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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.