0201-248 (SFD)LICENSED CONTRACTOR DECLARATION
�- I hereby affirm under penalty of perjury that I am licensed under'prmisims of
H Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
N W Professionals Code, and my License is in full force and effect.
O=) �,� License # Lic. Class Exp. Date
r-CYto
oZ r /Date Signature of Contractor—,
CD 1
J U C:) OWNER -BUILDER DECLARATION
UJ
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
N 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).
c'') () I am exempt under Section B&P.C. for this reason
O N Date ; t Signature' of Owner
rn
' 0 Q WORKER'S COMPENSATION DECLARATION
' p 2
Cc I hereby affirm under penalty df -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
mJ Q performance of the work for which this permit is issued.
Q (� +1 ) I have and will maintain workers' compensation insurance, as required by
d< Section 3700 of the Labor Code, for the performance of the work for which this
11 H'" permit is issued. My workers' compensation insurance carrier & policy no. are:
Z Carrier 1 Policy No.
cco 5 STNTR Nn4D IY7by37M
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(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 tot a workers' compensati� 9ions of,Se Rtion 3700 of the Labor
Code,aI h I f rthwith comply with se Lo.�u i ion
,/Date: f Applicant ��- � (t
i�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 have read this application and state that the above:information is
• correct. I agree to comply with all City, and State laws relating io the building
construction, and hereby authorize representatives of this CitVto enter upon
the above-mentioned property f6r"i7ion pur oses.
% gnature (Owner/Agent) { j -� Da� %�/
BUILDING PERMIT PERMIT# t,
DATE VALUATION LOT V.✓.�p-f ��i' TRACT
13LIK 309 U28
JOB SITE
ADDRESS 54-9 AVJ-Ffi.U)A. ARRAN A
rPN
774-294-0.20
OWNER
CONTRACTOR / DESIGNER / EN INFER
1-4.
PA IMIC HOW,a
PO13Oa"'i.134
'rl56f ACOVaTTR =`+DD.PC! `it`.9, 0 1hrf.0 13
LA QU)N A CA 92233
I AI. �+,�' I;P:Y1MT CA ;M 31
(760)408-3495 C K41 1249 S
USE OF PERMIT
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83.N'OL FAMILY D' ',i., ING
SteF: u P"l"PIMIT i90X,S'i` 0TJN'C'i,;UDF 81=9:'tT3.EbI&A, PGOL OR i;7ktN XWAY
i
t
TRACT CONST.Itti :now a
bIA17,fiQ-91C:4t,RPC'M Y " at i.tict SY
5 Fr. WOOD PENCE 2(0.00 LF
r10RC.1VPJAT10 32.80- 31?
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PRaMTEIM SUMMARY
CON3TRUCTICiX nX, 101-000418-000 ON."
KAN CHECK I .I? IM -000.439--3185610 7
F= DEPOSIT h 101.4=439-3118 439.311 u 42$0.130
MECHANIC ..AIA MY, 101-000-421-000 � IWI
EW TRICAL ISR 101 -MM -20-000 5123.19
PI.,L•3IABJ14GCZlp' 101-000.419-000 3I 18mo
3'I'3IC+I;titP;i MOTION FER - RRSID 1.01-000«241-000 SK18
C:tR4DR40 FLS 101-00"23.00fI V0.0V
PIVELC>PER IMPACT :Ris VA71.00
PM!591tLAI 101-0100.441--345 $100.0a
I'?��.C69UC.".j1CJ9WND PLAIA t .. CK'
$3-58'5. 94
FEB 28 ZQ�� ; ° . rimemer. P FETUS IAT NOW
cr
RECEIPT
DATE/ /
BYe V
D! INALED
INSP O
G
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
. Q Z
Exhaust Fans
O.K. to Wrap
?/
F.A.U.
Framing
,.$
Compressor
Insulation
O
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 APPROVALS
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
I I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Water Piping
o2-
Heater Final
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Piaster
Sewer Lateral
Sewer Connection
3-� –xJ 2�('
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole , OZ-
ZUnderground Conduit
Underground
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) Or
COMMENTS:
'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 2/28/02
No. 22998
Owner NameLa Quinta Partners
No. 54905 Street Avenida Carranza
City La Quinta
Tract # BLK309U28 Lot # 8
Type of Development Single Family Residence
Comments
Construction of 1846 sq. ft
APN # 774-294-020
Jurisdiction La Quinta.
Permit # 0201-248
Log #
Zip 92253 Study Area
Square Footage 1846
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
2.14 X 1,846 or $ 3,950.44 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/Dick Scott Telephone_
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Crystal Scott
Signature
�,;T
y
Payment Received $3,950.44
Check No. 62363
40TICE: Pursuant to 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
ibove 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
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: SFD
Occupancy Group: R3
54-905 AVENIDA CARRANZA
Bldg. Permit No.: 0201-248
Type of Construction: VN Land Use Zone: RC
Owner of Building: LA QUINTA PARTNERS
Building Official
Address:
P.O BOX 134
City:
LA QUINTA CA 92253
By:
KIRK KIRKLAND
Date:
' 8-01-02
POST IN A CONSPICUOUS PLACE