RER (0105-140)77233 Calle Mazatlan
0105-140
LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chr'aoter 9 (commencing with Section 7000) of Division 3 of the Business and
j?rofessionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
a ;
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:
( ) 1, 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 y
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of thefollowing declarations:
( ) [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.
Action
have and will maintain workers' compensation insurance, as required by
SAction 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' compensattionprovision oof Section 3700 of the Labor
Code, I shall forthwith comply with ose prove ons.
Date: 1' s! ,r Applicant+
Yarning: Failure to secure Workers' Compekjsaation coverage is unlawful and
shall subject an employer to criminal.penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety-
for
afetyfor a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or -cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby author ie epresent tives of this City to enter upon
the, above-mentioned property foe inspection purposes.
gnature (Owner/Agent)~ ! r ~ Date
6`
BUILDING PERMIT PERMIT#._ ,
DATE' VALUATION LOT Q3 4 TRACT
v. 3 4T'f .4J41
JOB SITE
APN
ADDRESS
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OWNER '
CONTRACTORDD E(S IpGryN E,gR / ENN61NEER +
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-7-1 D 3 CNUZMAMAN
614013 YUCCU.A ROAD —4460
LA'QU3% ITA. fid+. 92.253
T4ri0T:4Sw` 't R4 M— rEER Oil,, 92261
(760) .43-7439 CEW 248$.
USE OF PERMIT
RE SIDYMAL R.FJ:AQy 1i:L
YNdUD13i19'e.1.04 ATR] 0M..
CCAPPR4VED OLANS
• b
9Yf.[Y'tI+.00.i 7, di'C . p,TV1f. IV 1n5
UMU- r0R,V OP CONT AIc- 014,
311100.00
ffuY
PLAH VIVWX per. r' Q11-Ck043439t3 18
COwTI.RUCTIONFRIF.
-
MEWIQRyOANtK3 A1T.Tpy63N r..[0fij0( /
01-000.241-000
aTAtiN MOTION EU - =130 101-000-241-000
D a o
MAY • 1 5 2001
CITY Of LA QUINTA
FINANCE DEPT
Si.3 -i°t'i'!' +'AL L€ i13 rYT.i ' #` i: K AND PLAITi l k;
X334
TOTAL. PERMUF RMS DUE ITOW
$1M.45
RECEIPTDATE
BY i
DATE FINALED
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
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
(
BLOCKWAt APPROVALS
Final
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final I I
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
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:
JIM t►
City of La Quinta
Buildinj S Safety Division
P.O. Box 1504, 78.495 Calle Tampico
La Quinta, CA 92253 - (619) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address: CAS (e /Gt g24Z
Owner's Name:
'A. P. Number: 4 -- >CJ-
Address:
Legal Description:
City, ST, Zip:
Contractor: L
'
Telephone x -x:,::>:<:
g Z
Address: C rcDc> L, e -,,q etfi>
City,ST Zip:
......::...:::...... .:.::.....
Project Description: G /
Telephone:
P hone:
3 2 7
..,,., .
State Lic. #: Z 1 3 5- 3
City Lic. #
-
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
h ne:
State c. i #
L
Name of Contact Person:
Construction
ton T Y e:
P Occupancy:
P Y
ect type (circle one): New Ad ' o Alter Repair Demo
Sq. Ft.: # Stories: # Units:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
l
Req'd
Recd
TRACKING
PERMIT FEES
F2Pt',r,n
Plan Check submitted fl -4
Iv%
Item
Amount
l Cales.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calc%
Called Contact Person
Plan Check Balance
Title 24 Cales.
Plans picked up
Construction
Grant Deed
Plans resubmitted
Mechanical
School Fees
2' Review, read for corrcctionslssue
y
Electrical
d Pte.
Subcontactor List
Called Contact Person
Plumbing
Planning Approval
Plans picked up
S.M.I. .
Pub. Wks. Appr
Plans resubmitted
Grading
H.O A. Approval
Review, ready for corrections/issue
Developer Impact Fee
Coiled Contact Person
A.I.P.P.
Date of permit issue
Total Permit Fees
Notice:
Document Cannot Be Duplicated
-Desert Sands Unified School District
47-950 Dune Palms Road
La Quinta, CA 92253
760-771-8515
CERTIFICATE OF COMPLIANCE
h
Date 5/15/01 APN # 658-250-052
No. 22016 Jurisdiction I,a Oiiinta
Owner NamePat Collins
No. 77-233 Street Calle Mezatlan
City La Quinta zip 92253
Permit # 0105-140
Log #
Study Area
Tract # Lot # Square Footage 100
Type of Development Residential Addition No. of Units 1
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 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:
EXEMPT.
This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of
0.00 X 100 or $ 0.00 the property listed above and that building
permits and/or Certificates of Occupancy for this square -footage in this proposed project may now be issued4;59111,1
,
'j,
Fees Paid By exempt - Greg Scrivens Telephone 76.0.83;1`=7.439.r
Name on the check 6 w "1
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Arlene Garcia Exempt $0.00
c. .
Check No. NA
Signature
NOTICE: Pursuant of Assembly 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 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 District(s) or to another public entity authorized to
a 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
10, d -iuici y`
A43ri19, 2001
Pat &Betsy Collins
500. Newport Center Drive q 910
Nev *m Peach, CA 42660
Re: M-M Calle MA?441 '
Dear Mr . & Mrs. Collins:
Your Arehitaotural request regardi ciX; 5'wtndows
retnq ing and replacing French doors to match
those at 49.573 Vista Bonita, and r.,moving 1n,th. uin:sw_s batluo6m to change to 8" block has
.been approved subject to the following stipulations:
• ' .;Actual modification p# conform to the plans and spocifications stibmitted and approved.. .
' C'oiatpetenf attti'licen3ed prnfessiotisiIs shitll, do:aIi' cvoYlt'trr tCwort:matt tke gtan ev: ' ' _.
kH work is to be in compliance with local building cddes and ordinances:
• All axterior _ swicowork must be. painted to match existing stucco (Sherwin . Williams; Super Paint Satin
;,fie:')
• All eleotrical wVing, If appli.cible, must be contained within approved conduit painted to match the surikm it
contacts.
• Any damage to the common area resulting from this modification and its construction sli be repaired at the
Owner's expense. .
• If a coa*uction bin is rented through Waste 'Management it must be W. in color cad stored, if possible, In.
the garage. Ali cmistruetion debris is to be removed from, the site by the close of etch to maintain order
and retain the aesthetics of the Saata :Rosa Cove.
• Prior to the camtncncement of any work the contractor and their subcontractor(s) trust provide the Association
proof of wnrker's comp, liability and auto insurance, naming the .4ssoctarion as additionally hm red,
• Prior to the commencement of any work you or your contractor most provide the names of the scheduled
workmen to the security guards at the Mazatlan gate, (564-5414).
Parr to the commencement of any work; your contractor must read and si0 the Ass6ciation's Contrwor Rules,
which has been supplied to them,.
• Prior. to the commencement of any work you are required to pay a S 500 refundable deposit for the roof
oxt toior+. - -
Prior to tite commencement af4hy work you are.required to pay a one-time fee of S 5 per square foot or
fraction thereof, for the new roof area (Fur4 to be deposits in The roof reserve and replacement -und to ofEw
addl"wl ex ensu 000wrrin duo '6o the addltiori toaddi .op fa ats_to p*4vide she Association .tirith. a yvrittert
5-year guarantee covering the new roof area and the portion of the old roof withinr 64eer of the junction with ,
the''new.
Pleae.nontaet the Association bfltoe once your mnd;fimtirmc are complete for final inspection. A copy of the
approved variance will be mailed to you after the inspection. If you have any questions, please call.
Viry tmily yourA.
Carl McCulloogh
Association Manager
\ On gehalfofthe Arrhitachiral Committee•A•sei L;isonher
wr
THE SANTA ROSA COVE ASSOCIATION -La (litfn;u, California
i7i10' 777-7821 .
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