9706-147 (SFD)U)
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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. -_ � n:"".t,,
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:
( ) I, as owner of the property, or my employees with wages as their sole
compensation, mpensation, 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).
/ateam exempt under Section B&P.C. ,for this reason
ate "+ ,e..•.�en= Signature of O000'wne,'1�.�.p
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).
V 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 he'workers' compensation provisions of Section 3700 of the Labor
Qode;-4shall forthwith comply with those;proyisions.
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.
BUILDINGPERMIT .PERMIT# CONTROLk
DATE VALUATION. LOT !1'1lkf►-� TRACT 1 O
2 4 Si77; 1'i9,24. t5 11K V1.l f5
JOB SITE I APN
ADDRESS :1.940.1s.NrCN10A. CARRANZA
OWNER CONTRACTOR/DESIGNER/ENGINEER
1,kS.i.kr�.`..1.y4.�4::�i�:::%�iA��Y.,�.ii.�.�MMIMIC
$ 45701 n1:014ltOE 91'S1`9 1`9 0
c (760)347-3157 crit #i
USE OF PERMIT
Tis
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 purpose
s
. R
/Signature (Owner/Agent)- _ .••'^' Date
tii�t� -:%(":!hart 1 13L'?jl,`, N01' (NCI,(K19 k10WK WAM,8 OR 1*f,PC~L PLAN
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PLAN
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77,369.20
4 XV.04
J U L 2 4 1997
! ()TM, t'EltNOT FEKS 011N N0%V
,t \
ECEIPT I DATE i BY / 1 DATE FINALED INSPECTOR
INSPECTION RECORD
A,.
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 8
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wail Insulation
Condensate Lines
Party Wail Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final 3
POOLS
-SPAS -
BLOCKWALL APPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground PI . 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 4
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
�,�lG�� 'r;>
n O/j
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)
q -70(o - 14
P.O. BOX 1504 APPLICATION ONLY
Building d 78-495CALLETAMPICO
Address t/ � /�A7 r—J 4�,A1,X,LA OUINTA, CALIFORNIA 92253
Owner -011 , _ n
Address
BUILDING: TYPE'�CON?ST. OCC. GRP.
7
A.P. Number / 7J — l 1(o5 — 0/0
Description
VProject Description
AEF'
City �l Zip Z� Tel.��� y/
State Lic. City 3
& Classif. Lic. #
Arch., Engr.,
Designer
Address Tel.
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
t.
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effec
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 rile 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 Caw 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
orimprovement 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 or 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 amezG/�pt Zer Sec. B. 8 P . r this reason
�► n/�4 a
Dat Owner
WORKERS' COMPENSAIJQN 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
r) 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 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
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. No. No. Dw.
Size Stories Units
Add ❑ Alter ❑ Repair ❑ Demolition ❑
tstlmatea valuation
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOT
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 from Property Line
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated
Signature of aQplicant Date
Mailing Address Validation:
City, State, Zip
WHITE = FINANCE YELLOW = APPLICANT
PINK = BUILDING DIVISION
Coachella VaIIey Housing Coalition
Plaza 1, 4S-701 Monroe Street, Suite G., Indio, CA 92201 —
TEL: (760) 347-3157 FAX: (760) 342-6466
if F
ATTORNEY-IN-FACT AGREEMENT
INVe 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 15 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.
e 7'�
Date /AlIferto A. Perez
0 &2L-X�
Dat Maribel Durazo
Desert Sands Unified School District
Notice: 82-879 Highway 111
Document Cannot Be Duplicated Indio, CA 92201
619-775-3500
CERTIFICATE OF COMPLIANCE
Date 6/26/97 APN # 773-165-010
No. 15721 Jurisdiction La Quinta
Owner Name Alberto Perez Permit #
No. 51940 Street Avenida Carranza
City La Quinta
Tract # B58,VLQ5 Lot # 15
Type of Development Single Family Residence
Comments
zip 92253
Log #
Study Area 113
Square Footage 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
Fees Paid By oc/Bank of America/T.D. Neal Telephone '347-3157
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Pauline Pearson
Signature „ A; a PQ A " n 6^4,
Payment Received $2,226.40
Check No. 2003378700
10TICE: 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
bove 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
ollect 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
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:
Use Classification: SINGLE FAMILY DWELLING
51-940 AVENIDA CARRANZA
Occupancy Group: R-3 Type of Construction
Owner of Building: ALBERTO PEREZ
Building Official
VN
Bldg. Permit No:: 9706-147
Land Use Zone: RC
Address: 52175 AVENIDA NAVARRO
City: LA QUINTA, CA., 92253
By: DANIEL P. CRAWFORD JR.
Date: 7/31/98
POST IN A CONSPICUOUS PLACE