0207-086 (RPL)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.
License # Lic. Class �_� Exp. Date
4 1102
f5ate � Signature"oaf Coyntract���,,,,'"`"`��'""
OWNER -BUILDER DECLARAWTIO.N
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 property, 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.
Se( ) I have and will maintain workers' compensation insurance, as required by
ction 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 STATp FUNj,) Policy No. IMP"
(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, .1 shall forthwith comply with those°p'Yovisions.
s,"Date: 7/11 ,/'i_C-%-APPlicant^t^"
Warning: Failure to secure Workers' Compensati4coverage 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. i
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.war-
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iSignature (OWney.Agent) ,lry' =�^v = ^-°� DateXX 22 ' 6
PERMIT #
BUc._ IL_ DYING PERMIT [ ,f"
ff 0 OW
DATE/ VALUATION �� �ast� LOT TRACT
JOB SITE
ADDRESS 53.0055e'�:�1( A CA"NAr�ii�,.v�,
APN
OWNER
CONTRACTOR/DESIGNER/EN (NEER
XNA+�"�I.'40,
�E:"A',�.,�bAD Cali 92009
C:��.ikL9F, i3 CA 92+00,9,'
(70)730-1431ML-W 1955
USE OF PERMIT
P001:, ANDJOR VA
POi:iLAND:.PA ONLY. 51H.ALL BE rH PLACE PRIOR
TO PTS PLAIITRA INSPECTION. P .006 V..0,UXP "_ T MCWk 1AIR",1'4
1�dC�Y:E3.lwilf�'% iii fr`R�ifitk3T.
POOL ANNOR SPA 00 1.0
`'',I:o"TRO COST OF CSC NITI;R?ExMOR
ITE Km4malty
PLAN f;i RCK M 101 -6W-441 9.,3 3,, 8 $311.90
C"3 STk'' UCT10N ISE. 101.04( 41€ --tail $176.06
MECHANICAL NIC:.AL FFF,.-- POOL 101-000-421-000
I LF,,C'rRICAL IiFy a. POOL 101-000-420-000 00 0.00
11111WlIBINO AM, -- FOOL. '10) -000-419-000 g2'7,Gtf
lk;mlar 16MEN DUES. ;4_0W
CITY OF LAQUINTA
FINANCE DEPT.
RECEIPT
DATE / .: ,v
BYM" //
DAT FINALE
INSPECJJJO
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
Compressor
Insulation
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
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
_L o
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
U
Underground PIN. 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
jSewer 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
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
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CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
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Desert Sands Unified School District
47-950 Dune Palms Road
Notice: La Quinta, CA 92253
Document Cannot Be Duplicated 760-771-8515
Date 4/2/02
No. 23094
CERTIFICATE OF COMPLIANCE
APN #
Jurisdiction La Quinta
Owner NamePacific Trades Construction
No. 53005 Street Avenida Carranza
City La Quinta zip 92253
Tract # BLK 221 Lot # 1
Type of Development Single Family Residence
Comments
ingle Family Dwelling, Tract Construction
774-045-013
Permit # 0203-169
Log #
Study Area
Square Footage 1513
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
2.14 X 1,513 or $ 3,237.82 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 Mission Oak National Bank - Trent Garcia Telephone
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Crystal Scott
Signature
a
Payment Received $3,237.82
Check No. 11665
VOTICE: Pursuant to 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
: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: SFD
Occupancy Group:. R3
53-005 AVENIDA CARRANZA
Type of Construction:
Owner of Building: PACIFIC TRADES CONST
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Building Official
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Bldg. Permit No.: 0207-086
Land Use Zone: RC
Address: 2551 STATE ST #111
City: CARSLBAD CA 92008
By: KIRK KIRKLAND
Date: 11-25-02
POST IN A CONSPICUOUS PLACE