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SFD (0308-319)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 --h Exp. Date 81129:3 BMC f' �> Q8t � 1lit r /Date k- 1' r ' 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). y' 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. ( ) 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,PLli�i1�3 Policy No. L A, (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, I shall forthwith comply with those provisions. /Date.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 ori 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 tepid ding. construction, and hereby author zi a representatives of this City to nter upon the above-mentioned property for inspection purposes. II /Signature �(Owner/Agent) Date1 ^11-, -W BUILDING PERMIT PERMIT# r MATEV Y �.. VALUATION.' LOT - �� - �' cf TRACT � JOB SITE (� �y 7PNADDRESS $1„ M,15-"•� �D � `� 773-•14"27 .�T,II�'},i9..I�AY .. OWNER '4%.; CONTRACTOR / DESIGNER / ENGINEER ALSC`ELaC`i1T,,.. JO)71EsiiF;DtS.11C11E_DLtS.I.t3lT3I7 G° 355-552 8UWRa'I21'.a131� � '.. 33-S5K �i 7 c1+Ai�1i� AVE. PALM D1r.�:F'T' CA 92:211 PALM DESERT' Qk 922"11 60)360-2301 r USE OF PERMIT ��."5�C:11:..E F,%N M,Y }aVifFXI;,TNf r 2169 S.F. SF6 , PERMIT VOES NOT IA3'CI.,UDE B.L-OCKWAL4 POOL/SPA =' OR DMEWAYAPPROACH (: • �j t TRACT C0140'rRUCT163I SF' r PO CMP IO '. 261.00 Sp GARAC1DCARKAT $31,00 SP XSIM .1.5.' D COST OF CV.1V•fURVC No - 1.3116M.60 PF-R—My LY'�".:t� 3'Cfl /iYiltkRy t>N'PitLIC 1'iCAI "M. . ' A.01 -000 0.51-$a P1Ji14 CHECK F'&1, 101'000439-319 $632.011 ME DEPOSIT 101.00i1^ 39-318 -V`250100 MECHANICAL. FEZ 10L-000-421 -000 MECTRIICAL KE M-000-420-000 SIU04 PLUMBINIQ;«'1=r. 101-00"19-000 STROAI€3MPTiON FE : RUM -101.000.241-QOO $13,17 ORi DINO A'k.E. 101-000-423-000.,$15.00 '.GV>;iA,PFit 1M'` eE �7�i05,f50 PRECISE PLA.14 �11 -000-441 -345 .'` r ,R PDX. r SUIP"r 7 -AL E.t.�1,. '31RUMION AND P'T:.R,WC1 CK - /1 jj LESS PRE -P10) I _4 LTJ u -$250.00 110 PnM- T FEES DUE NOW JAN , 2 0': 2004 CITY OF LA QUINTA FINANCE DEPT: RECEIPT DATE BY; f DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs d Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck — d 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 O POOLS - SPAS BLOCKWALL APPROVALS 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 O 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) .T P.O. BOX 1504 Building[[ L 78-495 CALLE TAMPICO Address J^/S��w.`3��L� �ti L:4A,f,11144P1<GLAQUINTA,CALIFORNIA 92253 Owner A I" C C,/ L� r `1 BUILDING: TYPE'CONST. OCC. GRP. Mailing ,t A`dgress a� "S ,` �''A�7P, i�.rd_l✓1'w'� (L�' - f A P Number � % � — / �/ �I '- C,t 4LI CityZip / % C /.. /~ l -'5-4-z %` 1 tf Y _" f / Contractor 4(0 7070 B�eA s�rr APPLICATION ONLY t � f✓ j Legal Description_, 07 Project Description 1r/1� Q -y State Lic. City 8 Classif. �'�/ sem: Lic. # Designer mid I9 � ��. /LL UJA ,y� Address Tel. City( Zip ( State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of D(ivision 3 of the Business and Professions Code, and my license is in full force and effect. 1 \ \ y \ i\,_ SIGNATURE%T- 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 permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). ( 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 I I, as owner of the property, am exclusively contracting with licensed contractors to con- struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law 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.) i ] I am exempt under Sec. B. 8 P.C. for this reason 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 n Copy is filed with the city. O Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) valuation or less.) I certify that in the performance.of thg 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: It, after making this Certificate of Exe1nption you should become subject to the Workers' Compensation provisions of the Labors Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY Ihereby 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. 1 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 Sq. Ft. %� ! No. No. Dw. Size Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ itimated Valuation PERMIT AMOUNT Plan Chk. Dep."—=— Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side/S.e a _ Line FINAL DAT Issued by: III Al 11, f0a&IM 1. UUJ Validated.:: IT Y OF LA QUiNTA Validation: FINANCE OFPT WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patiostwalkways, residential additions under 500 square feet, detached accessory structures (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile homes. It has been determined that the above-named owner is exempt from paying school fees at this time due to the following reason: EXEMPTION NOT APPLICABLE This certifies that school facility fees imposed pursuant to Education Code Section 17620 and Government Code 65995 Et Seq. in the amount of $2.14 X 2,169 S.F. or $4,641.66 have been paid for the property listed above and that building permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued. Fees Paid By CC/Valley Independent Bank - Joseph Birdsell 'Check No. 301829 Name on the check Telephone 760/360.2301 Funding Residential By Dr. Doris Wilson Superintendent Fee collected /exempted by ron MCGilvrey Payment Recd so -00 • $4,641.66 Over/Under Signature c NOTICE: Pursuant to Government Code Section 66020(d)(1), this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified above will begin to run from the date on which the building or installation permit for this project is issued, or from the date on which those amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier. NOTICE: This Document NOT VALID if Duplicated Embossed Original - Building Department/Applicant Copy - Applicant/Receipt Copy - Accounting CERTIFICATE OF COMPLIANCE Desert Sands Unified School DistrictEl v�l�sc moo. �q� 11 47950 Dune Palms Road ¢ BERMUDA DUNES r Date 1/20/04 La Quinta s CA 92253 HO RAN ANWELLS LSMIRAGCf � INDIAN WE 25378 (760) 771-8515 PALM DESERT �NS y • " INDIO O Owner Alice Esqueiz APN # 773-144-027 Address .35-552 Summerland Ave Jurisdiction La Quinta City Palm Desert Zip 92211 Permit # 0308-319 Tract # BLK 111 Study Area Type Single Family Residence No. of Units 1 Lot # No. Street S.F. Lot # No. Street S.F. Unit 1 51555 Avenida Navarro 2169 Unit 6 Unit 2 Unit 7 Unit 3 Unit 8 Unit 4 Unit 9 Unit 5 Unit 10 Comments At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patiostwalkways, residential additions under 500 square feet, detached accessory structures (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile homes. It has been determined that the above-named owner is exempt from paying school fees at this time due to the following reason: EXEMPTION NOT APPLICABLE This certifies that school facility fees imposed pursuant to Education Code Section 17620 and Government Code 65995 Et Seq. in the amount of $2.14 X 2,169 S.F. or $4,641.66 have been paid for the property listed above and that building permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued. Fees Paid By CC/Valley Independent Bank - Joseph Birdsell 'Check No. 301829 Name on the check Telephone 760/360.2301 Funding Residential By Dr. Doris Wilson Superintendent Fee collected /exempted by ron MCGilvrey Payment Recd so -00 • $4,641.66 Over/Under Signature c NOTICE: Pursuant to Government Code Section 66020(d)(1), this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified above will begin to run from the date on which the building or installation permit for this project is issued, or from the date on which those amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier. NOTICE: This Document NOT VALID if Duplicated Embossed Original - Building Department/Applicant Copy - Applicant/Receipt Copy - Accounting 4 Certifica.te'of Occupancy Iworoan7m OF9� r Building & Safety Department This Certificate is issued pursuant to the requirements of Section 109 of the California Building 'r Code, certifying that, at the time of issuance, this structure was in compliance with the . provisions of the Building Code and the. various 'ordinances of the City regulating building . construction and/or use. a BUILDING ADDRESS: 51=555 AVENIDA NAVARRO Use classification: SINGLE FAMILY DWELLING Building Permit No.: 0308-319 ,j _ Occupancy Group: R-3 Type of Construction: VN `` Land Use Zone: RC FOwner of Building: ALICE ESQUEIZ `... °., 4_ Address: 35-552 SUMMERLAND AVE City, ST, ZIP: PALM DESERT, CA 92211, - ., . ; .. A ` ^ " '. a _, • • ' - , f+' ` s = By. STEVE TRAXEL y - ,Date: 01-11-2005 5 m Building Official,. i i, POST IN A CONSPICUOUS PLACE . ' Bin # CI of La 3B City Qulnta Building at Safety Division Permit # P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Project Address: S• S' Ij N� c ?,z e� 0%%mer's Name: A. P. Number %7 3,•- q ti_ Address: J Z j 9 Leal Dcscription:(jt Z, V a City. ST. Zip- 'ContractorX Gj , Jc- !s /���u !lv 7c�r�(�� x Address:-` FG�� �J L o,_4 , L, '/� Project Description: Z City, ST, Zip: �iJ C �G7 /��i1 / , x ,� c "? Grp isL 0/,,/s A, Telephone: 70 T A State Lic. # 2 q 3 City Lic. #: Arch., Engr., Designer. Address: City, ST, Zip: X Telephone: State Lic. #: _ - `" Name of Contact Person: Construction Type: Occupancy: Project type (circle one): New Add'n Alter Repair Demo Sq. Ft.: # Stories: # Units: X Telephone # of Contact Person:["Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Rec'd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Plan Cbcck Deposit Amount Structural Cala. L, Reviewed, ready for corrections r K Truss Cala. Called Contact Person Plan Check Balance Energy Calcs. Plans picked up Construction Mechanical Flood plain plan Plans resubmitted Grading plan Y' Review, ready for eorrectionsrssne Electrical Subeontaetor List Called Contact Person Plumbing Grant Deed Plans picked up S.111.1. H.0 -A. Approval Pians resubmitted Grading IN HOUSE:- ''' Review, ready for correcti0f1sne Developer Impact Fee Planning Approval Called Contact Person �� A.I.P.P. Pub. Wks, APpr School Fees Date of permit issue / `2 1 1 Total Permit Fees 3/2 �I IS Pw-��,;,su� PrrP^'.V�• ���� ix� st'f ,3 P /VL