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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
�Q to 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 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.
X 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' cpm ensation insurance carrier & policy no. are:
Carver . A A-%_ Policy No. 16,- 1316, y_ 0 J
! PT. F_X
(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
sub).Pct to the workers' compensation provisions of Section 3700 of the Labor
Crgde, I shall forthwith comply with those provisions,---,
Date: a*v'. Applicant-
_� 'wst¢
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 haveread thisapplication and state that the above information is
correct. I agree to comply all City, and State laws relating to the building
`c struction, and herd prize representatives of this City to enter upon
I t �bove-mentionhg propert for inspection purposes.
4
;,Signature (Owner/Agent)a�'s "7Y
BUILDING PERMIT PERMIT#
DAT j VALUATION LOT 01.01-118 TRACT
JOB SITE
APN
ADDRESS
OWrNEER-'
CONrTRAA/CjT�OlREQ/�DESIGNER
�j j % �� J��, �y
blf lA'�Y11 1.�41Giir.4.! 14 .W'.if..I,ldi''aFi
'�/fENGINEER
.ioT/l✓i.i6.E9i�13,l'UJ..�VI.I�w.tF.+.6`�6.
'
.i1LNIAN WELLS Qrk 92210
USE OF PERMIT
0O1 clLt FAloM�W Ch i lirf
SEWD - PARM L'i`.' DOES; NOT INCLUDE HLOC K, TWAaG3.lf{=f; GLI'll"IRWE'b4TA Y
APPROACH *75% P:ta► IC:1AFfC K FF,9 RY.DUCTION POR J1,:* JKRCX, OF SAN -49
TRACT CON3TRUCT10N 4�90,00 3F
S
PORCH4PATIO 8`7,6ig
�i.f0
C RAOM14A OXf (SP) 9180 `,00
3 6T. WOOD FXNCtr XW.00 ..ir
WMATPO COST Ole CONSTRUC170H
99,"4-10
A�'A—.i.P37MdLRk34 ��iLt�eit is r.i.l.•1,..�..�.t+
(i`L?NFrrR.UVf10N ITT 103 -ID00418.00iD $63510
PWT CHECK 1¢' : 101-000.419-318 $131.47
FEY, DEPOS'IT 101-0000-439-318 _$250,t"
.�•'
H M 101 -000 -421 -OW $40.00
FUX', RIC',AL F'E1~`.. ; 01 -000-410-000 $114,15
ry-UMBINO a a01-000-414,.000 S.113.23
STRONG MOTION F&,10D•'^1.01.-000.241000 *9190
ORA D)140 VU, "" 101-000-42.3-000 $20.00
DEVE OPRI1. IMPACT ft'l-,
b2L1�t:tf:`6a1,Rs 101-0001 441-34 5 $109.00
i ffB-1XYjr, 4(..'.r, H4MT<?JC°r1 ,M AN13 P1 J146 CM -Ole';.
$3,090.7-",
:s E 30 PR.r PA1D l< r'
4a50.0C
FI -79 06 K,
Ut: AkJ AM t g.
R .4 / r
RECEIPT
DATA�
C)
BY �r `
I
DATE FINALED
INSPECTOR
1 - 0
r/
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
/ d
�l '
Underground Ducts
Ducts
Slab Grade
Return Air
Steel
Roof Deck
_ _
�j �l�`�
;
Combustion Air
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
3
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
-�r��cY
POOLS -SPAS
BLOCKWALL APPROVALS
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
G
Z�ry/O�
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
�_llJ, p
�r
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
�6 •—(T�
Utility Notice (Perm)
P.O. BOX 1504 APPLICATIO NLY
Building 78-495 CALLE TAMPICO
Address 15CS.�A (�� r/a,it 7 LA QUINTA, CALIFORNIA 92253
Owner
J ^J Z- BUILDING: TYPE'CONST. OCC. GRP.
Mailing
Address A.P. Number
City Zip JTel.
�� Legal Description
Contractor Project Description
Address
? "7 _ 4 Ci 1 J);: !9;% 111) ,
City Zip Tel.
i1VAIA,v 41,,--- Pia, iet 00 -Tat
State Lic. City-
& Classif.. a . / Lic. #
Arch., Engr
Designer
Address
Cit Zi State I
y, �)' __ 4 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 I 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 thealleged exemption. Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than live 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 11, 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.)
. 1 1 am exempt under Sec. B. & P.C. for this reason
r1 /
Date' 1- I<-00 Ow7gr,
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. 3800, Labor Code.)
Policy No. Company
r7 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 -of this city to enter the above-
mentioned property for inspection purposes.
Signature of a0plican
Mailing Address_
City, State, Zip_
Sq. Ft. ' /_ C No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
PERMIT AMOUNT
Plan Chk. Dep.
Plan Chk. Bal. f "
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
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, 5�
Issued by: Date Permit
Validated by:
Validation: 1A' 4 !►�
J,a
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
VALUATION
o SQ. FT.
VALUE TOTAL VALUE
I ST FLOOR
SHOWERS I
ROOF DRAINS
2 ND FLOOR
FLOOR DRAIN
SINKS
COVERED PATIO a, �
BBQ/BAR SINK
GARAGE
TRELLIS
A/C
FIRE SPRINKLERS
TOTAL
MECHANICAL
FANS
TRASH COMP.
HEATERS
i
GARB. DISP. 1
COMPRESSOR
OVEN J
EVAP. COOLER
RANGE
APPLIANCES
COOK TOP
REFRIGERATOR
ELECTRICAL
ICE MAKER
DRINKING FOUN
SQ. FT. LIV
WASHER I
SQ. FT GARAGE
DRYER
SUB PANELS
DISHWASHER
MAIN SER.
=� A7mp
FREEZER
PLUMBING
TOILET GAS PIPE FIX TURES
BIDET
WATER HEATER
URINAL
LAV 3
SEPTIC SYSTEM
SEWER
SHOWERS I
ROOF DRAINS
BATHTUB
FLOOR DRAIN
SINKS
KITCHEN SINK !
BBQ/BAR SINK
VEG SINK
TUB/SHOWER i VU N DP -y TRAY
oe
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 2/5/01 APN # 774-115-014
No. 21621 Jurisdiction La Quinta
Owner NameLeonard M. Meier Permit #
No. 53-585 Street Avenida Carranza Log #
City La Quinta zip 92253 Study Area
Tract # Lot # Square Footage 1590
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 in the amount of
2.05 X 1,590 or $ 3,259.50 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/Washington Mutual - Barbara Meier
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Ellen Patino Payment Received
Check No.
Signature &Lt_)1a —W-0
Telephone, _
.n
$31,259.50
241403249
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 Districtfs)(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
RC DISTRICT - PLANNING REVIEW FORM
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 the Building and Safety Department as your
correction list. Please attach additional explanations as necessary.
APPLICANT Leonard Meier
SITE ADDRESS _
APN -
LEGAL: LOT
53-585 Avenida Carranza
BIN NO.:~,� CASE NO.: 2000-381
BLOCK
UNIT
CHECKED BY: Greg Trousdell DATE:
S.C.@V.L.Q. .
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
Y
N
COMMENT/CORRECTION
Compatibility Review
Case logged and number assigned
Verify legal and APN information
77 _ 1� �_
a 3
Consistent with MDG on file (as.applicable
i
MDG filing required (5 filings since 9/3/98)
n
Consistency with street/surrounding area:
t°ve
b
oma
Colors
VkI
°
�v
•/
Z a
o a to ials
flazcct
�GaS
N°
°ns
I e
Q
Other Requirements:
z
Certificate of Occupancy �� � o
City of La Quinta �
Building and Safety Department Of,E°`s
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: 53-585 AVENIDA CARRANZA
Use Classification: SFD Bldg. Perrn'it No.: 01.01-118
Occupancy Group: R 3 Type of Construction: VN Land Use Zone: RC
Owner of Building: LEONARD M. MEIER
Building Official
Address: 77-099•DESI DRIVE
City: INDIAN WELLS, CA 92210
By: STEVE TRAXEL
Date: 06-01-01
POST IN A CONSPICUOUS, PLACE