0006-051 (SFD)U)1
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LICENSED CONTRACTOR DECLARATION
l,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
70 10 B 1,2,^'t 10,"31/2(
Date £^ Signature of Contractor
i 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 affirn'under penaltyof perjury'one ofAhe 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:
CarrierSTATE CON, INS FLJ'A Policy No. 199426199-99
(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.l should become
subject to .the workers' compensation provisions of Section 3700 of the.Labor
Code, I�shall rthwith comply withl✓those provisions
Date: j i j 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 authorizerepresentatives of this City to enter upon
the above-mentioned property -for i6pectionn purposes. /r
Signature (Owner/Agent)-- �.,� —.Date��+ /
BUILDING PERMIT PERMIT#
i��.
DATE VALUATION��99 �{{j� LOT' ' TRACT
$8-9,1 -25M
JOB SITE
APN
ADDRESS Z_4 R� mDA mjwAmA
7
OWNER
CONTRACTOR / DESIGNER / ENGINEER
DENY= Y'OV
N0.P.TH-WFzr-S0LnT"i1F FST'I;EVE
W4,MDEEERT CA. 92211
(760)408-3495 CBU 6133
USE OF PERMIT
'IGU FAt. G LY DWMIING
SFD,.PZkM,1T DO&S NOT INCLUDIP BLOCK INALLS OT POOL
TRACT CONSTRUCTION 1,421.00 OF
PORCI IPATIO' 35.00 .SY
0AaItAC4BlCARPOT'r (M 4,800,00
3 F7. WOOD FM4CE 200.00 L
ESTXN A'IM Corr Or CON3"xRUCnov
E9,$.25SO
PIMflRZ'1:.. E'R SiP.iVmw1L
C ONOTRUCTION WE ' 101-000.418-000 $394.50
PLAN CHECK IEE 101=000-439-318 $500.07
MECHANICAL k7E 101-000-421-000 $60.00
1,02ACTP.ICAL ILEI; . 101-000-420-000 $129.24
Pi,UMOINd FEE 101.000+-419.000 $110.75
ORADINO FSE, 1 OI �OOD-423-000 $710.00
DEVELOPER IMPACT FEE $11007.00
PRECISE PLAN 101-O00- 41-345 $106,00
RE DEPOSIT 107�OOt3-439-318 -5:230,00
SUB-` UrAL C0W11W(.fT10W AND PLAN CH Clw
$:3,421'36
LIESS9 PRE-PAD)FE :'
-$250,00
'170TAL DIENOW
sa,171z%
RECEIPT
DATE
BY
DATE FI ALD
60
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Zil Of
Return Air
Steel
Combustion Air
Roof Deck
O.K to Wrap
p_ _
8 ��r—r✓?O
Exhaust Fans
F.A.U.
Framing8
2 3—Oc7
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
�j R
�+I
_
Final /�/� _O�
BLOCKWALL kPROVALS
Final
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
— OO
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:
_
P.O. BOX 1504 APPLICATIO ONLY
(
Building /h� // (1 78-495 CALLE TAMPICO
Address 0.V Q LA QUINTA, CALIFORNIA 92253 � S
OwnerINA C
BUILDING: TYPE'CONST. OCC. GRP.
Add ess
A.P. Number
, Legal Description �"� 16 r
Con_v� Project Description F�
WAAAV
Address... , r 1 ^It A _- . . .
Cit tiL1 Zip l2- IJelyfji�State Lic. & Classif. -�'�� , # b'
Arch., Engr.,
Designer / n 4 A I
1ddress � I SO Tel
City�+� Zip State
l (. i\ r 4 t LIC. #
LICENSED CONTR %O� DECLARATION
I hereby a ifir ' that I aD>=licensed gder rovi n of Chapter 9 mmencipg th ctlon
7000) of D�di11 3 of he Iislnes a P otes5i C e, an my cense ispn f I fb e d
effect. (� ( 1
SIGNATURE1 1 D
OWNER -BU DER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5%,liness 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 thealleged 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 (5500).
(2 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.)
f 1 1, ss 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. & 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
(l 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 hundred dollars ($100) valuation
of less.)
Icertify 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: If, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor 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 it 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 a0plicant Date '
Mailing Address
City, State, Zip
Si .f I- { No. No. Dw.
Siz / Stories Units
Ne\Qb_ _add ❑ Alter ❑ Repair ❑ Demolition ❑
S- I 1111451"W-4-
LICENSED
111 5��2
I PERMIT I l t G�_ I 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 Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
RC DISTRICT - PLANNING REVIEW FORM
This form is to be used by CDD staff for review of single family dwellings in the RC (Cove Residential)
District, in order to determine the applicability of compatibility issues or need to require the filing of Master
Design Guidelines by the applicant. It shall be transmitted to the Building and Safety Department as your
correction list. Please attach additional explanations as necessary.
APPLICANT NW SW DEVELOPMENT
SITE ADDRESS 51-430 Avenida Carranza
APN 773-082-009- BIN NO.: 3`C-� CASE NO.: 2000-231
LEGAL: LOT 16 BLOCK 67 UNIT S.C.@V.L.Q.
CHECKED BY: Leslie Mouriquand DATE: if�
Inform the assigned Building plan checker upon your assignment to this case. The CDD Executive
Secretary maintains a log book to track applications and assign case numbers.
REQUIRED ITEM
Y
N
COMMENT/CORRECTION
Compatibility Review
Case logged and number assigned
Verify legal and APN information
Consistent with MDG on file (as applicable
N/
MDG filing required (5 filings since 9/3/98)
Consistency with street/surrounding area:
Colors
Materials
Architecture
LA
Other Requirements:
PPR
Y
XHIBIT
ASE
Fn RY COMMUNITY DEVELOPMENT DEPT
DATE �—
40.
Desert Sands Unified School District
47-950 Dune Palms Road
Notice: La Quinta, CA 92253
Document Cannot Be Duplicated 760-771-8515
CERTIFICATE OF COMPLIANCE
`723 663'6N517
Date 6/12/00 APN # 773-M-009
No. 20538 Jurisdiction La Quinta
Owner NameDennis Yost Permit # 0006-051
No. 51-430 Street Avenida Carranza Log #
City La Quinta Zip 92253 Study Area
Tract # Lot # Square Footage 1421
Type of Development Single Family Residence No. of Units 1
Comments
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered
patios/walkways, residential additions under 500 square feet, detached accessory structures or replacement mobilehomes. It
has been determined 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
Government Code 53080 in the amount of
2.05 X 1,421 or $ 2,913.05 the property listed above and that building
permits and/or Certificates of Occupancy for this square footage in this proposed project may n6w,.be'issued
Fees Paid By CC/Mountain View Fed. Credit Union/Dennis Yost *teleph6ne
Name on the check
' Y
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Mary Ann L. Borja Payment Received $2,913.05
Check No. 100791
Signature "
NOTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1996) 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 sssued or on which they are paid to the District(s) or to another public entity authorized to
collect them on the District('s)(s') behalf, whichever is earlier.
Collector: Attach a copy of county or city plan check application form to district copy for all waivers.
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting