AR (9809-129)77333 Calle Mazatlan
9809-129
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
57777; a1/ /' 91/30199
Y(, Chi rr
Date ` ff Signature of Contractor
t
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 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
Yrtrmance of the work for which this permit is issued.
I have and will maintain workers' compensation insurance, as required by
on 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.
STt11E I LTIND
(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
gect to the workers' compensation,.p"rovisions of Section 3700 of the Labor
de, I: shall forthwith comply with those provisions,
Date: / Applicant
f
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 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
the above-mentioned property forji spection purposes.
Signature (Owner/Agent) Date 7
BUILDING PERMIT
DATE 9 `- - VALUATION $10..94.41) LOT
PERMIT # .CONTROL #
9801.11-129
TRACT 8243
JOB ADDRESS '77-333 04ALE h rFri,.fLAN APN -
(o31 -lee) - ri4
OWNER CONTRACTOR/DESIGNER/ENGINEER
MR. & MRS. Ci-1A.PMAN SMARK CQINT',K :U:: IO INI 01
77-333 C:ALLE Mf1,ZA"ALAN 394" GARAND IfE .
[,,.A QUWA CA, 92253 PALM DESERT CA 9221.1
(760)345.9711 CB1.11 790
USE OF PERMIT
RPSMt;:1V sA1-M)aAi'i`l:(:39
130 S.F. liOc7M A%1)IV91v
UST011t'"ONSIRUC '10N 130,00 SF
i;` TTA"i,A EM COST O1/ CONSTRUCTION
1/l' zip' '.: irti:1MMA:RY
Pf,AN C:T- EFCK. FEF
401-000-439•-314
S8i <s0
CC.fidS TI2tr TTONF E
i0.i-f)!in-41g-ono 0
$12fi.lDif
M, ECJDXN1CAL FEE
igi..000-421.,0001`
EI..Et`"MICAk VEE
101 ' 00-42000
$ f.9.76
; FROI G M6TJ0J E -.KESID
W,1 0-241-11,00
1.1rE,
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liJi- QO 42 4Dfln `
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SEP
SI47M AT,, U)Nr ',1' T k' ► A PT INN CH Et'?O:
j,
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LESS fKE, -PAID FEES
't'OUJI, :l'ERMfT 1+'CKS 11111E NOW
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RECEIPT DATE ), ^ i BY DATE FINALED INSPECTOR
1.0,594.410
$2-1022
$0.00
$270.22
NWA
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
% 5
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Q 2
Exhaust Fans
O.K to Wrap
F.A.U.
Framing TI amu,
Compressor
Insulation
/O/I Q
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Jf
Drywall -Int. Lath
� I
Final
Final
BLOCKWALL APPROVALS
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
c
x
Final
Utility Notice (Perm)
COMMENTS:
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
Date 9/23/98 APN # 631-700-042
No. 17787 Jurisdiction La Quinta
Owner NameMr. & Mrs. Chapman Permit #
No. 77-333 Street Calle Mazatlan Log #
City La Quinta zip 92253 Study Area
Tract # Lot # Square Footage 136
Type of Development Residential Addition. No. of Units 1
Comments
136 sq. ft. room addition.
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:
Residential Addition 500 Sq Feet or Less
EXEMPT
This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of
0.00 X 136 or $ 0.00
the property listed above andithat,buildmg0
permits and/or Certificates of Occupancy for this square footage in this'proposed projectmay ne,y be. issued'
ll
r
Fees Paid By N/A - Stark Construction Co.
1 el honel 3t4 7111
Name on the check
Dr. Doris Wilson
By
Superintendent
,v
Fee collected /exempted by Juanita Green
Exempt $0.00
Check No. N/A
Signature %WWW /ZVL—,
if If
NOTICE: Pursuant of Assembl 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 th 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
collect them on the District('s)(s') behalf, whichever is earlier.
t 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