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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:
( ) 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 ICode). .
(�y�J 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. fo this re son
Date. / Signature of Owner- n.�
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).
( ) 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 forthwith comply with thos prov si •ns. r /`
Date: r Applicant•�/,�s�:-
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.
BUILDING PERMIT
DATE MilSi1q,yaVALUATION mpWD if go LOT
PERMIT#
910-04
TRACT SJ3e3�R�!�f_{(sA
JOB SITE
ADDRESS 52-62.5 AVENIDAKAmM.4tm+ KI Z.4, AIN %�1.�•.c;�l Ya��J�
OWNER CONTRACTOR/DESIGNER/ENGINEER
Nr:r,`` r g* x.,ggf(r tf�,,c. E�y..;r
V L4,�.c,..i l�,iLl`.lA....,r I- N1 i.a..fV.r.J Ixl..I/.JA.. 44
PO BOX 604
LA QUINTA CA, 1),22,53
USE OF PERMIT
SM
S � . PO iI DOES N0'� INC t M 3�Ti.�:e�,t�.'4�r�i.:L CSR PCO
t Cl'i6 R�Yt �i. l'4�
}`IMACT C%.riwSTM;1CTi.YN
%,541(001 9
P0W?f11PATKP
4.59,00 8F
11-4, AN f I iFf `K 1»"1,
109.tN li.44.11R
ti Fr. Wa ,rt.)D FEWIIE
Jditi.iltil 111 <
. 'I;TIiZ'6'4 :A A'•Y"K`T� 'Ct.4"Ii' R•`1Yli' d"V YP�i'q y"y,, $.AiriM'.'k,ltdD1�.'{
t Cl'i6 R�Yt �i. l'4�
fX)N,%''!'1s0,.''.9'14UN FFE,
lot 00-411"-A)
11-4, AN f I iFf `K 1»"1,
109.tN li.44.11R
!t4t'aftk
0i'coo --121'000
IV; 0,0.,
I -i' a'�L a;��i.S�I
I4i3,nGirv- _0W
3'f,t. M-H).*1 FEE
$116.75
Hi'f,'f at�fC7 41ef41'3'ft }N r f � Y2Tt ; ('r
1111.-(myl-741-(hV
t i2r\I~iRiO FWE
fL.4-000-423MO
"A V10
TJE t1 A'P"ER 13V9t iv1 '1. L:
SL907.imi
PXW..1S.F, VI AN
4.0 R -t A)-441fi 30
$100.0u
ART 4%I WIRIF W W.,tf'ri°i - FU 3)C, 701% -ft A)4 115- 00
$7,41.1
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 fore inspection purposes. RECEIPT
Signature (Owner/Agent)' r.., 5 ` Ae Date •f�' �`�
S'1) tj _'R)TjA!, C Jr'`11r)' f i ,[ 11N4 Vl,Aihi {i;fyy'tF il!Yk�� pp' '2
4250 W
0/
DATE FINALED I INSPECTOR
14:
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings_
Ducts
Slab Grade
�
Return Air
Steel
Roof Deck
_
Combustion Air
Exhaust Fans
O.K. to Wrap
Framing
_ _C
1
F.A.U.
Compressor
Insulation
3 �� . �- ��
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wali Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL P ROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
I I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Linesrte/
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
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
CtT'y
SEP 24 RECD
RC District - Planning Review FormSUILDti� ,
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
Building & Safety as your correction list. Please attach additional explanations as necessary.
APPLICANT: Wally Miles
PROJECT
ADDRESS: Avenida Carranza
APN:. 773-285-014
i
LEGAL: LOT , BLOCK �� , UNIT, S.C. @ V.L.Q.
CVD BY: Greg Trousdell
i
BIN N0:. CASE NO. 99-137 CHECK-DA'TE.
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 —TY
-1 N
COMMENT/CORRECTION
y.v%.,. t13
ELL—
Case logged and number assigned
Verify legal and APN information
5, ,, �cG5Consistent
with MDG on file (as applicable)QMDG
filing required (5+ filings since 9/3/98)rounding
Cbiititte'nty-with-street/sur-(,oundingarea:. OQ�
Colors A-i�
Materials
Architecture .
V0•
OTHER REOUIREMENTS:;
JE
The zoning code, architectural and landscaping manuals, and/or assigned inspector should
be consulted where uncertainties arise. The completed checklist shall be maintained -in the
Building '& Safety address 'file..
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
Date 10/22/99 APN # 773-285-019
No. 19502 Jurisdiction La Quinta
Owner NameWally S. Miles
No. 52-625 Street Avenida Carranza
city La Quinta zip 92253
Permit #
Log #
Study Area
Tract # Lot # Square Footage 1526
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 iethe amount of
1.93 X 1,526 or $ 2,945.18 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 cc/B ofA/Golden State Mortgage Teleph6oe 1=400-821-9028
Name on the check
• +Irk - .
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Juanita Green
SignatureC-I'le"',&
Payment Received $2,945.18
Check No. 2006251179
NOTICE: Pursuant of rembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 9D -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 ofcounty or city plan check application form to district copy for all waivers.
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting
CITY OF LA QUINTA SUB-C,ONTR_ACTOR LIST e;
JOB ADDRESSS2- PERMIT NUMBER 'OWNERBUILDER
This form Shall be posted on the job with the Building Inspection Card at all times in a conspicuous place. On ersons appearing on this list or their employees are authorized to work
on this job. Any changes to this list must be approved by the Building Division prior to commencement of w Failure to comply will result in a stoppage of work and/or the voidance
of building permit. For each applicable trade, all information requested below must be completed by applicant. "On File" is not an acceptable response.
Trada / Classification ::
Contractor
c
,.:::. State: Contractor s la ense . .
Workers Com ebsation insurance
Cit Business License :..
Company Name
Classification
(e.g. A, B, C-8)
License Number
(xxxxxx)
Exp. Date
(xx/xx/xx)
Carrier Name
(e.g. State Fund, CalComp)
Policy Number
(Format Varies)
Exp. Date
(xx/xx/xx)
License Number
(xxxx)
Exp. Date
(xx/xx/xx)
EARTHWORK (C=12)U
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C. f2,
5r`g72-
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CONCRETE -(C.8)-
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C�aeCNDoa NAT'S ►N'S
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FRAMING (C-5)
NC
36 va
c 0
c 2 S- / -/��" 6
s 3 ar,25-303
-
STiRUCT. STEEL (C=51)
MA'SONRY`(C-29)
PLUMBING (C-36)
A 114,m C AS %
7,337,5--7
3 -31 -zoo
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1-26W
L199 k
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LATH; -'PLASTER (C-35) :''
LOA W,5 GO
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DRYWALL (C-9)
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HVAC (6-20)
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ELECTRICAL (C-10)
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ROOFING.(C-39)
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SHEET METAL (C-43)
FLOORING (C-15)
G �J C q k %-
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4>900 ?2-
% 1-30 o
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SEWAGE OISP:'IC-42)
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PAINTING'IC-33)
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571 -97-C-
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CABINETS (C-6)
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FENCING (C-13)
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LANDSCAPING (C-27)
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'217.00
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POOL (C-53)
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76
,_Certificate ,of Occupanc . ,
Cit o fL Q�uinta
Building and Safe�yDepartmefit '
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:. 52-625 AVENIDA GARRANZA
-Use Classification: SFD Bldg: Permit No.: 9910-014 "
:Occupancy Group: R3 Type of Construction: VN Land Use Zone:• RC
Owner of Building: WALLY S. MILES Address.: ' P.O. BOX 604
City: LA QUINTA, CA - 92253,
By: STEVE. TRAXEL
Date:" -10-17-00
Building Official
POST IN A CONSPICUOUS PLACE