BLDG (0002-233)p a LICENSED CONTRACTOR DECLARATION
y' I hp eby�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 ' 7�° Signature of Contractor r'✓ G -1'"
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). :
( ) 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. 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
performance of. the work forwhich this permit is issued.
`( ), I have and will maintain workers' compensation insurance, as required by
Section 3700 of the'Lalior Code; for'the•performance of the work for which this
permit is issued. My workers' compensation insurance carrier & policy no. .,are:
CarrierPolicy No..
!
/,1:+-�'.(jG"'s 154
(This section need not be 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 any person in any manner so as to become subject to the
workers' compensation' laws of'Californ'ia; and agree that if.1 should.become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code; 1 shall forthwith comply with those/prow `sions.
Date: 9 � Applicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
'addition to the cost of compensation, damages as provided for in Section 3706
of -the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made -to the Director of Building and Safety
for a permit subject to •the conditions 'and restrictions set forth on his
application. ,
1. Each person upon Whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date,of issuance, of such
permit, or cessation of work'for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply'with•.all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
- z
'Signature (Owner/Agent) ..�" . Date
PERMIT PERMIT'
•, F ;''/,j,BUILDING
yJ
DATE VALUATION LOT, TRACT _
JOB SITE 7 .
ADDRESS 81-80 MOUNTAIN TAIN VIEW LANE
APN
OWNER
CONTRACTOR / DESIGNER / ENGINEER +
f+0 .4 �'
J e.i:.e: •..ad: -
['1��y? Y+C CIO',,IST f r �rtrgr m
,A TOM
.. t.�. €•�.t.+�ii,S�u a.vl.4 ISTr �sv�,, da.t.�t'a
79-495 Nt71iF/_,i N PALM CIRCLE
6407 PARSONS iS Wj\.' ' .
LA CQUIN'iA i",E\ 922%3
RAk:.EWrifM- LD CA .93107
(77)772-2,W_ ' r BL# .1451 ,
�� ✓ - z''
USE OF PERMIT -
SLITY EN-111IN i AL "'10 Pi+a?ty( )19OU3:1- 222 S1. VT. i:trz 17 INCREASSE .
F,AT10 C:rN a^si£SI:o. N 222.013 SF
ss
1
P•
ii
a 0114 t V47tY¢!k LlrrT"s irll
VQ1r'9A ' ,' p!'r a^F,
flvwY E$AO..t $L''N'i,.G +JAV ` %,1.r`+,,► 8. PAP.: LA$%^N
a �ROR fie
PLAN C FCK lVB d0I -X39-3D8 �7c;,1i5
(7r±`N:�7TtI!f;'l'tc)}+iFFF, illi -!111(;1-4.1$-000 Rt!7JAI
ljl.,.;, ,.i1.. •.. eta, t'I:.ir-. i V.t'••�levey.t;v-VIJW
M10146 N-10TION.f?EM - REISM 1111-000-2,41"C► o v.94 ,
}
AK'1' 1N PUi31.lt•: PLA(,'F_S - iMS0.1:: 7113•U0C 2554)00 $99.25
f.IE:.S8 ni 'F-P_A 1D FE, ES
$0,00 . f
�220.9_9
RECEIPT
DATEBY
D TE F LED
INSPECTOR g i £ 's"
INSPECTION RECORD
OPERATION
DATE
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
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
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
Final
Utility Notice (Perm)
COMMENTS:
'
- Coachella Valley Unified School District
P.O. Box 847, Thermal', CA 92274.
(760) 399-51375 Ext. 235
This Rns Fnr District I Ice 0 1l
CERTIFICATE OF COMPLIANCE
(California Education Code 17620)
Project Name: Date: February 17, 2000
Owner's Name: J Torres Companya Phone No. T7760 772-2848
Project Address: 79-495 Horizon Palm Circle, La Quinta, Ca 92253
Project Description: Patio Conversion
APN: M M n(1R Tract #: Lot #'s:
Type of Development: Residential' XX Commercial Industrial
Total Square Feet of Building Area: 222 Sq. Ft.
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.
J
Dated: C242 ZPA Signature:
******,r,r*,►*,r+r+t,r*******,►*,r,r,r,r,r**=v*T,r'*�*�*`***********+r*,r*+t*******************
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
17620 65995
Project Agreement Existing"
Approval Prior to 1/1/87
Not Subject to Fee
Requirement
Note: Pursuant to AB -181 anyroom additions "
Number ofSq.Ft. 500 or enclosures of 500.sq.ft. or less, are
Amount per Sq.Ft. $ -0, exempt froM developer-fees.
Amount Collected $ -0
` Building Permit Application Completed: Yes/No
By: Foch "Tut" Pensis. Assistant Superintendent Administrative Services
Administrator in Charge
Certificate issued by: Marcel a Valdez Signature:4"
aci .1 i es Clerk/
Section 66020 of the Government Code asserted by Assembly Bill 3081, effective January 1, 1997, requires that this District provi efl .(34written 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
t 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. 09/27/99
DEVELOPER FEES PAID
M
AREA:
AMOUNT:
RCPT q: -
CK M
CASH:
INITIALS:
'DATE:
CERTIFICATE OF COMPLIANCE
(California Education Code 17620)
Project Name: Date: February 17, 2000
Owner's Name: J Torres Companya Phone No. T7760 772-2848
Project Address: 79-495 Horizon Palm Circle, La Quinta, Ca 92253
Project Description: Patio Conversion
APN: M M n(1R Tract #: Lot #'s:
Type of Development: Residential' XX Commercial Industrial
Total Square Feet of Building Area: 222 Sq. Ft.
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.
J
Dated: C242 ZPA Signature:
******,r,r*,►*,r+r+t,r*******,►*,r,r,r,r,r**=v*T,r'*�*�*`***********+r*,r*+t*******************
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
17620 65995
Project Agreement Existing"
Approval Prior to 1/1/87
Not Subject to Fee
Requirement
Note: Pursuant to AB -181 anyroom additions "
Number ofSq.Ft. 500 or enclosures of 500.sq.ft. or less, are
Amount per Sq.Ft. $ -0, exempt froM developer-fees.
Amount Collected $ -0
` Building Permit Application Completed: Yes/No
By: Foch "Tut" Pensis. Assistant Superintendent Administrative Services
Administrator in Charge
Certificate issued by: Marcel a Valdez Signature:4"
aci .1 i es Clerk/
Section 66020 of the Government Code asserted by Assembly Bill 3081, effective January 1, 1997, requires that this District provi efl .(34written 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
t 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. 09/27/99