulating building
construction and/or use.
BUILDING ADDRESS: 53-125 AVENIDA MARTINEZ
Use classification: SFD Building Permit No.: 0306-184
Occupancy Group: R3 Type of Construction: VN Land Use Zone: RC
Owner of Building: CHRISTINE HARRIS _. Address: 77-480 LOMA VISTA
City, ST, ZIP: LA QUINTA CA 92253
. By: KIRK KIRKLAND
- ! d Date: 4-16-04'
Building Official
POST IN A CONSPICUOUS PLACE