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SFD (9610-088)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 rofessionals Code, and my License is in full force and effect. License # Lic. lass Exp. Date - l ate I 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 herebyi affirm under penalty of perjury one of the following 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. (}� 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 is§0,&,a� My?(workers' compensation insurance carr &i%110olicy 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 personyin any manner so as to become subject to the workers' compensation laws oPCalifornia, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Vie, I shall forthwith comply with those provisions. r % /Date: ! , 1` , t t Applicant—k 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 for inspection purposes. �ignature (Owner/Agent) „ •.�� -%'� Y.=`rte Date r BUILDING PERMIT PERM T# °°NTR°`# �►dsa,t►aEtwr 4263 DATE VALUATION^'LOT TRACT JOB SITE ADDRESS 524315 AV :i�f��DA!�9ENDOt.:�i. APN (773--23,.2-0 OWNER CONTRACTOR DESIGNER ENGINEER DAVID aWS4tiLi:rr PA:iVIC"I'RACES PO.. C r2Z PAI Bu.�X 112 LA. C,d ).}NIA CA 92251 IA 0U NTA (7;A. aZ25.A 11619)'44i4 -()2'i (610)"-64.0271 (18t.ii 1935 USE OF PERMIT 8F1)-PHRtoI1T IX*'S *YC ENt_`l.VDV b1,! K WALL Ott 1"(4Q1. (1kAC i 0*811W( t.ION t..4i0.0U Sr' E1t..,(i.0E/i'AXt0 42.00 SF GAId AOIV A+.Fat?WY 499.00 SF a!':.'��! �1�'5��►� i�..��c'�' R O�� 4�1'��4f� [ t��Y� t'Y�C►:�'�Ci.�t} 1'EMAA111' Vie* *3;#,tt1HMARY . N' ��i•�kc``i"fti PLL11V111 cf1c .ff1, 170" ., FEE: fit KOSIT 4250.0 A•(Rt' HANICAL FEE $.53.50 - ,tn1!•-/L•y(?,�()-4 (!-f/3��/y SX'..ti",t0n yFLE3tg"I'p1i�,•�1,;C�YA�?-.iFTyI:; C'l..ts:ti3ic7� NO t°i`'a.''. ti l'ONG fiviU'i'1014 FEE FT 31f) 1{}t-000-24411-000 C}t;Af ING F(F it) E-000-42 +dh?U ;t0 fi(i fXI F'RASTR(f/,`<'t°1JRF.,FU% ;2'',,,5-()0()-4 ' -342 PRECISE PLAN 301.-000-F14:I-345 'T :L CONSTWJCTfON AND :Pi.OT CHECK OCT 3.0 1996 TOTAL PERMIT 1TE'S -001, NOW .x,112.62 By RECEIPT DATE]BY DATE FINALED INSPECTOR 10 INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs G Underground Ducts Forms & Footings JAW, 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 Final BLOCKWALL APPROVALS POOLS -SPAS Steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground PI . 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 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 PowerC4 AZJ Final Utility Notice (Perm) COMMENTS' 57 f A� 46— o G v I 5 Ave Mot,14L, P.O. BOX 1504 Building a O '1 SINTA CAL CALIFORNIA 92253 Address J Owner L1 I Address � l City C. Zip Tel. Contractor Address City Izip Tel. State Lic. City & Classif. Lic. # CA Arch., Engr., Designer Address Tel. CityI Zip I State I Lic. # LICENSED CONTRACTOR'S DECLARATION I her affirm that I am licensed under provisions of pter 9 (commencing with Section 7000) of 'vision oft usiness and Profe sLpns Code, nd my license is in full force and effect. ,, S' SIGNATURE DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis for the alleged exemption. Any violation or Section 7031.5 by 'any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). 1: 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, Buisness and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon and who does such work himself or through his own employees, provided that suchimprovements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he did not build or improve for the purpose of sale.) I 1 I, as owner of the property, am exclusively contracting with licensed contractors to con- struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) 17 I am exempt under Sec. B. & P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure, or a certificate of Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No. Company ❑ Copy is filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) valuation or less.) I certify that in the performance of thg 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. Date Owner NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code.) Lender's Name Lender's Address This is a building permit when properly filled out, signed and validated, and is subject to expiration if work thereunder is suspended for 180 days. I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives sof this city to enter the above- mentioned property for inspection purposes. Signature of applicant -Date- Mailing ateMailing Address City, State, Zip FINANCE '7610 - 099 APPLICATION ONLY BUILDING: TYPE CONST. •OCC. GRP. A.P. Number —?:? —< Z 3Z — a l 3 Description Project Description Issued by: Validated Validation Sq. Ft. ( Y / O Size No. No. Dw. Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation PERMIT AMOUNT Plan Chk. Dep.5�� CID Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side Setback from Property Line FINAL DATE INSPECTOR Issued by: Validated Validation Notice: Document Cannot Be Duplicated Date 10/30/96 No. 14953 Owner NameDavid Ross Miller is Desert Sands Unified School District 82-879 Highway 111 Indio, CA 92201 619-775-3500 CERTIFICATE OF COMPLIANCE APN # 773-232-013 Jurisdiction La Quinta No. 52-035 Street Avenida Mendoza City La Quinta zip 92253 Tract # Lot # Square Footage Type of Development Single Family Residence Comments Permit # Log # Study Area 113 1410 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 1,410 or $ 2,594.40 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 David Miller/Capital Bank of North County Name on the check By Dr. Carol McGrew Administrator in Charge Fee collected /exempted by Ellen Patino Signature 0 t Payment Receive Check No. ti. Telephdne 967-0069 ! A d /$Z 59NN4A0,. _ 045509 . 11 "'4 ~ Collector: Attach a copy of county or city plan check application form to district copy for all waivers. rtnbossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting '�Meteil�).� a "Y:} ��.i%��. =± E'i • L�:.aY c� -a .[ RECEIPT QETAI� yi. .- � :.' �.i�' Ts ',4 �.►''� 3T � .•�'t i f ._ ,. �-_ a t�ti 'r.'� a='i� ..i-.j�2,'�t,r :tt �Z,+,�,7M�'��,ry s.;' �`�,}'? r -(t _ p . D L l _+ i• J - � tip• � ��.� i'' �` y,-.cS?`�7 e..ss ,." � �t �� yx. tat":� A S Tf t sy r+ �w. •+.... it ��+ 4-4 ~',�1s41�9a Veno Y�l �� ' •ArY•w•nn � �'�...� +�+../►+r.• � _ y .1. �•5<5-�-L�^ Q� Le�. �a '1'unporary � 4•''J 'YnNV"t4Ml�MI�V�VVIa, 1�Itl� r - w � -' � ' '. '"'.L - • ` '. y '� r1 % d4ek �� 1t i *r I �t�N•t 0AOMI- 4017Occlillil, W. �. .�•.. .. -ry.•f tk�.. r,,.1L. �. i.A. ._. Y�u:Y. " _ :1'e� <...._ '. .;_ _ } 4 .. 7 �e'� .. ..S .� '�* .. A F