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SFD (9907-631)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 kl ,y 12131/20( e 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). () 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 pert rmance 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 umnmr rrrnrr. Policy No. n+r r++r sM�wpe .,} t r1 t)3 d• Lrarokt r W W'+.7 ••Vl7trl J..Yv (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 CodeeAI shall forthwith comply with those p "visions- Dpie. ?T Applicant- -L-4/ r'n i Warning: Failure to secure Workers' Compensation;cbverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Applipation is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his application. 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspection purposes. /Z" Signy2t �ure (Owner/Agent)%%� Da BUILDING PERMIT PERMIT7'�'} DATE 09130/1" VALUATION `} ) LOT TRACT JOB SITE ADDRESS 81-810 MOUNI 'L1► N VIEW 1eANE APN .. OWNER CONTRACTOR / DESIGNER / ENGINEER 79-49-5 lii:IR.:17,c: N CIRCLE 6,407 PARSONS WAY LA QIJTNTA. CA 92251 BAMCSFIRLD CA Y.k-'W7 (760)772- 2?418 CRLIN 1451 USE OF PERMIT � pA oNcid.3 ('71fv31l.1 t LV L.d:.l.h G u� :.• l'�iL'c' 3'al,f� �iti`1 ilVlif.Fl1�L I'Us:)% �tJ1$ i3l�Cit'it ALL - �i mr•wn r 11:1_. '.-r.vTrr . .+ STnr• f di �i�. S i,V1401 ALl {k(k...t 11-:) 14 ^f. 1.010 P(,JkCAPKf1(J 825 W SIF ttMUk4 ,WC,"f HP''C#kr 91510) `;F GrW'Ir'4i4�J A7'iD*L'► 8'+p'"iti'R" r`87fs• rr^W171.ta:'Y'p�itv'r'x`tR'lT.r Talk aaDxt 'int! 1..� 1 A60piY it Wl� •1.Kda# a tJM' 1.•4pl'p.f 7, �p7d b. L..S.Gt'i :GMvai*1N +.i.,r'Y CXJNSTY U("t 1QN 1171.11 101 -OW -41 S-iJou P1, AN 0441K Ft F %t Agn 3S 14"R, DIXOSIT tui; iCIIANI :N':1%161 161iRll +J X21-t24)k? +1112. J t::l,.frif�'I'fifb"A.�..'I���'ES 1�1•�>>13(J-it2('..gltt0 i'.�ti.3� Ptblh 4f!\►f1t t l4I141S)f#•41f#-(XN) �net�rya Sd (arC iVi0171CW 11M 1 :. If? 10.1.00 -7414*0 $2807 t_fft,aNNO 1,1:h 1411-000-423-M $20.W ART IN !AIi3LW KA$'I 3 - RWRI: '701.000-215wf3(1i) S451.14 'i"1t�: V1+1:01?F''R 1•W/%('T VRV 1,907 (k) S"k 11'x: FUTA1., C())q.%"7VT r10W AND MAN 014FOw%1.4" 77 LES'S PRO-PR'1'l'S •$1,0+'3.04) il,'f)"f� r !I,1{"1;111, I:! �; .�1 I3t1li. W ►4V I 54.4".77 RECEIPT DATE IBY DisFjfJAyEq/�� INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs i Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck Z rp. G(J Exhaust Fans O.K. to Wrap F.A.U. Framing Compressor Insulation - _ CAA Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wali 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 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: l0f�Ai G'�'4 A N e Z-1 S� 0'dUtility e 6� l -,P.O. BOX 1504 Building p� 1I 78-495 CALLE TAMPICO APPLICATION ONLY .. Address s 11tt V E 1A/ � LA QUINTA, CALIFORNIA 92253 Owner �✓� „ ! VAI 6 2S I-ANd` CO - Mailing 1 Mailing Address City L..e1 Contractor /t. b. Address D�%.��/� •Lrl G l.L. Zip ITel. %% -,4, a State Lic. & Classif. . Arch., Engr., Designer Address ko'N /v CX ..r Tel. 2,2 S,3 %7'2 -2941V City G Lic. # ff�a4"l V el. D' CityI 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. . �GNATURE - DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following 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 also 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 7000) of Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a,permif subjects the applicant to a civil penalty of not more than five hundred dollars ($500). l2 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, Buisness and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon and who does such work himself or through his own employees• provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he did not build or improve for the purpose of sale.) I'1 1, as owner of the property, am exclusively contracting with licensed contrac.tors'lox61n struct the project. (Sec. 7044, Business and Professions Code: The Contracfoi's License".Law if does not apply to an owner of property who builds or improves thereon and .who contracts' for such projects with a contractor(s) licensed pursuant to the Contractor's License Law i7 I am exempt under Sec.�� B. & P.C. for this reason •4'- ti Date Owner WORKERS' COMPENSATION DECLARATION I hereby affirm that, I. have a certificate of consent to self -insure, or a certificate of Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No. Company 17,7 Copy is filed with the city. ❑ Certified copy is,hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundredt'dollars ($100) valuation 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. Date Owner NOTICE TO APPLICANT: If, after making this Certificate of Exemption you Should become subject to'theWorkers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. i CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code.) - Lender's Name Lender's Address This is a building permit when properly filled out, signed and validated, and is subject to expiration if work thereunder is suspended for 180 days. I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives -of this city to enter the above- . mentioned property for inspection purposes. Signature of applicant Date Mailing Address City, State, Zip WHITE = FINANCE YELLOW BUILDING: TYPE CON0I.. 9 OCC. GRP. A.P. Number / 4 ^7 — l�f� Legal Description Project Description Lo V -4 d �y It l Z� Sq, Ft. y�� No. / No. Dw. Size Stories 0 Units [ New, Add ❑ Alter ❑ Repair ❑ -Demolition ❑ Rear Setback from Rear Prop. Line ,l 2 � , 01 INSPECTOR 0 Date Permit �r •rte - rri �k F !�•;yrbl J Validation: APPLICANT Estimated Valuation. PERMIT f' .. AMOUNT Plan Chk. Dep. 1000 ,00 Plan Chk. Bal. Const. d y-- Mech. r f Electrical � '",,,,: ►" f,;,��`.�•�.:' w• "Gradln9-. Driveway Enc. r� ` Infrastructure t .C1 i..• TOTAL REMARKS 1 1 ZONE: BY: Minimum Setback Distances: f 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 Validated by: •rte Validation: APPLICANT PINK = BUILDING DIVISION Coachella Valley Unified School District P.O. Box 847, Thermal, CA -92274 (760) 399-5137, Ext. 235 7"hic Rnr Fnr Mai irr I J.. r ­ Iv DEVELOPER FEES PAID AREA: AMOUNT: RCPT N: CK M: CASH: QJI7•IA1.S: DATE: CERTIFICATE OF COMPLIANCE (California Education Code.17620) Project Name: Date: September 13, 1998 Owner's Name: Towers Land Phone No. 760 772-2848 Project Address: 81-810.Mountain View, La Quinta, CA 92253 Project Description: Dwel l i na - Si nal a Fami l v Home APN: 767 480 008 t M Lot Vs: Type of Developmen Residential XX Commercial Total Square Feet of Building Area: 4624 Sq . Ft . Industrial 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: --- /—/3— C/ 1 Signature: ****w�.**,r*««*•,►r,r..r.+t«.,t*•r•r.+►,t,r«#**.*r*+r*•:*r**w..,►w*r*..**rw*,r«r.,►* SCHOOL DISTRICT'S REQUIREMENTS FOR THE ABOVE PROJECT HAVE BEEN OR WILL BE SATISFIED IN ACCORDANCE WITH ONE OF THE FOLLOWING: (CIRCLE ONE) Education Cod_ a Gov. Code Project 17620 65970 Approval Number of Sq.Ft. '4624 Amount per Sq -Ft. $ 1.93 Amount Collected $ 8,924.31 Agreement Existing Not Subject to Fee Prior to 1/1/87 Requirement Note: • v By: Foch "Tut" Pensis, Assistant Superintendent Administrative Services Administrator in Charge 11 q t Certificate issued by: Marcel a Valdez Signature: _____Ta__cil sties Clerk Section 66020 of the Government Code asserted by Assembly BW 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. T44 PUBLIC WORKS CLEARANCE.LETTER FOR CUSTOM HOME LOTS - - Dear Builder.- l Prior to issuance of a building permit, 'you will be required to obtain, clearance from the.- Public he Public Works Department for one, or more, ofthe following: 1. Verification that rough grading. is complete; and the, pad elevation certifications �a prepared,"by a licensed surveyor, or 'engineer; are on file in the Public Work's Department. _ Verification that infrastructure improvements and other required tract -improvements are complete, or sufficiently advanced to warrant building permit Issuance:, ;` Y` .3. Prepare an engineered grading plan that provides for on -lot storm water retention; and have it checked and approved by the Public Works_ Department . • Tract 26524 (Estancias) ' -• `��r ` 1A • �.` - y '`-_ rte'" i ` , ,n' • - y - ..fe • Tract 26769 (Mountain View Estates_) 4. Prepare an engineered grading plan that provides for building -'pad grading accordance with the existing soils report and tract 'grading plan;. andy'haye checked and approved by the Public Works Department. • Tract 28034 (South -Valley Estates) fi A FOR INTERNAL USEBY PUBUC WORKS DEPARTMENT Y " COMMENTS: ti- .. sem. TRACT: 2 -7 6, 5 LOT PUBUC WOWS A TH TION ATE ^ * r F:IPWD&T0OCS%FORMS%PW CLEARANCE LEMRtzs'. + r + 4 r ` _' - .� . , �. a T.:4•. .'�'i. � "'' ;%!?:y�"