0001-034 (SFD)R
LICENSED CONTRACTOR DECLARATION
-Ahereby affirm under penalty of perjury.that I am licensed under proVisions.of
9 (commencing with'Section 7000) of Division 3 of the Business and
Pr6iessionals Code, and my License is in full foFce and effect.
License # Lic. Class Exp. Date
B OW31,120(
vDatel':' ?� &,�.Sgnature of -Contract
OWNER -BUILDER DECLARAcr�ION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason: I ;
( ) 1, 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).
1, 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 hav6 and will maintain a certificat6 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.
(k)'ll I have and will maintain workers' compensation insurance, as required by
Section 3700 of the. Labor Code, forthe performance of the work for which this
pe rmit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
GOLDEIN FACU! XNS.
(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' compen'sgtionlprovisions of Section 3700 of the Labor
C As'
,pde I shall forthwith comply with those provisio _A
Date?'Applicant
Warning: Failure to secure Workers' Compdnsatlon coverage is unlawful and
shall subject an employer to criminal penaltiets.and civil fines up to $100,000, In
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building . and Safety
for a permit subject to.. the conditions and . reiStrl6flons set forth ,on his
application.
.1. Each person upon whose behalf this application is made &,each person at
whose request and for whose benefit work is performed under or pursuant to,
—any permit issuedas a result of this ipplicaton agrees,to, & shall, indemnify
&, hold harmless the Cityp .-of, ' La.Quinta, its officers, agents and er6p'Ioye-e-s.'__
2. Any permit issued a result of this'application becomes. -null and void if
.
work is not commenced within 180: days - fr6in,dati of'isSuance of such
permit, 6r�cessation'.oi` work for 18'0'c1a'y$'wiII subject I permit to cancellation.
I certify that I have read this application andstate thatike ab6\i6 information is
correct. I agree to comply with.all City,"and , State la * ws rela . ti n . g?to the. . building
construction, and heieby- a6iliorize represen I tatives,,of this City.t , 6 enter upon
the above-mentioned pro erty. for inspection purposes.
f�'o
Signature (Owrior/Adidrit) L
BUILDINGPERMIT #
PERMIT
0001-104
DATE VALUATION LOTTRA6T�,. .
17 r BLK307 W
ADDRE$ 54- 660 AVY-EiNiiM CAIMV47A
APN
774 - 275-608
OWNER
CONTRACTOR DESIGNER ENGINEER
1,4,r1f T�! AJ%,� M 11
LJ X's --.k 11�� t;Lv.
51-370 BERMUDAS SLUE 1
51-540 EISENHOVVER"M
LA QUINTA CA 92253 -
LA QUIKA, CA 9 253
(760)564-.11004 CRIA 2261
USE OF PERMIT
SWOU FAND(DWELLFNO
SFD-- FIMMUT r*ES NOT MLTJr)E- LALOCK'%NUL OR POOL
TRAM" CM4S'J-1AAJM"1GN 11.01901.00 SF
GAR, kGLY'CARPORT 533.00 SF,
3 FT. WOOD FENCE 200,00 LF
TIMAIATED CIOST'OF CONS'f NIUCT. ION'
CONSTRITC110N FM: 101-000-41MOO $657.00
C"FCK VIE.5 10) 4VOC-4,39-31 8
%tEC11PXNNICJU1711ME 3,13.00
'M RICAL FLT 101-W042"00 109,52
-----Pl-, Lim -of NIN C, f! -EE 1014)00-419-000
M"R0-NOIOINFR-AREYSIT) 0J-000-2,44-0%)
_101-000-423-000
Dt %IFLOPER EMPACT FRE
PRECISE PLAN 401-00"4i-345 $100.00
AR ''1N PUBT-1Q, PLACES -RE 701-000-25 -1000 S10-60
V ME DEA -'O S IT 1014*439-318. 4250.00
CONSMUMONA-11M PUAN Q'I'MCK
FEES.-
.-rZ50-0110
T OTAL-FERMrF M -s' 0111i,, NOW
I RECEIPT
DATEBY
-JDATE
FINALED
INSPECTOR
J.
t W`f
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Slab Grade
_
_
?i 2
Ducts
Return Air
Steel
Combustion Air
Roof Deck
_
4 - 0-
Exhaust Fans
O.K. to Wrap
4-1-2-00
F.A.U.
Framing
-00
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
BLOCKWALL AP ROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings -
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
I
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
Ov
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas) l
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)
COMMENTS:
Desert aauub uwnru Jc„uu, L,�►r,c.
47-950 Dune Palms Road
Notice: La Quinta, CA 92253
Document Cannot Be Duplicated 760-771-8515
CERTIFICATE OF COMPLIANCE
Date 1/7/00
No. 19887 Jurisdiction
Owner NameWilliam Buffet
No. 54-660 street Avenida Carranza
City La Quinta zip 92253
OKRA Pw- Mt�
C�Op�
APN # 774-275-008
La Quinta
Permit #
Log #
Study Area
Tract # Lot # Square Footage 1696
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
1.93 X 1,696 or $ 3,273.28 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/Hazany Coronel Telephone
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Olivia Aguirre Payment Received $3,273.28
Check No. 209540
Signature
NOTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 -fay 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
P.O. BOX 1504
Buildingll 78-495 CALLE TAMPICO
Address - i(Air n No( -_C 4 --lo LA OUINTA, CALIFORNIA 92253
I
Address f ti i
City Zip Tel.
ractor
Address _
City Zip Tel.
State Lic. City
& Classif. tr3I-Ag I� t Lic. #
Arch., Engr.,
Designer
Address Tel.
City Zip State
Lic. #
LICENSED CONTPACTaR'S DECLARATION
j,(hereby affirm that I am,licensed and provisions f-Ehl'tb'r•9.(.commencing with Section
110001 bf Digislon 3 of the`Busriness aAd,Professio Cope, and mvliicense is in"AulI force and%
�..f OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5%,liness and Professions Code: Any city or county which requires a
permit to construct, alter, improve, demolish, or repair any structure, prior to'fts 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
orimprovement 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.)'
I II'
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.)
11 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
Ihereby 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
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 thg workforwhich 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, atter 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 applicant Date
Mailing Address
City, State, Zip
LDING: TYPE'CONST. OCC.-7-74--Z75-006
GRP.
. Number :73u/ ,q Xr� t r ( 7-174-' 2% 5 '0O6
al Description (2 17 C)LK 1-07 lulu 1T
ject Description
Sq. Ft. p No. No. Dw.
Size t Stories zn Upilaw�--
New Add C/" Alter O &1 VJ Demolition ❑
��D S
Estimated Valuation
QUINT,
PERMIT AMOUNT
Plan Chk. Dep. %�' �`,
Plan Chk. Bal. v
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
Issued by: Date Permit
Validated by:
Validation:
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
b
RC District - Plannin4 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
Building & Safety as your correction list. Please attach additional explanations as necessary.
APPLICANT: QORONEL CONSTRUCTION
PROJECT
ADDRESS: 54-660 Avenida Carranza
n og
774-2�5-01-P
=A PN:
LEGAL: LOT 17 , BLOCK307 , UNIT 28 - . S.C. @ V.L.Q.
CK'D.BY: Leslie Mouriquand
BIN NO:. CASE NO. 99-176 :CHECK DATE: �' 3 -i BSD
Inform- the assigned Building plan checker .upori..your._assignment to this case. The CDD
Executive Secretary maintains a log book to track applications andassign case numbers.
REQUIRED ITEM
Y
N COMMENT/CORRECTION
,..:r.v:.. :•: i:v: n,v.... •.. . .. :•�^: ....\K\.:^: Si;,vti,v.. •tin+.: S�.S�i,,\Oi�+,:tii�:'•i: •..Cn„+.
\.....
R. ... C
Case logged and number assigned
Verify legal and APN information
_20MW
Consistent with MDG on file las applicable)
MDG filing required 15 + filings since 9/3/98)
Consistency -with-street/surrounding area':'.
Colors
Materials
..Architecture .
OTHER REOUIREMENTS:'
Ana
It
BY DATE > -3 -0 04 ZI
EXHIBIT
ASE NO. ._....I T 76
The zoning code, architectural and landscaping manuals, and/or assigned inspector should
be consulted where uncertainties arise. The completed checklist shall be maintained in the
Building'& Safety address file.