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9801-074 (SFD)
C/) (V Cn W O :D M r— Ou) 'W tiR1�- ozr- �0 _J Z co LO N OC\J U Q 11 — Lo F2 0 LL O_JQ mVU O li 0) I'llZ C6 Q J 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 CI'1h-. 12/3108 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: (X) I, as owner of the property, or my employees with wages a's 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). W I am exempt qnder Section B&P.Cff r his rjeason ,/Date : r Signature of Owner .f =•' �_ ---- 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 Policy No. IV -kA}'; 43,0 00 96 (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 forth i omply with those p dV1 ions. •� ✓Date: A 2-34PPlicant Y-^►" "'.o ""� Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000', in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his application. 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for 'hs ect•on purposes. /Signature (Owner/Agent) Date BUILDING PERMIT PERMIT93�-�3�$' CONTROL# DATE VALUATIONy, �"T.3t69.it) LOT TRACT JOB SIT ADDRESS SI - 4.96 AV���{VIM E rLWWXI..� OWNER CONTRACTOR / DESIGNER / ENGINEER J(„JSV, R00(-.1QQ42P.C`(Y1r.A. owl fEat l Cvuc MR)C.'•A 92:111 (7e+(1i:4 ^31 1 rRf,ff USE OF PERMIT SPD Y 51�C�^ PrC�I+�Ii' i�©I::3 lv�•11 1'1�iC P.C.;1��.�L31;rr•JI:IS. VS/�iJ..A.S r1li, lyti�lJ`.. 1'I;1'3�s � CRE '10101 1014 0f+' ISSUANCE OF SAME PLAN `I 1'k+F., `' 9 �� LIA JAN 7 2 3 1998 TRACT C ONSTRIJC .I'IGN1 1. 1(i.fA .,F t'C3iZCMIATIO 102.00 SF (JARAG61 At'{ )C -PRT i (i.{3{'t'Sk 4TY 3 a TA P"s:'B'W'211Y�. 7.6:r vJ �os a•i.a*1! 'r1:.wil.'i>i�b4v���,, LiY'�i C.ONfr"['RLiC?t'OW11:E: 101-000-4.18-000 54c! ) lat:.A2d'17H8CKYEE WI -(!t -4`39,'318 Mi i';4IrVOCAL FUE 101 -WO -4211010X) . S40.50 S.H4.37' PI9r�:3ltlN{ '.Ir'twE 143.O(k)-419-.000 St'►a()Nt !4I TYIIN.t�ET>-kh'80'D '�101,.'�k)1���-74111-p(ff3l0 V. .1 0ct.ftt'W,1011-33 'vt RA,s`l.t?Fjt^T(s3W.1--M "00-443-342 $iRtttr.� 101-000-141-345 St' `r<.��'f!1, t t iV� � �,� IC'"1'I(`tni �1;4�Frrf') R i .�pN C tpf?1 cK ' P2,4(9(ytl(�) 0 AE TO s°At VCR Al U F Q ,8' Dil,I:+a NOW RECEIPT DATE BY i %r DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APP OVALS MECHANICAL APPROVALS Set Backs/ Underground Ducts Forms &Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck ' Exhaust Fans O.K to Wrap I F.A.U. Framing Compressor Insulation Q qF Vents Fireplace L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath - D II - InA�.__L��at__h_ _ Final Final t' 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 /f/ Heater Final Water Piping (7 Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral /� r Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test _ 2 Z 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) Desert Sands Unified School District Notice: 82-879 Highway 111 Document Cannot Be Duplicated Indio, CA 92201 619-775-3500 CERTIFICATE OF COMPLIANCE Date 1/22/98 APN# 773-081-011 No. 16532 Jurisdiction La Quinta owner NameCoachella Valley Housing Coalition No. 51-455 Street Ave. Carranza City La Quinta zip 92253 Permit # Log # Study Area Tract # Lot # Square Footage 1210 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 1.84 X 1,210 or $ 2,226.40 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 Cashier's Check/Bank of America Telephone Name on the check By Dr. Doris Wilson Superintendent Fee collected /exempted by Ellen Patino Payment Received $2,226:40 Signature =IZ() ' Check No. 2006714095 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 rolled 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 ATTORNEY - IN - FACT AGREEMENT I/We hereby appoint COACHELLA VALLEY HOUSING COALITION, and/or any of its authorized agents as my/our attorney-in-fact for the purpose of executing any notices of completion, waiver, of liens and/or executing contracts with subcontractors, and/or release of liens and/or handling building permits relating to that certain real property described below. . All that certain land located and being in the County of Riverside, State of California, described as follows: LOT 7 BLOCK'68 OF UNIT 6 OF SANTA CARMELITA AT VALLE LA QUINTA, AS SHOWN BY MAP RECORDED IN BOOK. 18, PAGE 63 OF MAPS, RIVERSIDE COUNTY RECORDS. D Date -- /5 q7 Date Jose Rodriguez Cota I Myra Estela RodrigueiJ BOX 1504 APPLICATION ONLY Building 78-495 CALLE TAMPICO AddresSc/' rIS00 `i(h,Ak)2A _ LAQUINTA, CALIFORNIA 92253 Owner , N P Mailing / City Zip_, Tel. � ress Zip State Lic. City & Classif. I Lic. # Arcn., tngr., Designer Address Tel. 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. SIGNATURE 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). 1J 1, 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 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 contractof(s) licensed pursuant to the Contractor's License Law.) 1! 1 am exempt under Sec. B. & P.C. for this reason Date -Owner,I r WORKERS' COMPENSATION DECLARATION Ihereby 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 r7 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 thq 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 1 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 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 sof this city to enter the above. mentioned property for inspection purposes. Signature of applicant Date Mailing Address City, State, Zip .DING: TYPE'CONST. OCC. GRP. Number :7 -75 ' 091 - 011 I Description ~� L I,T r` &y Ar' i oto t r Ict Description l� Sq. Ft. No. / No. Dw. Size Stories 1 Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ 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 Setback from Property Line FINAL DATE INSPECTOR Issued by: Date Permit Validated by: Validation: WHITE = FINANCE YELLOW = APPLICANT PINK a BUILDING DIVISION ql�