0102-034 (SFD)04
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LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 99 (commencing with Section 7000) of Division 3 of the Business and
Profes5{onals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
}ate Signature of Contractor—
OWNER-BUILDER
ontractor
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.
'( ^) I have and will maintain workers' compensation insurance, as required by
Setion 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.
i-- r
(This section need not be completed if the permit valuation is for1$100.00 or less).
( ) I certify that in the performance of the work for which this permit is issued,
I shall ngt, employ any person in any manner so as to become subject to the
worker�s °compensation laws of California, and agree
.,that if I should become
subject to the workers' compensation,,provisions of Section 3700 of the Labor
C, I shall forthwith comply with tho,se provisions.
te: Applicant
Warning: Failure to secure Workers' Compensation c`overage"ts""unlawf 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 ct
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// agree to comply with all City, and State laws relating to the building
construction, and hereby, authorize rep a)entatives of this City to enter upon
the of ove-mentioned prope tfor inspec lion purposes.
nature Owner/A ent 10,4- �' �` ;.w`�` �-~' Date
r
.5" P% BUILDING PERMIT PERMITN
DATE VALUATION LOT 0102.0.M TRACT
JOB SITE
APN
ADDRESS
A RRAKU
'17441 "15
OWNER..._...
CONTRACTOR / DESIGNER / ENGINEER
L2 C?HARD M.
DVi f',AWWrI LS CA. 92210
(760)345.7266 CS'Lif. 2816
USE OF PERMIT
.?V • PERMIT DOES 110T 040:1.. DE 3LSOC:X 'Pd14%,1,JP00UDRF V SWAY
APPROACH
P�yyi°��y,?,�ArCH `71% PL,&NCHKC4K PER FkRIXIC'3'IaM ICOR I sMIAN'CE OF SAME
7. 1
lyI.i'xPL
TRACT CONSTRUCTION 1;390>i'>fl aid
PSORC1.1d1pAVO S7. CID sp
0 ARAONC APP'OI)VT (;00) 0,800.00
S FT. W06D Falm 700.00 LF
,. "ErUM .'lid? COST 0V COBRUR:E7::M.GH
99 994,10
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CONSTRUCTION ION T'EX.">' '101.000-41 8-000 U",00
K -KN CHECK Yf,?E 201-000.430-318 $131.47
F EX DEPOSITxs 101.000.4.39- 2 8 4230,00
101_000-421-aw �4iL.CnD
-
:R2.,1rCTRICA L ", 101-000-420-000 $1 M.1 S
- �FIt�.Fil#31T�CrP'F3 101-#1 0-4 -000 $11.3.25
S'Pi ONO MOTION F P g - RINZ ID 101 O -?A 1 N00 $9,90
a7yyi€yy::]{�g1.'driA/ttv�t{11. 1 1101-000-423-000
p/ 7� y+g
KII
PRECISE Pf-,,AN 101-000-441-345 �Atr0.013
C` 4�
,1,5UB-'F (YYA1, r ONVRi'FL:ITIO2d AND F'1'.,AX CFMCK
V-3,090.77
W PRE, -PAID REED
_$2 0.00
1.1LYrAb PIMMIT P% KS D14, )W
t2,940,77
FES OU 2.�1
SAT Y W- LA LJOW
RECEIPT
DATE BY / �%I
DATE FINALED
INSPECTOR
S
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
_
�N%/ (
Underground Ducts
Ducts
Slab Grade
ll ll(
Return Air
Steel
_ _ _
_
Combustion Air
Roof Deck
O.K. to Wrap
Framing_
3 D
_
_
Exhaust Fans
F.A.U.
Compressor
Insulation
_ re (
/
5,�
Vents
Fireplace P.L.
6
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath?
Final
Llc-!l `�l
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Final
POOLS - SPAS
BLOCKWALL
AFPROVALS
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
Water Piping
_ rj _
y L�
C_�_
w r
Heater Final
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
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�,�
Encapsulation
Gas Piping
Gas Test
Appliances
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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)
Desert Sands Unified School District
47-950 Dune Palms Road
Notice: La Quinta, CA 92253
Document Cannot Be Duplicated 760-771-8515
Date 2/5/01
No. 21622
Owner NameLeonard M. Meier
CERTIFICATE OF COMPLIANCE
APN # 774-115-015
Jurisdiction La Quinta
Permit #
No. 53-605 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 Mututal Bank - Barbara
Name on the check
By - Dr. Doris Wilson
Superintendent
Fee collected /exempted by Ellen Patino
Signature aLd
Payment Receive
Check No.
Telephone
Y
Received r $3,259.50
/lr-
241403240
40TICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1998) 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
rolled 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
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
Leon
SITE ADDRESS 53-605 Avenida Carranza
APN - - BIN NO.: ' CASE NO.: 2000-380
LEGAL: LOT BLOCK UNIT S.C.@V.L.Q.
CHECKED BY: Greg Trousdell DATE:
i
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%
0
_ l/S- U Z33 4
Consistent with MDG on file (as.applicable
O
MDG filing required (5 filings since 9/3/98)
Consistency w' s eet/surrounding area:
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Other. Requirements:
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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:
Occupancy Group:
SFD
53-605 AVENIDA CARRANZA
R 3 . Type of Construction:
VN
Bldg. Permit No.: 0102-034
Land Use Zone: RC
Owner of Building: LEONARD M. MEIER Address: 77-099 DESI DRIVE
City: INDIAN WELLS, CA 92210
Building Official
By: STEVE TRAXEL
Date: 06-01-01
POST IN A CONSPICUOUS PLACE