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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
Date 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:
(Y 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 (Seca 7044, Business & Professionals
Code).
I%) I am exempt under Section B&P.C. forthis.reason
Date .f�'.s't Signature of OPBF
fir'^'
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.
(This section need not be completed if the permit valuation is for $100.00 or. less).
( 1 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 t4workers' compensation 'provisions of Section -3700 of the Labor
6ode;rl-shall forthwith comply witbftse, rovislons.
✓Date:/=f�-� ' pplica�ntl,.+,
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant -to.;
any permit issued as a result of this applicaton agrees to, & shall,.indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for,inspection purposes
iignature (Owner/Agent) / Dat4s e'
BUILDING PERMIT PERMIT# CONTROL#
G
wo"115262
DATE �,.y VALUATION 7' 9.Z� LOT 17 TRACT T;58, VI_Qi
Y
t00
JOB SITE
ADDRESS .51- 4t1�' I�� IDA Ct0U&NNIZA
APN 773-165-008
OWNER -
CONTRACTOR / DESIGNER / ENGINEER
Aft. 1.GOBEIRT0 P0%,CE
� 1ATIER; Pa11T1t.,DER WITT MAIC,
INDIO CA 92201
(760)347,.157 t:;BLY
USE OF PERMIT
ti l� l"f
SSU - PRAM -IT 060 NOT 1NCLt' DIV .i3Lt 4-X lxiALL$ 01Z POOL. PLAN
4 liSi� ►~ k ISI . tPT..f:)1_t(i C18Y 75% FOR. M.IJUI` IX FSSIM Oil' SAME FLAN
4'1Z�ie"`.1' f.i7%11i14lG'TB41V 1,210.130 1i
1,10RCTI%tiilTIO 102.06 SF
OAR-ACI;XUAW/CaRT 526.0) Sl
Zr b't'.t �lt4:<'3i;:D) CWT OF CONN`4'R�JC':i ON
17.369:21:
4'_()N8'iltiJl:l'I�.a'Rf:V13F 101-000-418-000 S540-%
9-18 $p1.14,01
?p''i7 N{r." 4177,(.7 `,. VC R t+0'1 ri(��tp#pr0--114:t`]
1.001- M1421 -OW
t;l.tU'1'4r'd�%i ails .. 1.G1 i)t!-d2tl-,tfifi}} Si16.37
l3LI,1i\4F d1;IC"s.d�fe1; 1.01 -f -M-419-000 $121.50
81-'040 ttiKYr[f1N YG - KF,94) 101-•W-2.41 AM $7.14
t"lt�1i1T1�C1�k . tU]-000-un-.000 4S4,E}FI
►1di�tdi�`�(`►�tfC�'1�J1zl�.f�i11! :�J.S-Cri10-�i4�-3/13 $1,"t'1;r,�
E,(1,142' PLAW !f.)1-iK►f1()•4�11-:145 S'L5.r30
.r
;�t (B—TT;YCAI, C'ON'$$t �2L�G 1"JO ��;ND MAN C'1• E x
$2,{95.00
LESS PRE . WFF
a�� AII, ���;:zMIT a��3?i48 �A1JE'N0VV .
241997
JUL
Pon., e°'s
RECEIPT ..., -
DATE + 7
By
DATE FINALED
INSPECTOR
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
Exhaust Fans
O.K to Wrap
F.A.U.
Framing q
Compressor
Insulation 8
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
BLOCKWALL APPROV LS
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
Encapsulation
Gas Piping;
Gas Test
Appliances
Final
Final
Utility Notice(Gas)
ELECTRICAL A P ALS
Temp. Power Pole
UndergroundConduit OK
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
-Exterior Receptacles
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm) 110,7170
COMMENTS: ��'
l2-
T4'it 4 4 Q"
P.O. BOX 1504 APPLICATION ONLY
Building 78-495 CALLE TAMPICO
Addres 4 44N/ LA QUINTA, CALIFORNIA 92253
Owner ^ /
!G & 4= BUILDING: TYPE'CONST. OCC. GRP.
Mailing '1 -7 / st
Address g e ,(�G1j� D A.P. Number 173 -
City D Zi�n n Tel.0�
L� !/ Legal Description L521 1-7
Contractor Project Description
ress :7 %� �� xf v
Zip ZU� Tel % 73`, ,
State Lic.I City
& Classif. Lic. #
Designer
Address
CityI Zip 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 Business and Professions Code, and my license is in full force and
effect.
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractors 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 (8500).
(: 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
01 oving that he did not build or improve for the purpose of sale.)
I, as owner of the property, am exclusively contracting with licensed contractors to con.
st the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does pply 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.)
t7 I
8 P.C. for this reason
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. 3900, Labor Code.)
Policy No. Company
n 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, 1 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
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 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.
Sq. Ft./ _� C) No. No. Dw.
Size / , Stories Units
Add ❑ Alter ❑ Repair ❑ Demolition ❑
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
AMOUNT
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback ftom Property Line
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by:
Signature of applicant Date
Mailing Address Validation:
City, State, Zip
WHITE = FINANCE YELLOW = APPLICANT
PINK = BUILDING DIVISION
Desert Sands Unified' School District
Notice: 82-879 Highway 111
Document Cannot Be Duplicated Indio, CA 92201619-775-3500
CERTIFICATE OF COMPLIANCE
Date 6/5/97
No. 15607
Owner Name Rlgoberto Ponce
No. 51-900 Street Avenida Carranza
City La Quinta
Tract #
Lot #
Type of Development Single Family Residence
Comments
APN # 773-165-008
Jurisdiction La Quinta
zip 92253
Square Footage
Permit #
Log #
Study Area 113
1210
No. of Units 1
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
v
Fees Paid By oc/Bank of America/Coachella Valley Housing�Telept] ne, 347-3157
_ -
Name on the check
By Dr. Doris Wilson .
r. ,�'
SuperintendentCom.
Fee collected /exempted by Pauline Pearson Payment Received $2,226.40
Check No. 2003318233
Signature ,,(/� y�Lt A Sgt
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
Coachella Valley /-lousing Coalition.
Plaza 1, 4S-701 Monroe Street, Suite G., Indio, CA 92201
TEL: (760) 347-3157 FAX: (760) 342-6466
T1 9 0
ATTORNEY-IN-FACT AGREEMENT
I
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 17 BLOCK 58 OF UNIT 5 OF SANTA CARMELITA AT VALE LA
QUINTA, AS SHOWN BY MAP RECORDED IN BOOK 18, PAGE 63 OF \
MAPS, RIVERSIDE COUNTY RECORDS.
G`-
Date Rigoberto Gallardo Ponce
V
A.
Certificate of Occupancy
City of L.a 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:
51-900 AVENIDA CARRANZA
Use Classification:
SINGLE FAMILY DWELLING
Bldg. Permit No.:
9706-011
Occupancy Group:
R-3 Type of Construction:
VN Land Use Zone:
RC.
Owner of Building: RIGOBERTO PONCE
Building Official
Address: 84908 BAGDAD #23
City: COACHELLA, CA., 92236
By: DANIEL P. CRAWFORD JR.
Date: 7/31/98
POST IN A CONSPICUOUS PLACE