AR (9807-280)LICENSED CONTRACTOR DECLARATION
4P16reby 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 contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
O I am exempt under Section B&P.:C. forthis reason�
Date K� . r� A Signature of Owner—N/A 0 b
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
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.
J,'4X[A411i',1C'1,4 Cara tILFF
(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 provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.
Date: & t l:.<' Applicant' ^^p ' • J
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.
Signature (Owner/Agent)^ �► /' 4 it Date r t
BUILDINGPERMIT PERMIT°°NTR°`#
DATE VALUATION j a {;{ I{{ {II) LOT TRACT I�
_i w
JOB SITE
ADDRESS �''—:!/� FIVia�l'`YP11i�..iV9.ilYVil,iii
APN
laas••aai.t.—eiir3
OWNER
CONTRACTOR / DESIGNER / ENGINEER
ar.i.Ci{.eiT!1a t?i KI:RIZ.
ei�ti cL,l (MIZIl iG8'A`.1EkPkf. C'10i rl R2'1.1.1OR
,1W ��ie:�.WGtlN VE �v
4-3_50.AVFNJJ0r'�xi�i'rii ERA
BAME' J'IaI C'I,tF; iC MI 49017
LA. t;?tJiINITA CA Q2251
f?(-ifi�iFi-1«�tSI 1 C'T"IT •# f i, i 5
USE OF PERMIT
",;:4 S.t . Cwt tiSr N1�Lii.1'Ci`rtd
1• l'i{..I.I.d'> NON 10,(ifiO.W .LS
ES"3'114M';SLM C'048 OF CONY1':>?' VC'iION'
Ytl,€ililt.f}t!
i"( N,",," `RI i C11 C) Nt Fr-t's 101 -000 -418 -WO Si17 (9)
�
t41tsC 14-'�G 101-000-^144.1^000 - 121,50
a,fiti 1'I2.li'e1l, 111ftt 10,14W426-000 li22.814
'rR N K K>'f1Cifa 1743E -RESII 101 -00t1 -211-f IW $1.00
19(JB-T(YFA1, 071(APRI.#G"i` O?N AND FLAN C TMC.
§_ VE 4tit ;~RE-PAJI1) Fle,E9
$o.t)t)
QR" OIjAColtMIT le6+,F y 0110, NO'
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
A
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap A
F.A.U.
Framing p
Compressor
I isulation
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 Plbg. 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
Poor 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:
Desert Sands Unified School District-
`� - e 47-950 Dune Palms Road
otice: La Quinta, CA 92253
Document Cannot Be Duplicated 760-771-8515
CERTIFICATE OF COMPLIANCE
J r C
Date 8/4/98 APN # 646-181-008
No. 17451 Jurisdiction La Quinta
Owner NameRichard A. Kerr
ti _ Permit #,
No. 49-575 Street Avenida Montero Log #
City La Quinta ' Zip 92253 Study Area t
Tract # Lot # Square Footage 224
'Type of Development Residential Addition No. of Units 1
Comments 224 sq. ft. addition.
At the present time, the DesertSands 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 lids 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 224 or $ 0.00 the property listed above and that buildVi a
permits and/or Certificates of Occupancy for this square footage in,this proposed project Lnav nowTbe issued 1z
Fees Paid By N/A - Jack Clark Jclephonei 56";3511 .
Name on the check
`M ��
}
, yrs'
By Dr. Doris WilsonKr.
Superintendent tk'f l.h-�
Fee collected /exempted by Juanita Green Exempt $0.00
Check No. N/A
Signature
S
[NOTICE: Pursuant of Asse ly Bill3061 (CHAP 549, STATS. 1996) lhis,will serve to notify you that the 90�ay approval period in which you may protest the fees or other payment idented
bove will begin to run fro a date on which the building or installation permit for this project is sssued or on which they are paid to the Distriel(s) or to another public entity authorized to
llect them on the Dislrict('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 -
1
SUB -LIST
CONTRACTOR -_ C14( Calk. ADDRESS 5`1 350 AJw11.{ct I �ewerc� ^
OWNER_ 2i ckov4 4<0_y-- JOB ADDRESSJM 575 Ag. Motkyv
This form shall be posted on the job with the Building Inspection Card at all times in a conspicuous lace.
It is the responsibility of the General Contractor or the Owner/Builder to monitor the sub -contractors that
are on this list are the same persons performing the work. Any changes to this list must be approved the
City of La .Quinta Department of Building & Safety lZLI 1 to work being performed by a changed sub-
contractor. Failure to comply will result in a stoppage of work and/or the voidance of building permit.
TRADE
SUB=CONTRACTOR'S:'
NAME
TYPE OF
LICENSE
r
STATE'
CONTRACTOR'S'
UCENSE, .:`
NUMBER
WORKER:'
COMP.' NAME/
NUMBER ON FILE.
CITY
!BUSINESS
LICENSE
.NUMBER/ .
EXP.DATE
GRADE/
EXCAVATE.--.:
A/C -12
PIPELINES
C-34
CONCRETE/ . .:::.
FOUNDATION&`.'
' y
Co.}LS LvKj{✓uG��a
C-8
b 31oy�i
•1-31-00
`�fa�t Fro(
ll1D-i
-1kSz5-1I
419 95
IZ-lS-`18
ASPHALT"',
A
FRAMING'* -
B
STEEL/
STRUCTURAL
C-51
MASONRY •
C-29
PLUMBING.. ..
C-36
LATHING
C 26
DRYWALL
P�{)�
C 9
713108
10-31-1
(;Jctdc.k Code
NWL '19 -too 9-6-5a
q01q
11_a3 -`lo
PLASTERING
ij
C-36
HVAC
C-20
ELECTRICAL ..:...,�o�¢
(General)
(2G
C-10
a i 1
C, l, l (_
4 0t752 2A A
ROOFING �
Rv�; •(��C S,p:=�',�.l�ty
C-39
I-3 -oo
It9Z�{3a-98 -1-
;L0 II -1-9r
SHEET, METAL
C-43
FLOORING
C-15
GLASS/
GLAZING
C-17
INSULATION
Q-o%iU Irtstc�ri �oK
C-2
381�3`i
-30-9
REP. I FM•
35�13A1 I -I-99
10 511
12-31= I�
SEWAGE DISP.....:
C-42.
PAINTING/ .>'.: °.
DECORATING
C-33
TILE
USP C."„SAvuc{i�
C-54
5`11a��}n1e
1-30-96.7.�.i
fwwl
II I-199
3118
z•io-tip
CABINETS/
INSTALLATION
C-6
FENCING
C-13
LANDSCAPING:
C-27
POOLS
C-53
OTHER
s