9906-206 (SFD)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. Clads Exp. Date
ate�3 �!�-'7 � Signature of Conti. actor-�-� r --
OWNER -BUILDER DECLARLTaON
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 pooperty, 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.
( ) 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.
p
(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'--
sub'ect to the"workers' corhpensation proyisionskof Se fon 3700'of the Labor
de-'I`sh 11 forthwith cc - ply6i . tfios royis—lo_ it.
Date: r� - J APpTiQ* t v�•• 4* � ,
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 here�y'au orize representatives of this City to enter upon
the above-mentioned pfopefor inspection purposes. �}
Signature (Owner/A nt) �' ri :� Date(t
PERMIT #
BUILDING PERMIT -
9.91* 116
DATEVjr TRACT
1'.t37` ix jB
SITE
J DDRESS S1-745 z�r�' E:�i �.�>�dF�� tl.l�.�.l1�il'A WA.
APN 7774.24-024
OWNER
CONTRACTOR / DESIGNER / ENGINEER
I n iY �� F� �k IVA 4YdwY1%Ti;�1v
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00P�'}�iT4�)rA
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i1_370.fiVINIDA BERMUDAS
1-54iEKSE3'EVHOA1ERDR.
LAQil191-A CA !#2153
LA. 4rUINTA, CA 93:33
±7fit?�fr:lr'.�tl•�i (::)3t,� 221
USE OF PERMIT
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RECEIPT
DATE
BY �}
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
I INSPECTOR
OPERATION I
DATE
I INSPECTOR "
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air i
Roof Deck
Exhaust Fans
O.K. to Wrap
zil.
F.A.U.
Framing
Compressor
Insulation .
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wali Firewall
Exterior Lath
rp
&—Lo
Drywall - Int. Lath
_ Gg) "
Final
Final
POOLS - SPAS
BLOCKWALL
AP ROVALS
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
Z • ,'d S✓4 57
Appliances
Final
COMMENTS:
-
Final c
Utility Notice (Gas) J
ELECTRICAL AP OVALS
Temp. Power Pole 17
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)
Buildingd^-
Address
4 4 "
P.O. BOX 1504
` 78-495 CALLE TAMPICO
If �t I A, Z 4,, LA QUINTA, CALIFORNIA 92253
i► Ir ISI..; �' N
Mailing _
Address
City Zip Tel.
Contractor r
Address r't
City./ Zip Tel.
�/�C.o r L cn d i e- , - /7 O d
State Lic. City I
& Classif. Lic. #
Designer
,-Address
Tel.
City IZip I State I
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°Busihess and Professions Code, and my license is in full force and
effect. �—}' �'q ...ter �.k_—
SIGNATURE
_ -rSIGNATURE 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' 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.)
II
I, as owner of the properly, 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.)
17 1 am exempt under Sec. B. & P.C. for this reason
Date Ownet
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
F1 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
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 the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions of this permit shall be deemed revoked.
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 a0plicant Date
Mailing Address
City, State, Zip
APPLIC NLY
)ING- TYPE'CONST. OCC. GRP.
lumber
Description*I I. lie ;
:t Descriptions t� D A 41, � �f
f
Sq. Ft.r f f No. No. Dw.
Size �/ ( Stories Units
New10 Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
PERMIT AMOUNT
Plan Chk. Dep. 2 ��
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 DAT
INSPECTOR
Issued b
Date Permit
Validate
-
Validation:
�` SIN
J`
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 applicabitity of compatibility' issues or need
to require the filing of Master Design Guidelines by the applicant. It shall be transmitted to
Building & Safety as your correction list. Please attach additional explanations as necessary.
APPLICANT: La .Quinta Land Partners
PROJECT
ADDRESS: 51-745 Carranza
APN: .773-124-024
LEGAL: LOT 12 , BLOCK 53 , UNIT , S.C. @ V.L.Q.
CK'D BY: Leslie Mouriquand
BIN NO:. CASE NO. 99-7.9 ..CHECK DATE:~'�--
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 I
N I COMMENT/CORRECTION
• .'';,<':'.'` .;).. .,�.ri;•:u .C44�\v�',��:.iy� ..,+.2 �: `1ti:; : .: tiY,4Q�:,tit:l\v. �t'•`j):4,';`,J�^ `L,` ���",\ .. \ ��++��X022: \Vi;`'.."$::: "t'`..•..•..uro.:•":4.�„ti:y,<+ \
�:\:4v,3:?}:w�.; �}h.�$:•4k:2'•ty\.'\;.^4.\. •}: :•;:n}2i�\Cv, x`i:� `4\ ,(. \� ���^h::'••C; �y:.i �%�Y::•.ti.�'.$'•f>�4•t.\ `� �>�
Q♦{,.� {a ,yl,•Q:N ` n\iM1i`''`x', wC� 12 i:�,:h" �� ]i1•4 i^'CC'm ish�A .
''' '' yiiNy__`` T. •: 01"L,` T`'J" .'',''}.^�iwA'`'l ��ih $�i4n{ i`}i'.:.a` ii:`^i�2r�Nv+},WnC,: :v``{'}.tii.4t4.,:,`i1.is^:�,.:�:.'?..\•G•�\�,:>.}�i!ti C'�.:ti $:Out:: \\ itiC:•`.. v.T.`�.
Case logged and number assigned
Verify legal and APN information
Consistent with MDG on file (as applicable)
MDG filing required 15 + filings since 9/3/98)
Cohsistency-with -street/surrounding area: -
Colors
Materials
Architecture
V
®�
OTHER REQUIREMENTS:
The zoning code, architectural and landscaping manuals, and/or assigned inspector should
be consulted whereuncertainties arise. The completed checklist shall be maintained.in the
Building '& Safety address file.
V
Certificate of Occupancy
City of La Quinta
Building and Safety Department
This Certificate issued pursuant to the requirements of Section 109 of the Uniform Building Code,
certifying that, _at the time of issuance, this structure was in compliance with the various ordinances
of the City regulating building construction or use. For the following:
BUILDING ADDRESS: 51-745 AVENIDA CARRANZA
Use Classification: SFD
Occupancy Group: R 3
Type of Constrgction: VN
Owner of Building.: LA QUINTA PARTNERS
Building Official
Bldg. Permit No.: 9906-206
Land Use Zone: RC
Address: 51-370 AVENIDA BERMUDAS
City: LA QUINTA, CA 92253
By: STEVE TRAXEL
Dater 12-30-99
POST IN A CONSPICUOUS PLACE