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LICENSED CONTRACTOR DECLARATION
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 ih full force and effect.
License # Lic. Class Exp. Date
75 4M
Z
.� ,� 1
Date Signature of Contractor r
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:
( ) •1 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.
( ) I 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.
CTM�i�G Yf,Y'� l
(Thi ection need not be completed if the permit valuation is for $100.00 or less):
1 certify that in the performance of the work for which this permitis 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 prowsjons of Section 3700 of the Labor
code, all fo with comply wit�einsDate: +Applicanf._Warning: allure to secureallorkersompensation 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; & shalt, 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 repf�sentatives of this City to 'enter upon
the above-mentioned prope for iAspection purposes. t
Signature (Owner/Agentl - Date
PERMIT #
BUILDING PERMIT 99419-,.11
DATE VALUATION LOT TRACT
JOB SITE
ADDRESS 40-72;1 C601"IRR111.1..1.,' APN
OWNER CONTRACTOR 7 DESIGNER / ENGINEER
r11FOlP1 IV- 1t�1U'.-�k S.01A A*F 111X � _ ! ¢,�,. ¢1 CY'�:NISCT'i.L(:�."���IJON'pvy��•�
S ,y 1. 'Ll�f.�:f!i.i4.�i HILLS 436651 PASE.O +.:S+z+l.\,�JK IWC./
1...C1. (' U11,171 -A CA. x;+2251 INF)11. IN W)"Is"s CA 92A"6
P7i:►(i`,33:�-;114 ;'.t�S.•� g�;rr�
USE OF PERMIT �.
it•E� �it3.S�i'�'l�'�f.. Au�:7 �'tt�aty '
2,04 SQUARL FOOT ROOM �VA:Wfff0ld
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s
{rRS'4I M, -.h •' w"D #"UIT 611N:' �J!`L�iW`0`QDYfI•�h{"dA•4A!' Y:O' dJLLN !'kD
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PLAIN t,"HEC:13:.E.f3. _ ! (} t-i,HI(i•�%39-J t ii ad i l.1 �
(�il°d�"t'ttl,lt:'1'3f.'+N f`i''`,F; ih"ik �7ri!t{)-�t.�•1.1(�1 �'171_'Ikl ;i
tr^tlf, C't.t�lii, ice, 1t?j.-vitt"<:;2aj-.(sfrt�• ��i'�.l.ii
3`fitt �F3t'N}+,r1`1+ 1N f1if�- 4tL'x`tiir 100'' 40-241-(11�t3 i,g`�
S B-'ftYt'!tE-R.i'l ► 1s;,59,,UCT)ON AhDP _.,AN {_.'"�01(,. 7. 7W
`S9� I.ES
T xTr91L ll'R11 A4. 01"14,1KIN PHTE N0W 524271.$s
RECEIPT DATE BY bATE FINALEDINSPECTOR
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
Exhaust Fans
O.K. to Wrap
F.KU.
Framing
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
BLOCIrZWALL APPROVALS
POOLS a SPAS
Steel
Set Hacks
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
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
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)
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 8/24/99 APN # 769-362-014
No. 19240 Jurisdiction La Quinta
Owner NameLeonard H. Spitzer
No. 80-721 Street Cherry Hills
City La Quinta Zip 92253 Study Area
Permit #
Log #
Tract #
Lot #
Type of Development Residential Addition
Comments
104 sq. ft. room addition.
Square Footage 204
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:
Residential Addition 500 Sq Feet or Less
1 W4 D161
This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of
0:00 X 204 or $ 0.00 - 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 N/A - J & J Construction Telephone ..
Nameon the check
By Dr. Doris Wilson -
Superintendent
Fee collected /exempted by Juanita Green Exempt
Check No. N/A
Signature
NOTICE: Pursuant of Asser B"' 3081 (CHAP 549, STATS: 1986) 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 date'on which the building or installation permit for this project'is assued or on which they are paid to the District(i) or to another public entity authoriied'to
tolled them on the Distnct('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
LICENSED CONTRACTOR DECLARATION '
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 Businessand
Professionals Code, and.my License is in full force and effect:
License # Lic. Class Exp. Date. .
743878• B 1131/19!
Date - 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).
O 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:
O 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 issc:d.
() I 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 carver & •policy no, are:
Carrier Policy No.
IDT
(This section need not be completed if the permit valuation is for'$100,00 gr less).
O I certify that in the performance,of the work for which thiB permit:is issued,
1 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.
Date: Applicant,
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,.1ndemnify
& 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 1$0 days from date of issuance of such.
permit, or cessation of work .for 180 days will subject permit to cancellation.
I certify that l have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent)
Date
BUILDING PERMIT PERMIT)
9998 -ISS
DATE VALUATION 1.60 LOT TRACT
JOB SITE
ADDRESS W721 C3 ERRY iIJ,>1.I,$
APN 769-362-014
OWNER
CONTRACTOR'/ DESIGNER / ENGINEER
LEONARD H SPrrLM
J di: J CONSTRUCTION
80721 CHERRY HILLS
43651 PASEO CORONADO
I:A QUINTA CA, 92253
2260-
INDIAN WELLS CA 92260,
(760)333-1109
(760)333-1108 CBL# 5572
USE OF PERMIT
RESIDENTIAL ADDIMION
2N SQUARBFOOT ROOM ADDM;0N
CUSTOM CONSTRUC!'TON -204.00 SF g
��
EST== COST OF CONSTRUCT' ON
15, IAC
PERMIT FEE 9U1fMIIKARY • - •
PLAN CHB K FES ` 101-000439-318 $111.15
CONSTRUCTION FEE 101-000-418-000 $171.00
me igAmca FES - 101400,421-000 121.30
BLFCIRICAL FES ` =101400424000 $2214
mom MOTION FEB - Row, 101-000-241-000 $1.59
Y
SUB -TOTAL CONSMUMON AND PLAN CHECK
$327.38
LESS PRE -PAID FEES
$0.00
TOTAL PERMIT FEES DUE NOW
$327.M
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR