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BLDG (0001-083)LICENSED CONTRACTOR DECLARATION 11 hereby affirm under penal� of perjury that I am li6ensed und6r provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and 'Professionals Code, and my Licenie,is in full force and effect. License # Lic. Class Exp.. Date a /te� 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). , ( ) 1, 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.6 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,6rovided for by Section 3700 of.the..Labor Code,, for the performance of the work for which'this permit is issued. (Q I have and will maintain workers' compensation insurance, as required by Se6tion 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. STAT�'Vl A 5 0" VOAT-4 (This section need Bed not. b6 completed if the permit valuation is for $100.00 or less). O I certify that in the performance of the Work for which this permit is issued; I shall not employ'a�-hy 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 Wbrk6rs' compensation provisions of Section ction 3700 of the Labor Code, I shall forthwith comply with thbse-*provisi6ns. ate: Applicant - VO Warning: Failure to secure Workers' Compens-at-ion coverage is unlawful and shall subject an employerto criminal penalties and civil fines up to $100,000, in additio6 to the cost of compensation, damages as provided for in Section 3106 of the Labor Code, interest and attorney'b 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/Ag e'nt) Date BUILDING_ PERMIT PERMIT# - DATE VALUATION LOT' -8 TRACT I,.,, 114 JOB SIIIEAPN ADDRESS SIAN MOUNTAM VIEW LANE' OWNER t CONTRACTOR -/'DESIGNER-/ ENGINEER IFIDWE'u) L.141111 -111D C01, 11)]MRS (.7"NST11C'0111 79-4915 HCATZ0.14 CIRCLE 6407 'PARSONS W.AY: LAQWNrA GA 9253 25 3 BAKEkSHELD -CA,93-10", M.91 1.481 USE OF PERMIT GE, KR f6kL 5U3)..UNO 84 ST. (WE71 OAR) ADDiTION TQ USH)ENCE, CURawaY UK)ER WIN' STKV01' 10 N 34.0 SP CIV " May. WW P.111FEE MNR C61'SUMV 418 1'LA14 CktkfX FW -1' I Q I -.000-A'39-, 41 All SM-1-71(frAL CON 1111PAU(Tf ION AND PLAN CHECIK' USS PRE -MID 1711311�1"S TOIAL PEA M. IT f3K9 S 04i It, N OW -7 RECEIPT DATE BY! DATE INSPECTOR:, -% f& 16 INSPECTION RECORD OPERATION DATE I 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 Final BLOCKWALL APPROVALS Steel POOLS -SPAS 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 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.1. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) COMMENTS: err Coachella Valley Unified School District P.O. Box 847, Thermal, CA 92274 (760)399-5137, Ext. 235 This Rns Fnr r)istrir.t I Ice Onlu CERTIFICATE OF COMPLIANCE (California Education Code 17620) Project Name: Date: January 12, 2000 Owner's Name: Towers Land Co. Phone No. ( 760) 722-2848 Project Address: 81-810 Mountain View Lane, La >Iin a, CA 92253 Project Description: Room Addition APN: 70 4RO OOR Lot #'s: Type of Development:esidential XXX Commercial Industrial. —�- 84 S Ft. Total Square Feet of Building Area: q - Certification of Applicant/Owners: The person signing certifies that the above information is correct and makes this statement under penalty of perjury and further represents that he/she is authorized to sign on behalf of the owner/developer. Dated: Signature:. ` SCHOOL DISTRICT'S REQUIREMENTS FOR THE ABOVE PROJECT HAVE BEEN OR WILL BE SATISFIED IN ACCORDANCE WITH ONE OF THE FOLLOWING: (CIRCLE ONE) Education Code Gov. Code Project Agreement Existing Not Subject to Fee 17620 65995 Approval Prior to 1/1/87 Requirement Note: -Pursuant to AB' -181, any room additions Number. ofSq.Ft. 84 or enclosures of 500 sq.ft. or less, are Amount per Sq.Ft. $ -0 eXemDt from dPVPloner fees_ Amount Collected $ _fl Building Permit Application Completed: Yes/No By: Foch "Tut" Pensis. Assistant Superintendent Administrative Services .Administrator in Charge Certificate issued by: Marcela Valdez Signature: Faci 1 i ti es .C1 erk ' - AT/11V711"1M AT Aft T 1 tr AW"T/171 TAT •ATT T ♦ TT AATT AW Section 66020 of the Government Code asserted by Assembly Bill 3081, effective January 1, 1997, requires that this District provide (1) a written notice to . the project appellant, at the time of payment of school fees, mitigation payment or other exactions ("Fees"), of the 90 -day period to protest the imposition of these Fees and (2) the amount of the fees. Therefore, in accordance with section 66020 of the Government code and other applicable law, this Notice shall serve to advise you that the 90 -day protest period in regard to such Fees or the validity thereof, commences with the payment of the fees or performance of any other requirements as described in section 66020 of the Government code. Additionally, the amount of the fees imposed is as herein set forth, whether . payable at this time or in whole or in part prior to issuance of a Certificate of Occupancy. As in the latter, the 90 days starts on the date hereof. This Certificate of Compliance is valid for thirty (30) days from the date of issuance. Extension will be granted only for good cause, as determined by the School District, and up to three (3) such extensions may be granted. At such time as this Certificate expires, if a building permit has not been issued for the project that is the subject of this Certificate, the owner will be reimbursed all fees that were paid to obtain this Certificate of Compliance. Rev..' 09/27r/99 te) DEVELOPER FEES PAID AREA: AMOUNT: RCPT#: . CK #: CASH: INITIALS: .. , DATE: .. -. CERTIFICATE OF COMPLIANCE (California Education Code 17620) Project Name: Date: January 12, 2000 Owner's Name: Towers Land Co. Phone No. ( 760) 722-2848 Project Address: 81-810 Mountain View Lane, La >Iin a, CA 92253 Project Description: Room Addition APN: 70 4RO OOR Lot #'s: Type of Development:esidential XXX Commercial Industrial. —�- 84 S Ft. Total Square Feet of Building Area: q - Certification of Applicant/Owners: The person signing certifies that the above information is correct and makes this statement under penalty of perjury and further represents that he/she is authorized to sign on behalf of the owner/developer. Dated: Signature:. ` SCHOOL DISTRICT'S REQUIREMENTS FOR THE ABOVE PROJECT HAVE BEEN OR WILL BE SATISFIED IN ACCORDANCE WITH ONE OF THE FOLLOWING: (CIRCLE ONE) Education Code Gov. Code Project Agreement Existing Not Subject to Fee 17620 65995 Approval Prior to 1/1/87 Requirement Note: -Pursuant to AB' -181, any room additions Number. ofSq.Ft. 84 or enclosures of 500 sq.ft. or less, are Amount per Sq.Ft. $ -0 eXemDt from dPVPloner fees_ Amount Collected $ _fl Building Permit Application Completed: Yes/No By: Foch "Tut" Pensis. Assistant Superintendent Administrative Services .Administrator in Charge Certificate issued by: Marcela Valdez Signature: Faci 1 i ti es .C1 erk ' - AT/11V711"1M AT Aft T 1 tr AW"T/171 TAT •ATT T ♦ TT AATT AW Section 66020 of the Government Code asserted by Assembly Bill 3081, effective January 1, 1997, requires that this District provide (1) a written notice to . the project appellant, at the time of payment of school fees, mitigation payment or other exactions ("Fees"), of the 90 -day period to protest the imposition of these Fees and (2) the amount of the fees. Therefore, in accordance with section 66020 of the Government code and other applicable law, this Notice shall serve to advise you that the 90 -day protest period in regard to such Fees or the validity thereof, commences with the payment of the fees or performance of any other requirements as described in section 66020 of the Government code. Additionally, the amount of the fees imposed is as herein set forth, whether . payable at this time or in whole or in part prior to issuance of a Certificate of Occupancy. As in the latter, the 90 days starts on the date hereof. This Certificate of Compliance is valid for thirty (30) days from the date of issuance. Extension will be granted only for good cause, as determined by the School District, and up to three (3) such extensions may be granted. At such time as this Certificate expires, if a building permit has not been issued for the project that is the subject of this Certificate, the owner will be reimbursed all fees that were paid to obtain this Certificate of Compliance. Rev..' 09/27r/99 te)