RER (0106-034)' „LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that l'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
f 6708 5 B flit 088 1 /2(
Datee,J _g Signature of. Contractor
F—. 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
performance of the work for which this permit is issued.
(XN�� I have and will maintain workers' compensation insurance, as required by
S ction 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.
ACCORD 46 WT1'. f 3�494f9
(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,
4-•1 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 I311'forthwlth comply with those provisions.
D-.-. Applicant Ed-
Na—ming:
d .a—ming• 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 Qulnta, Its officers, agents and employees.
2. Any permit Issued asa result of this application becomes null and vold 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
corredt,,l,agree to comply with all Clty;"and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for Inspectloh,.`pyrposes.
Sig lure (OwnAgent) -•. 4E.7 M r^� • �- Date
=`BUILDING PERMIT + PERM T#
Y
DATED.I."; VALUATION LOT ; �.I."; � TRACT
JOB SITE r
APN 1
ADDRESS
- S 1AMINTAIN VIEW"L'A NIP
�? ,
OWNER-
CONTRACTOR / DESIGNER / EN (NEER -,:
W1.7 MOfi:FMIRO1i.
CON`•'P3.'RUf :' 1,014 DMON SY"38:3 IA", N- C
81 -0 1 5MOUITTAM"VIEW LANE
P, 01 BOX §218
LP, Q7.1111` . ('A 92253
;tom QCTMT'A I (Tfix 1225
in. mill 5 83 0
USE OF PERMIT
.a
.. 4
pFly q y��,,pp e'�pp qqyy•�;.•� �ry.yyy�+q�
.9.'�XrI'efE.1"'!'rIA L S1�ri.Y1SRJ.JEL
PATIO CONVERSION 1`1i14,f10 i j7
01► ' C0.1 t'UM
PLAN t;3)IECK, FIZZ f ID3 -•OW-439.5) 6
M "3'RtN -f_gi18-000fi�$399,50
s
1i%`.z 1 a;t S °A1d SdLF� 101-060.421-01DO $50,00
0.3
TUMBIAN10FRE 103-000-419.1000 ' - • , WIN'.
ST1if"X(I !ogO";'1f:3fm"FEIK. I..0 101-000-:u1 `i oo
.R.
JUN - 8 2001
f
(M-7 &f A3_ C 3�i��::tat"`p��'F(14'�ff� bT" 'cf-rFC�
1.
0ad0l
RECEIPT
DATE , / f
7
9Y
DAT NAL D
INSPECTOR
t f
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
Q— '_0 _
Exhaust Fans
O.K. to Wrap
Framing�f
Insulation
—G
_
F.A.U.
Compressor _
Vents
_
/ �{
C
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wali Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall -Int. Lath
/U—/610 r -A-4-A—, i/
/ Gam(.
Final
/!2
Final
l G ZO Z
POOLS - SPAS
BLOCKWALL
APPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. 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
COMMENTS:
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)
F ll�vlh�
Bin
Quin City of Lata
Building 8t Safety Division
P.O. Box 1504, 78-495 Calle Tampit:o
La Quinta, CA 92253 - (619) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address: - 15 Paan<kq V�£-{,j
Owner's Name: ' Ls PA W-AL'� fti
A. P. Number: 7 (o 190
, QD
Address:81-SIC, M o14f YBI tJCw
Legal Description:
City, ST, Zip: LA Q019TA CA 9225
pp
Contractor:
Address:
Telephone: 3 8°S C
7 9
City, ST, Zip:
Telephone:�d
7 s 3 9
lc-zav
State Lic. # :
City Lic. #:
Arch., Engr., Designer:
Address: V2, 23 D4Q• N 44D -
City, ST, Zip: CA
Telephone: 2''�xxt
ne: 5 S
State Lic. #:Project
�
Name of Contact Person:
Construction TYPe: Occ uPa nc Y•
Pro1e ct (circle one): New ,
tYPe�cir Add
n
Alter Repairai
r Demo
Sq. Ft.: II # Stories: # Units:
Telephone # of Contact Person: 2. 5s S
Estimated Value of Project:—/ 00, � --
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Z
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections0,5/6,Plan
Check Deposit
2
Truss Calcs.tiMO,
Called Contact Person
Plan Check Balance
Title 24 CalcsW
Plans picked up
q' It 0(
Construction
Grant Deed
Plans resubmitted
Mechanical
School Fees
2" Review, ready for correctionstissue
Electrical
G �.
Subcontactor List
Called Contact Person
Plumbing
Planning Approval
Plans picked up
S.M.I.
Pub. Wks. Appr
Plans resubmitted
Grading
H.O.A. Approval
''' Review, ready for corrections/issue s
Developer Impact Fee
Called Contact Person
A•I•P•P,
Date of permit issue
Total Permit Fees
Coachella Valley Un' 1, School District
P.O. Box 847, Thex inal, CA 92274
(760) 399-5137, Ext. 235
This Box For District Use Onl
DEVELOPER FEES PAID
AMA:
AMOUNT: RCPT w
CK k CASH
INITIALS: DATE
CERTIFICATE OF COMPLIANCE
(California Education Code 1.7620)
Project Name: Date: June 7. 2001
Owner's Name: Pete Morrisroe Phone No. 771-3593
Decrp. Project U)JXft Addition to pxi.sti ng Single Family HnmP
AddresTroject jpl1Y&M)tft R1-81 5 Mountain Vi slat Laile
APN: 767 4Rf1. nu Tract #: Lot #'s:
Type of Development: Residential XX Commercial Industrial.
Total Square Feet of Building Area: 1,114
Certification of Applicant/Owners: The person signing certifies that the above information is correct and makes this statement
under penalty of perjuryand .timber represents that he/she is authorized to sign on behalf of the owner/developer.
c,
Dated: �� ��� I ' Signature:
tr,twt,t,r+r.wt+ewww,►,rtww*,twwtwrrwtwwsestrsA*►w,►rrwwwiwts,►,►wa,►,►f,►w,►t,tw,►,►i,►,►rsw♦
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
17620 65995 Approval
Number of Sq.Ft. 1,114
Amount per Sq.Ft, $ 3.34
Amount Collected $ 3,720.76
Building Permit Application Completed: Yes/No
Agreement Existing Not Subject to Fee
Prior to 1/1/87 Requirement
Note:
By: Foch "rut" Pensis Assistant Sggerintendent Administrative Services
Administrator in Charge
Certificate issued by: Marcel a Valdez Signature: I '
Facilities Clerk . OF F4S
NOTICE DAY PERIODPROTES1 OF FEES AND STATEM
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 appU¢able Isw, this Notice shall
serve to advise you that the 90 -day protest period in regard to such Fees or the validity thereo4 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 Certillcate 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 nil fees that were paid to obtain this Certificate of Compliance.
Rev. 09/27/99
ISPEC7INSPECTION SERVICE
REGISTERED INSPECTOR'S WEEKLY REPORT
JON-TANDY
37630 Medjool Ave.
Palm Desert, CA 92211
Office (760) 772-7192
Fax (760) 772-7193
Pager, (760) 776-3338
TYPE OF
INSPECTION
PERFORMED
❑ REINFORCED CONCRETE ❑ STRUCT. STEEL ASSEMBLY ❑
❑ POST TENSIONED CONCRETE ❑ ASPHALT ❑ OTHER
❑ REINFORCED MASONRY ❑FIRE PROOFING
JOB LOCATI
oinvout
REPORT SEQUENCE NO.
T UCTURE �
PERMIT NO.
/V� J
D T�V 3 O
DAY OF WEEK
MATERIAL DESCRIPTION
ARCHITECT
I N.CJ
_ l (
HRS. CHARGED
`
EER 1
ASSISTANTS
HRS. CHARGED
INSPECTION
DATE
GENERAL SUB
CONTRACTOR G . S CONTRACTOR
6_p�
`
UOWI,
(,L)
O
Egob 3�
E
! COPY SENT TO CLIENT O
CONTINUED ON NEXT PAGE ❑
PAGE OF
CERTIFICATION OF COMPLIANCE
I
'll HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MV
:KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE
NOTED. LHAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED
PLANS. SPECIFICATIONS. AND APPLICABLE -SECTIONS OF THE
iGOVERNING BUILDING LAWS.
IGNURE OF REGISTERED SPECTOR
A
( _ _1:ZA b 6, (+:74q
TE OV REPORT REGISTER NUMBFR