0005-237 (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
CN U Professionals Code, and my License is in full force and effect.
C) M License # Lic. Class Exp. Date
11� Lu_ 291?2218 13 0$131l2�
oZ t -'gate - f 7 Signature of Contractor
o '� J/
: U coo OWNER -BUILDER DECLARATION
LU w I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ n -License Law for the following reason:
Z_ ( ) 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
LO
O N ` Date Signature of Owner
rn
Q WORKER'S COMPENSATION DECLARATION
> z I hereby affirm under penalty of perjury one of the following declarations:
U) � O () 1 have and will maintain a certificate of consent to self -insure for workers'
X w L= compensation, as provided for by Section 3700 of the Labor Code, for the
O � Q performance of the work for which this permit is issued.
m Q C) ( ) I have and will maintain workers' compensation insurance, as required by
O U Q Section 3700 of the Labor Code, for the performance of the work for which this
rn — permit is issued. My workers' compensation insurance carrier & policy no. are:
�t Z Carrier Policy No.
oo 5 STATE FUND 229-00 UNIT 0004493
�CY
J
(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
wofJ� ers' compensation laws of California and agree that if I should become
sdbject to the workers' compensation.provillons of Section 3700 of the Labor
ode, I shall forthwith comply with, those-pro�visio.ns.
Date: ' �`�! Applicant"'
Of"
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
• correct. I agree to comply with all City, and State laws relating to the building
i construction, and hereby authorize representatives of this City to enter upon
the above-mentioned prope rty"foriinspection purposes.
'i
Sigfiature (Owner/Agent)%' �-✓'tet--� `" Date
~
BUILDING PERMIT PERMIT#?i
DATE VALUATION LOT TRACT
Z�'�SS1.14}
JOB SITE
APN
ADDRESS .
4i. l��%i�.. i ���. �
a
774-081�1t�
OWNER
CONTRACTOR/DESIGNER/EN (NEER
STAH.i GIff MMAC1;i MMT E 9C
WhIIAM RUSSML Si.CMS
110 BOX 3578
56900 JACXWON ST '
PA't M DEM'r CA 92211
THBR 1IAL CA 92274
(760)3�99a1200 C$LO 1954
USE OF PERMIT
MOLE F`AIALY DVM LI.dN
-
SPD- PE,#:.f><!IT Dogs NOT INCLUDE BLOCK WAL U OR POOL
TRACT CONSTRUCTION 1,4 9.00 SP
QAItAG JC.AR.PO-;tT (SW) 10,172.98
5 FT. WOOD FZNCE 200,00 V `
ES'.1T141A rRD COST OF C:f)I:§1MUCUON
$8,381.10
PFRAM FEE SMWMA.RY
CONSTIRUC ION FIEM 101.000.418.000 $390.00
PLAN CHECK FEE 101-000-4.39-316 $495.01
�
MECHANICAL. FEE 101.000.421=000 $53,50
X1XCTR.1CM, FEL 101-000-420.000 $129.20
PLUMBINO PER 101.000-419.000 S110175
STR.OR0 MOTION FEE - RESID 101-OW241-090 $8.34
GRADING FE Le 101.000.42.1.000 $20.00
DLYEL OPER IMPACT PES $1,907,00
PRECISE PLAN 101-000.441-345 s100.00
IEEE DEPOSIT 101.000-439-310 .$7s0.00
SU13-IMAL CONSTR.UMON A14D PLAN CHECK
$3,414,50
1MV PRE -PAD) r. •G �
4250,00
TOTAL FI WY KE KS DUE NOW
RECEIPT
DATE
By,!�
DATE FINALED
INSPECTOR
- —
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
zUnderground
Ducts
Forms & Footings
Ducts
Slab Grade
WReturn
Air
Steel
Combustion Air
Roof Deck
77——cup
Exhaust Fans
OX to Wrap
O
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
BLOCKWALL APPROVALS
Final
POOLS - SPAS
Steel
Set Backs
— $ 7
Electric Bond
Footings
Main Drain
Bond Beam
b — (, p—W7 S
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 APPROVALS
04
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)
COMMENTS:
L
6005-.,2-31
Building
53 Aq
Arlrlracc
t
T41y� 0 "
P.O. BOX 1504
-495 CALLE TAMPICO
�4Ld.L�UINTA, CALIFORNIA 92253
t
APPLICATION ONLY
rof f~'h� BUILDING: TYPE'CONST. OCC. GRP. R�
A.P. Number
Tel.
1771 . 147 a Legal Description
Project Description
Tel.
/Z0
State Lic.
City
& Classif.�9_?/
Lic. #
Arch., Engr.,
Designer
/—a
fl
l>1 1 4_-_—
Address'
41
Tel.
0
Cit Zi State
City
4.0 p� Lic. #
LICENSED CONTRACTOR'S DECLARATION
I herebgffirm that J am licensed under provisions of Chapter 9 (commencing with Sectio99
7000)-o�f,.Daiyvi�s-iioo+n';3 of,the Business and Professions Code, and my licensefis I full force rrd
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,Susiness 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)
1; 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.)
1'1 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.)
V] I am exempt under Sec. B. & P.C. for this reason
Date = r Owner
r°
WORKERS' COMPENSATION DECLARATION
I her y affirm that 1 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'7 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 or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
Ihereby 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 sof this city to enter the above-
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
Sq. Ft.t r. ® NO. ! No. DIN.
Size t "� Stories 1
New'A Add ❑ Alter ❑ r Repair ❑ Demolition ❑
n
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
AMOUNT
a
,lY i �jit�
A
t
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 by:
Validation:
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
a
Notice:
Document Cannot Be Duplicated
Desert Sands Unified School District
47-950 Dune Palms Road
La Quinta, CA 92253
760-771-8515
CERTIFICATE OF COMPLIANCE
Date 5/25/00 APN # 774-081-012
No. 20476 Jurisdiction La Quinta
Owner NameStarlight Management INC. Permit # 0005-237
No. 53-490
City La Quinta
Tract #
Type of Development
Comments
Street Avenida Carranza
Lot #
Single Family Residence
Log #
Zip 92253 Study Area
Square Footage 1409
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
2.05 X 1,409 or $ 2,888.45 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 CCNalley Independent Bank/William Rogers Telephone')
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Mary Ann L. Bor a
Signature
• f
f.c
Payment Received ,,-"$2;,888.45
Check No. 216412 : . k
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
Certificate of'Occupa'ncy
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
ollowing:
BUILDING
ADDRESS: 53-490 AVENIDA CARRANZA
Use Classification:
SFD
Bldg. Permit No.:- 0005-237
Occupancy Group:
R 3 Type of Construction:
VN
Land Use Zone: RC
Owner of Building:
STARLIGHT MANAGEMENT INC.
Address:
P.O. BOX 3578
City:
PALM DESERT, CA 92211
By:
STEVE TRAXEL
-- 's 'l
Date:
11-16-00
Building Official
POST IN A CONSPICUOUS PLACE