0102-233 (SFD)LICENSED CONTRACTOR DECLARATION
U) I hereby affirm under penalty of perjury that I am licensed under provisions of
H Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
C14 W Professionals Code, and my License is in full force and effect.
O =) chLicense # Lic. Class Exp. Date �-
�CY� �r
oZr— Date `', % ` Signature of Contractors ,
CID O
J U �, OWNER -BUILDER DECLARATION
HLU I hereby affirm under penalty of perjury that I am exempt from the Contractor's
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).
Cl) () I am exempt under Section , B&P.C. for this reason
LO
O N Date Signaiure of Owner
rn
d Q WORKER'S COMPENSATION DECLARATION
p ZIr I hereby affirm under penalty of perjury one of the following declarations:
p () 1 have and will maintain a certificate of consent to self -insure for workers'
X W �!-_ 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 L) ( ) I have and will maintain workers' compensation insurance, as required by
O tJ Q Section 3700 of the Labor Code, for the performance of the work for which this
Il 0 Z permit is issued. My workers' compensation insurance carrier & policy no. are:
Carver Policy No.
ob =) STATE FUND 044009026227
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
workers' compensation laws of CF lifornia, and agree that if I should become
subject to the workers' compensation provisions of Section' 3700 of4he Labor
3 Code, I shall forthwith comply with those Prov" ions.
Date: 'Applicant—
Warning:
pplicant Warning: Failure to secure Workers Compens t5 ion 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
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned propertyyf��spection pu rpo 61
Signature (Owner/Agent) .'"✓,=�`;•o--�/ Date ' a
BUILDING PERMIT PERMITN
DATE VALUATION LOT 01(j2,�`�1„3 TRACT
%A091-17-1110
JOB SITE
APN
ADDRESS
-220 AVF.MDA CAMAMA
774-211-0.1.1
OWNER
CONTRACTOR/DESIGNER/ENGINEER
k.,1.. AWRICANHOME BUILDER WC
AU, MAMOAN HOW t`3M.:s3 .WC
PALM DIM -11T CIA 92211
1%Ai.IA17nT.RT t :A -92211
V60)200-0277 C1 VP 6373
.
USE OF PERMIT
4VJ��X, SAM(�
.VY i:i6•a0 `�.'!
Q
31eT2 & ,I 50 tFN X 6° f::O;y UO W 9 & - MERM1T DOES 140T INCYe�i
POOL. Oil Uf1WOM"AY,hPPR(AACH. 48 MASI%'R. PLA, T 17Vt,i�,,
MAR
12 2001
TRACT CO ryyCT9N Iyyoo Ap
A7
1
IQWkA0VC.AP.P0P,T (SF) y
ve LA
rMuVan'm Coa 6J'rci1,r A,63ik•JI, o..r4
IC09,212.ao
PIV C111 X,IK YELI 103 18 $550,64
1t'ifg? DEIPd3 IT 101-000-489-.318 1R .V56.00
MECHANICAL AL WE 102.000-42.1.000 $5$.50
WNC 2 RIC IAI,..l'tYt tf 101.100 !-•4:$�t' -000 $119.65
P#. U MtO1HO FEIR 101-000-419,,000 It IC'A1
STRONQ MO's 101W F13% - RESM 101-000-2A 1-0,00 00.'72
GRA.471'N0 RE 101-000423-000 $?0100
lZf °* 1'"I.CF'i�Ei dAdFtAC'.'1 115E $1,907.00
PFUX119 PIAR 101.OM441-345 $100.00
COUS RUC`i ION P92 101-000-418-000
M311-1.'OTAI, CC1~F.S"1.'�t1,t'C';iTO ,11'11=3 PLAX CUTWX
$3,554.m
E MS
= �,��5�0�.(�0
�P`�RE-PAM.
(vet `y �y FEES
11A�ILL FKMM i�,R'aES D�ll.Cr NOYO'
RECEIPT
DATE
BY
D F AL
INSPECTOR
INSPECTION RECORD
OPERATION j
DATE
INSPECTOR
OPERATION
DATE TINSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings�/Q
/
S
Ducts
Slab Grade
�
Return Air
Steel '
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
Framing
_ _
0 d
S
F.A.U.
Compressor
Insulation
/�
Vents
Fireplace P.L.
Grills
Fireplace T.Q.
Fans & Controls
Party Wall Insulation/�
7
�/� !
S
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
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
Waste Lines
�{ Ll _��
��—
Electric Final
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
_
O /
S�
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROALS
Temp. Power Pole
_ _ _ 0_7
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)
( UY
Desert Sands Unified School District
47-950 Dune Palms Road
Notice: La Quinta, CA 92253
Document Cannot Be Duplicated 760-771-8515
Date 3/12/01
No. 21754
CERTIFICATE OF COMPLIANCE
APN # 774-211-011
Jurisdiction La Quinta
owner NameAll American Home Builders Inc.
No. 54-220 street Avenida Carranza
city La Quinta Zip 92253
Tract #
Type of Development
Comments
Lot #
Permit #0102-233
Log #
Study Area
Square Footage 1787
Single Family Residence 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 1,787 or $ 3,663.35 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 / 1 st Bank - Mark Tuvell Tele F none
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exe ted by Annette Barlow
Signature &Ir
Payment Received $3,663.35
Check No. 58436
VOTICE: 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
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
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 All American Home Builders
SITE ADDRESS 54-220 Avenida Carranza
APN 774 _ 211 _ 012 ' BIN NO:: CASE NO.: 2001-417
LEGAL: LOT 14 BLOCK ' 285 UNIT IL S.C.@V.L.Q.
CHECKED BY: Greg Trousdell DATE:
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
COMMENVCORRE ION
Compatibility Review
/
Case logged and number assigned
Verify legal and APN information
g °
Consistent with MDG on file (as.applicable
e b •G
�� eP4
MDG filing required (5 filings since 9/3/98) P
Consistency with street/surrounding area:
Colors
a 6 M iterials
Mrch tecture
Q�an Gov
/
Other Requirements:
�� C� elk
17 97. Z
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