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0102-224 (SFD)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.fro m'the Contractor's License Law for the following reason: ( ) I, as owner of the property, or my employees with wages as their sole compensation; w'ill'do the work; and the structure is not intended or offered for sale (Sec. 7044, Business & ProfessionalsCode)', e ( ) I, asowner :of the property, am exclusively contracting with licensed contractors'4o .co6struct-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 ,1 y,,Section-3700 of,the"Labor Code, for the performance ofi 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 "'':;•...2` Policy No. (This section need not be completed.if the permit valuation is for $100.00 or less). Spy) 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 }t f l, P. Warn! ng:'Y Fallure�t6 secure Workers' Compensation Covera a 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 he eby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his application. R 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 isnot 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 representajives of this City to enter upon the above-mentioned property for inspection pu[poses. i ! l Signature (Owner/Agent) _ Date j BUILDING PERMIT PERMIT# DATE VALUATION LOT�1i: ,bra �i TRACT JOB SITE APN ADDRESS t�+' q�9��•4�p : .Z420 A.V'.&MA .4rxn�.11l. 07 .t Ca�1f c 7•• �'-u '..� OWNER CONTRACTOR / DESIGNER / EN INEER Ut�i�aiy:_�jl�'t�x) ., ( '. Cplut USE OF PERMIT ST -11 - PT<'.IMIT ia.0&J N(:)T 114CL,f DP, SLOC K. IVA.L:I. YtOOL, WU ]DRI3i.F AY APPROACH, 984 MA811R. LIA,Pf.AK TRACT CONIS i'k2.UC T 1013 1,732.00 9F ESC RCHiPA:t"TO 5 CIO SF 0ARMWt:A.Ft:f'OiiBT @Pi 10, 53"3,.20 5 511. Wt101S MCF it'll � +� cryv� � / p ;q r'/� �vq� fir. /•yp�,yC ry,{��q ..."r,7 g.Rdti.{E''a��Pi'Y.r�i�t:4.6 P/� ��6 AX7t�P5J 4.��bi.JdY q /y } {�7S RL7 Pp•!',Y:.'Y C"STAVICITION rIVIR, 101-000-418-000 $067450 P11AN Ck;ERCK .1q �) •Q�3+0- 3 i-''� Li 5 1.4 i it3ECHNN ICAL TEFL 101-000"221.000 S62M MAC`FRItCAL.I`EE, 2U1- ii5(�- •'�t3•ti�Jd9 $1.u0.p6 PLUMBINO 1TTIR 101-000-419-000 $11617$ 3TRUNO AACF'f ION' M .»931.1? ; 01 -000-24 1 •-000 $1t3.?v S; R.A..M..90 FR): MmOW-423-000 S20.00 '0 '/.ZL0PP_-R EMPA+CT FEE $1.907.00 PRLI IME PLAN 101-000-441-344. $100.00 FeEDEPI '31 1t7i.-(Jilt?-43 t- 1 �$3a0.itf1 p Q 0 'a `,.. Ly �. 1'tiT(:TJC31`1 ���",I'3 i=.C.A�k• �k�C,&s. �:���'3&.t�� !.i a T�1`-Z-.P'd?7.I"�:E?E m 4250MMAR 2 2 2001 'aq' A l Tr ' �� elf k°� )w 006.04 CITY OF LA OUINTA FINANCE DEPT RECEIPT DATE BY DATE FJ(JALED O INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs S� Underground Ducts Forms & Footings ��t� Ducts Slab Grade _ _ ��� Return Air Steel Combustion Air Roof Deck • 3l•Ei' Exhaust Fans O.K. to Wrap F.A.U. Framing 7• . O <? Compressor Insulation 7•J ,O e Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior lath Drywall -Int. Lath j- Final Final " POOLS -SPAS BLOCKWALL APPROVALS Steel Set Backs 7}_3 O"+� s % Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines Heater Final Water Piping _ 7 , Q! Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection�..� O C Encapsulation Gas Piping Gas Test Appliances Final COMMENTS: Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole < Underground Conduit Rough Wiring Low Voltage Wiring Fixtures y Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) _ Q00, O1 Building 6 _ 80 4e , ��rOV, Address 1L� t U Owner LWAIAP4 LAN Mailing Address City Zip Contractor r Address P.O. BOX 1504 APPLICATION ONL 78-495 CALLE TAMPICO t� LA QUINTA, CALIFORNIA 92253 City Zip Tel. State Lic. & Classif. City Lic. # Arch., Engr., Designer Address Tel. ;ity ` (Zip I State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. OWNER -BUILDER DECLARATION - I hereby affirm that I am exempt from the Contractor's License Law for the followi4 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 d1so 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 700b) of Division 3 0/ the Business and Professions Code, or that. he is exempt therefrom, and th 'basis !or the alleged exemption. Any violation of 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 I, as owner of the property, or my employees with wages as their sole compens ion, will do the work, and the structure is not intended or offered for sale. (Sec. 7044, B sness and PrIssions Code: The Contractor's License Law does not apply to an owner of p operty who Duil $ or improves thereon and who does such work himself or through his ow employees, providBBd that such improvements are not intended or offered for sale. If, how eve , the building or impY vement is sold within one year of Completion, the owner -builder will h e the burden of provi Q 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 cqq tractors to con. struct lhe\projecl. (Sec. 7044, Business and Professions Code: The Contr btor's License Law does not apPpply to an owner of property who builds or improves thereon, and who contracts for such project wdh a contractors) licensed pursuant to the Contractor's LicenseKaw.) I t I am exempt,under Sec. B. & P.C. for this reason Date ORKERS' COMPENSATION DECLAJRATION \WIt hereby affirm tha%J have a certificate of consent to self -insure, or a certificate of Worker's Compensation Insurance, or a certified copy there°of. (Sec. 3800, Labor Code.) Policy No. Company n Copy is filed with the ci \O Certified copy is ereby furnished. CERTIFICATE OF EXEMPTION FROM (This section need not be completed iAv , Pa ifl 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 toecome subject to the Workers' Compensation Laws of California. Date Owner NOTICE TO APPLICANT: ll, after makin this d 'ficafe o/ Exemption you should become subject to the Workers' Compensation provisions 'q! the Labor Code. you must forthwith comply with such provisions or this permi shall be deems (evoked. CONSTRUCTION LENDING AGENCY 1 hereby affirm that thererls a construction lending agency for the performance of the work for which this permit isltssued. (Sec. 3097, Civil Code.) Lender's Name Lender's Address This is a building p rmit when properly filled out, signed and validated, and is subject to expiration if w/dh launder is suspended for 180 days. y I certify that read this application and state that the above information is correct. 1 agree to comith all city and county ordinances and state laws relating to building construction, ereby authorize representatives -of this city to enter the above- mentioned profjor inspection purposes. Signature ollaQplicant Date Mailing Address Ci,V, S te, Zip BUILDING: TYPE'COl4* a OCC. GRP. ` -� -7 n A.P. Number -4 r'�f 73 " 2335 - Legal Description X L PST t4- r L K 94- W f A' 0%, Project Description rr &f r , (; f • Tf rni r I Ar Sq.No. No. Dw. SizeFt. iZ Stories Units New Add ❑ ,Alter ❑ Y Repair ❑ r Demolition ❑ Estimated Valuation , `� Et'.i"Ti ' PERMIT AMOUNT Plan Chk. Dep. ,,.� `7 Plan Chk. Bal. Front Setback from Center Line Const. Rear Setback from Rear Prop. Line Mech. Side Street Setback from Center Line Electrical Side Setback from Property Line Plumbing FINAL DATE S.M.I. Issued by: Grading Validatedby: Driveway Enc. Validation: 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: Date Permit- ermi-Validated Validatedby: F n L Validation: A-1A�l�y • WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION Desert Sands Unified School District 47-950 Dune Palms Road Notice: La Quinta, CA 92253 Document Cannot Be Duplicated 760-771-8515 Date 3/20/01 No. 21777 Owner NameLeonard Lam CERTIFICATE OF COMPLIANCE APN # 773-233-009 Jurisdiction La Quinta Permit # 0102-224 No, 52-180 Street Avenida Mendoza Log # City La Quinta zip 92253 Study Area Tract # Lot # Square Footage 1752 Type of Development Single Family Residence 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: EXEMPTION NOT APPLICABLE This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of 2.05 X 1,752 or $ 3,591.60 the property listed above and that building permits and/or Certificates of Occupancy for this square footage in this proposed project may riot be issued Fees Paid By CC / Guaranty Federal Bank - Leonard Lam TelepE®me 760-34C-9882 Name on the check By Dr. Doris Wilson'{ Superintendent Fee collected /exem ted by Annette Barlow Signature Payment Received $3,591.60 Check No. 1769402 VOTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1998) 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 :ollect 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 SCHEDULE B AT THE DATE HEREOF EXCEPTIONS TO COVERAGE IN ADDITION TO THE PRINTED EXCEPTIONS AND EXCLUSIONS IN THE POLICY FORM DESIGNATED ON THE FACE PAGE OF THIS REPORT WOULD BE AS FOLLOWS: PROPERTY TAXES, INCLUDING ANY PERSONAL PROPERTY TAXES AND ANY ASSESSMENTS COLLECTED WITH TAXES, FOR THE FISCAL YEAR -2000-2001. 1ST INSTALLMENT: 2ND INSTALLMENT: EXEMPTION: CODE AREA: ASSESSMENT $111.75, OPEN $111.75, OPEN NONE 020-017 773-233-009-8 j 1A. THE LIEN OF SUPPLEMENTAL TAXES; IF ANY, ASSESSED PURSUANT TO THE PROVISIONS OF CHAPTER 3.5 (COMMENCING WITH SECTION 75) OF THE REVENUE AND TAXATION CODE OF THE STATE OF CALIFORNIA. ASSESSMENTS, IF ANY, FOR COMMUNITY FACILITY DISTRICTS AFFECTING SAID LAND WHICH MAY EXIST BY VIRTUE OF ASSESSMENT MAPS OR NOTICES FILED BY SAID DISTRICTS, 1 B. ANY UNPAID AND/OR DELINQUENT BOND OR ASSESSMENT AMOUNTS WHICH MAY HAVE BEEN REMOVED FROM THE ROLLS OF THE COUNTY TAX ASSESSOR AND WHICH MAY HAVE BEEN REMOVED FROM TAX BILLS AND TAX DEFAULT REDEMPTION AMOUNTS. 1 C. AN ASSESSMENT BY THE IMPROVEMENT DISTRICT SHOWN BELOW 2 3 ASSESSMENT (OR BOND) NO: SERIES: AD 91-1 DISTRICT: CITY OF LA QUINTA FOR: SEWERS BOND ISSUED: JULY 17, 1991 SAID ASSESSMENT IS COLLECTED WITH THE COUNTY/CITY PROPERTY TAXES. AN EASEMENT FOR THE PURPOSE SHOWN BELOW AND RIGHTS INCIDENTAL THERETO AS SHOWN OR AS OFFERED FOR DEDICATION ON THE RECORDED MAP OF SAID TRACT. PURPOSE: AFFECTS: PUBLIC UTILITIES THE REAR 5 FEET AN EASEMENT FOR THE PURPOSE SHOWN BELOW AND RIGHTS INCIDENTAL THERETO AS SET FORTH IN A DOCUMENT PURPOSE: PUBLIC UTILITIES RECORDED: JULY 23, 1934 IN BOOK 181, PAGE 310; DECEMBER 12, 1934 IN BOOK 205, PAGE 300; JUNE 25, 1935 IN BOOK 233, PAGE 568; OCTOBER 6, 1935 IN BOOK 234, PAGE 473; AND JUNE 1 1936 IN BOOK 281, PAGE 449, ALL OF OFFICIAL RECORDS 4 RC DISTRICT - PLANNING REVIEW FORM This form is to be used by CDD staff for review of single family dwellings in the RC (Cove Residential) District, in order to determine the applicability of compatibility issues or need to require the filing of Master Design Guidelines by the applicant. It shall be transmitted to the Building and Safety Department as your correction list. Please attach additional explanations as necessary. APPLICANT Leonard Lam SITE ADDRESS 52-180. Avenida Mendoza APN 773 - 233 - 009 BIN NO.: CASENO.: 2001-406 LEGAL: LOT 14 BLOCK 94 UNIT S.C.@V.L.Q. CHECKED BY: Stan Sawa DATE: -�5j JJDJ Inform the assigned Building plan checker upon your assignment to this case. The CDD Executive Secretary maintains a log book to track applications and assign case numbers. REQUIRED ITEM Y N COMMENT/CORRECTION Compatibility Review Case logged and number assigned \, Verify legal and APN information V Consistent with MDG on file (as.applicable MDG filing required (5 filings since 9/3/98) Consistency with street/surrounding area: Colors Materials Architecture V Other Requirements: COACHELLA VALLEY WATER DISTRICT CASH RECEIPT DETAIL Received From. 3 Address: Dater._ 4- �-1 -XIC .10coo-vid.- A-. Account No. L Tract` LC�CCL Lots Service Address G.A. Code 0-Meter(s) 314 Q', Service(s) • Backflow(s) • House Lateral(s) • Detector Check(s) • MeterSuicharge .&-Sanitation Capacity Charge • W.S.B.F.C. • Temporary Construction Meter 0 Turn on Charge -0 Uncollected Account - Name 0 Inspection Fee - Tract - Fee - 0 Plan Check Fees Water Sewer - Tract - 0 Bond Payment - A.D. --Bond Assmt. 0 Customer Deposit 0 Other TOTAL $ Remarks: t"_u Q,C6py to: Cash Water Service Check Order Money t CA Cashier �-U CVWD-438 (11189) ft6�V,_`b 3/22� / o CITY OF LA QUINTA SUB -CONTRACTOR LIST JOB ADDRESS?`�n tl/��(lID/� r/I��/I} %'..�'i PERMIT NUMBER c7/?_OWNER L���� ��`) -.2gy°_ BUILDER This form shall be posted on the iob with the Building Inspection Card at all times in a conspicuous place. Only persons appearing on this list or their employees are authorized to work on this job. Any changes to this list must be 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./.,Cla§Mfication,..:. Contradtor , State..Contractot s.Ucense Woi ri keis Compensation Insurance Cit Business License: Company a n Name Classi ' cation License Number Exp. Date Carrier Name Policy Number Exp. Date License Number Exp. Date (e.g. A, B, C-8) (xxxxxx) (xxlxx/xx) (e.g. State Fund, CalComp) (Format Varies) (xx/xx/xx) (xxxx) (xx/xx/xx) EART`:, --- 7-oHWO .. .........C poot g � CONCRETE; C:;S). .- T - EZ :" F', 2 p OY - > �.,�... T LLI tr Co�(/CR�- C- C - 9 9- x% S Al o A C—wrL F U>Jvc 01 01 oz -SI p 3 �Zz,L (0. Z 0.3 - 3 � 6 74-C SS -71311 r) M 6W4 -6o ouxpz7©1 o,o2,1 �-f-q a 9 JC�3o r 02,1bK. FRAMING::IC=51;: ' :.... b w N K STRUCTi:.-STEEL?;(C;=511;':``' .......::..:..........:::...:.....:....:........ 11✓ /�� � LAOt,f✓-MAiKCONlpftot/MI MASONRy`:(C=291.Co Sr�(c�r jy PLUMBING IC ALbAAi Nd tuA,1B(A/C /NC S Ivl r LF -c ?'IC r �� LATH;PLASTER (C;351;' p��/NEiZ fohw 0 1 -r,., ca/s/US DRYWALL{G:91 ':. `"`:' JA)Ah. � (0. Z 0.3 - 3 � 6 74-C SS -71311 r) M 6W4 -6o ouxpz7©1 o,o2,1 �-f-q a 9 JC�3o r 02,1bK. -1 K C-,5 71►iZ���r�C7./�z7 �SIt/I+�1����� �.`71��_sq. ' � M. E =I UN 0 � � LAOt,f✓-MAiKCONlpftot/MI 1(o-tcn75 ZD -9 - ELECTRICAL` IC=101;;> >: ; ': S Ivl r LF -c ?'IC r �� _ G l o �� 150 fohw 0 1 -r,., ca/s/US 3 8 /S 6 �5 0 ��f%v z90 ehs/of R00FING:(C39.1<'>'< >`:> ii wNGI� SHEET METAL 1C 431 D -W 0, FLOORING: .C.:.15.:.:.1..;.. :.:;... I NI 1 a ✓F►✓ 5I AL O:..:..:; ' f 7 3ir'3 ° aLAzlnaIc7 �Ktwtnno/NC C- $ f( (odIz" INSULATION:IC=2►`.'.:<::'r. ArtAc_ ?N /N� �t LA ion/ P C— Z 63Z D7 2- 64 n p t -I c m/�k'� , U I �L z G L Z 0�~1 4 ,f o I ' I O Z $� 0 SEWAGEpISPz (C;421;" .<'', ice.^�f I /(� �L t wl B i ti/r I&/(- C - / 6-7 Il 6 z ; c 9 PV 14 d 3 0 udNGIQ -1 K C-,5 71►iZ���r�C7./�z7 �SIt/I+�1����� �.`71��_sq. ' � M. E =I UN (_ CITY OF LA QUINTA SUB -CONTRACTOR LIST JOB ADDRESS 5 PERMIT NUMBER Q /� - ZZ Y OWNER BUILDER L.�ti" LAS This form shall be posted on the job with the Building Inspection Card at all times in a conspicuous place. Only persons appearing on this list or their employees are authorized to work on this job. Any changes to this list must be 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 Policy Number Exp. Date License Number Exp. Date (e.g. A, B, C-8) (xxxxxx) (xxlxx/xx) (e.g. State Fund, CalComp) (Format Varies) (xx/xx/xx) (xxxx) (xx/xx/xx) EARTHWORK'IC=12) '> CONCRETE.IC.`:.81:'; ° >' FRAMING IC 51 LN�I'Yl 5TRUCT ' STEEL'19C 011..': ` ........:::..........:......::.....:....:...... MASONRY ZZN 79 y22Sr 11i PLUMBING IC. =361 LATH .PLASTER (.0351'- L�d/j�if2>) yy��� 3 �•/ �' yv�} I V � �/ DRYWALL IC.=91 `.;:> > :< :;<;;: L C-0 �%1 i'--`� Lj-cti')gj Y 2i o v0H (/Gl/ HVAC.IC0).:::::.,:::..:,;;:. ELECTRICAL IC:=10.1`.;<:>;: tp-� ZAW 9HEE`1`::METAL IC=431 < ' . Z�0IV 4 ' I PLO0NNG:IC: 151` ": ? <>:: aLAZINa'IC:=1;71:;;:::;`;:`::. INSULATION SEWAGE`DISP>(CA2)'.>::`', PAINTING 1C-331. .`::'' -�'L� 1 --cc INA -g-% LSn CERAMIC TILE IC -54I.'::,': �(� L TZ e? FENCING IC 131 LN7 1i/}-W� •: 22 �i� V ' " � Vvb t LANDSCAPING.'IC 271 ' r -;o ? I'V& I VIM%