9807-075 (SFD)LICENSED CONTRACTOR.DECLARATION 1
I hereby affirm under penalty of perjury that I am 'licensed under. provisions of
Chapter 9 (commencing with Section 7000) of Division 3 of the Business and ,
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
f 743025 t3 �a' fif 11/30/99
,Date �7 ;'� Signature of Contractor
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.
(,) 1 have and will maintain workers' compensation insurance, as required by
Section 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.
317401113 tul"ID 1440.125-93
(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' compensation provisions of,Section 3700 of the Labor
Code, I shall forthwith comply with those provisions f
Date:
Applicant—
Warning:
pplicant Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees..
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
thabove-mentioned property for ihspection,purposes.
VSignature (Owner/Agent) A J `� Date
v /-
PERMIT #
BUILDING PERMIT
19897.07$
DATE / VALUATION $40.7G'9.4li LOT TRACT LLA, -2 J7
1
JOB SIT91
ADDRESS 79-325 CE.�.4ZINO
APN 769-660.017
OWNER
CONTRACTOR / DESIGNER / ENGINEER
JIMJOAlvt'virANL. SS
it;AE;14IN 1.I0MRS
46350 GC?[. EN[= LN
78-080 C,AL.LE ESTADO, 2ND I+T.,OOR
PALM U.I Sfi121' 1.A 912260
LA QLfINTA CA 92.253
(760)771-2567 CW, 5,107
USE OF PERMIT
.903LET'AIMILY WRUNG
,I -D - PlaWi T .i r-112-, NOT INCLUDE 1 CLOCK. i?dt LLS Olt �':'G'DO L 1
• r
Aln
CUSTCM CONSTRUCTION 4,780,00 3F NOVo5
1998
1'URC,:-tvilIvrio 982.00 ,SFS
.,1TY ®e
LA QU1NTA .
3
S
u
AESTI.iLLV[ E.D COST OFCONST.. UCTION
400,769.40
i?ylTrRMIT FE.0 SUM.MYOW
C-ON3TI2UCTION I-I&B 101-000-118-000
Vt..,AN C PECK' FF
1'- ED..POSIT itJ1-000-n319-31$ �I,il(TiJ.ftt1
till i7rt3.A3�11CAL i':1" 101-000-1421-000
'ELEC."i'KICAL F'k% 101 -WI -4204000 5�l.4S
KII rkM 4 t I=1xIi 101 -OW -419-00 [ g2r J HiQ
S,T1iCJxdC'I:M0111O,M1; X13-,12:I:ISH) 1.01-000-241-000
Ci12E'iDlNG FIX, 101-000-4D-060 �21i.taii
IN.E"!`dAS`iRUC i`URF, £'lid• 2,25-1100-443.342 Sf:,Q{lt3.Gt1
f+•'RT 1Td PITRUIC PLACPS - K.F.'S1 703.0-255-0,0
S ,JR4Cf1 A(. C)MSI2?A'?10N ANT) ILrN.Ci:C ,
$30,532.95
LESS
-S%00v.(x)
RECEIPT
DATE
BY
DAT INA D
INSPECTOR
t17
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 Ali
Roof Deck
C.
Exhaust Fans
O.K. to Wrap'3
_
F.A.U.
Framing
Compressor
Insulation
t
C
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
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
Electric Final
Waste Lines
6 r
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
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) •;Z/_-
w
Building
Address
c&ty/ 4 4 "
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Owner sl /
J4 1. .k a
Mailing
Address ' "J'(� '� GD i�► �Ud �/%
City Zip Tel.
01
Contractor �y(
Mill ry//1 / //.AC'
Address
Zip 17-71 - 2Sfie%
State Lic. / City
& Classif. `�43 Lic. # S
Arch., Engr.,
Designer
Address Tel.
CityI Zip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Secllon
7000) of Division 3 of the Business and Professions Code, and my license is In full force and
effect.
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5.Business and Professions Code: Any city or county which requires a
permit to construct, atter, improve, demolish, or repair any structure, prior to its 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
Diviston 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).
I-] 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. 11, however, the building
or improvement 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.)
( 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 contractors) licensed pursuant to the Contractor's License Law.)
1'7 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
Ihereby affirm that I 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
n 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 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.
Date Owner
NOTICE TO APPLICANT: If, after 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
I hereby 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 properly for inspection purposes.
Signature of a0plicant -Date-
Mailing
ateMailing Address
City, State, Zip
tool- d�S
APPLICATION ONLY
ILDING: TYPE'CONST. OCC. GRP.
1. Number 7(pq' 66-0 - 017
1al Description LOT LIJe
eject Description ' i� //
GO'J`TA c('- ZTG 2 4 J Ac0f3S
Sq. Ft. /, No. No. Dw.
Size r/,y(% Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
PERMIT
AMOUNT
Plan Chk. Dep.
-• , pht� ---�
Plan Chk. Bal.
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 C u
G tiP�
Validated by:
Validation: JUL 1 Aad
WHITE = FINANCE YELLOW = APPLICANT
PINK = BUILDING DIVISION
Poe OVC6
City of La Quinta
Developers Project Approval Form
Prior to the issuance of Building Permits for the project listed below, the following Departmental
clearances must be obtained. Please return this form to the Building and Safety Department only
after approval. Contact applicant for resolution of conditions preventing or delaying approval.
Project: 1 Single Family Dwelling (Plans in Bldg. Dept.)
The Citrus Club, Lot 1, LLA 98-277
Applicant Contact: Peter Jacobs, Marvin Homes, 771-2567
Application Circulatio Date: Jqt 5
Date
Community Development Department
Christine Di Iorio, Planning Manager Date
Public Works Department
Steve Speer;,- Senior Engineer
- Building and Safety Department
Mark Harold, Building and Safety Department Manager
Health Department
Fire Department
Schools Fees Paid
Date
Date
Date
,/,-, 1-1�
D to
Date
CCU 1?cd
City of La Quinta
Developers Project Approval Form
Prior to the issuance of Building Permits for the project listed below, the following Departmental
clearances must be obtained. Please return this form to the Building and Safety Department only
after approval. Contact applicant for resolution of conditions preventing or delaying approval.
Project: 1 Single Family Dwelling (Plans in Bldg. Dept.)
The Citrus Club, Lot 1, LLA 98-277
Applicant Contact: . Peter Jacobs, Marvin Homes, 771-2567
Applicatio /Circulation ate:
Community Development Department
Christine Di Iorio, Planning Manager
Public Works Department
Steve Speer, Senior Engineer
Building and Safety Department
Mark Harold, Building and Safety Department Manager
Health Department
Fire Department
Schools Fees Paid
Date
Date
Date
ctt5,8Ia-5
Date
10���1G�
Date
Date
Date
Notice:
Document Cannot Be Duplicated
Date 10/29/98
No. 17933
Owner NameJim & Joan Wanless
No. 79-325
City La Quinta
Desert Sands Unified School District
47-950 Dune Palms Road �]
La Quinta, CA 92253 1
760-771-8515
CERTIFICATE OF COMPLIANCE
APN # 769-660-017
Jurisdiction La Quinta
Street Cetrino
Permit #
Log #
Zip 92253 Study Area
Tract # Lot # Square Footage 1
Type of Development Single Family Residence No. of Units
Comments
1780 sq. ft.
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:
Under Mitigation Agreement
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to Mitigation Agreement in the amount of
628.00 X 1 or $ 628.00 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 Cashier's Check/Peter Jacobs Telephone
Name on the check
By Dr. Doris Wilson
Superintendent y
Fee collected /exempted by Ellen Patino Payment Received `i $Q8:00`��
Signature d - �7C
Check No. 082758
IOTICE: Pursuant of 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
bove 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