BLDG (0004-185)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
DateSignature 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. 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 for which this permit is issued.
(A,; 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 S`i'.l'<`! ii FUNID Policy No. 046.92.9>lti$394.
(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, w't
I shall forthh comply with those provisions.
Date: % Si' Applicant
Warning: Failure to secure Workers' ComperSsation 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.A 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) w`}' Gr Date
BUILDING PERMITPERMIT# y
DATE VALUATION LOT �s3-Yo:i TRACT
04117/200 � 44d3,7^,�,.'�m 8 26769
JOB SITE APN
ADDRESS
81-01.0 MOUMAM.WOW IdWE 71,67-480
OWNER - ; CONTRACTOR / DESIGNER / ENGINEER
t
WY3VM,RS LhY0 CO, .► A.O. TORRESS CONS'.IRUCTIO.W
79.495116. ON CIRCLE 6407 I'A.SONj YWAY
LA QtMn A. CA 92253 BAk`'ERSKEL'.,D CA 93301?
(760)772--2848 c; . LY 1451
USE OF PERMIT
GEN RAJ-Tsi) I X31 Or
750 S...? ROOI't+l ADDITION TO HOUSE UNDER CL MISTRUCTION
ADDITION
750.00 SF
ES -I3 TATRD COST OF CONSM TC.ICION
PLAN CHEM "10,' 101.000-439.318 Xi $231.$9
CONSTRUCTION FEF 101-000-416-OGO $3543.00
MECHMICAL, FUR 101-000-421-000 $3'3,00
IL, i
IME CAEZ 101-0O0-420-000 ${41.25
STRONG MO'$1014 FEE - RE SID 101-000.241-000 54.07
SUB -T f:AL. f"aNi:Y,Pk M71- ON AIM Pl'..AN C7tMCK
L LESS PRF --,PAM PrMiS
TOTAL P 1�£.-r1IM6,1810NOW
B RECEIPT DATE I BY { :..7 I TEI AL J INSPECTOR
40,72.5.00
$665.72
S0100
5,72
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
— mac!
Underground Ducts
Forms & Footings
Gv
Ducts
Slab Grade
Q — <5v
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 8 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
I
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:
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1.8 (
L"a Quinta -A •92253.
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Coachella Valley UnifiAaSc ool "District
P.O. Box 847, Thermal;JCA 92274
(760) 399-5137, Ext. 235
This Rny Fnr nistriet I ke, nnly
CERTIFICATE OF COMPLIANCE
(California Education Code 17620)
Project Name: Date: Ari 1 18, 2000
Owner's Name: TowprsLand Co_ Phone No. (760 497-7701
Project Address: 74_495 14nri7nn Circlp, Ia Quinta. CA 92253
Project Description: Room Addition
APN,: 767 480 006 Tract #: Lot #'s:
Type of Development: Residential 'XXX Commercial Industrial
Total Square Feet'of Building Area: 754798 `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.
Dated: ��1� 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
17620 65995 Approval Prior to 1/1/87
Note:
Number of Sq.Ft.. 754.98 ,
Amount per Sq.Ft. $ 2.05
Amount Collected $ 1,547.70
Building Permit Application Completed:.Yes/No
By:
Foch "Tut" Pensis. Assistant Soerintendent Administrative Services
Certificate issued 1
Not Subject to Fee
Requirement
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. 09/27/99
DEVELOPER FEES PAID
AREA:
AMOUNT:
RCPT p:
CK #:
- CASH:
IMTIALS:
DATE: '
CERTIFICATE OF COMPLIANCE
(California Education Code 17620)
Project Name: Date: Ari 1 18, 2000
Owner's Name: TowprsLand Co_ Phone No. (760 497-7701
Project Address: 74_495 14nri7nn Circlp, Ia Quinta. CA 92253
Project Description: Room Addition
APN,: 767 480 006 Tract #: Lot #'s:
Type of Development: Residential 'XXX Commercial Industrial
Total Square Feet'of Building Area: 754798 `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.
Dated: ��1� 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
17620 65995 Approval Prior to 1/1/87
Note:
Number of Sq.Ft.. 754.98 ,
Amount per Sq.Ft. $ 2.05
Amount Collected $ 1,547.70
Building Permit Application Completed:.Yes/No
By:
Foch "Tut" Pensis. Assistant Soerintendent Administrative Services
Certificate issued 1
Not Subject to Fee
Requirement
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. 09/27/99