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9707-155 (AR)LICENSED CONTRACTOR DECLARATION I_hecebytafArm 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 effdlft:�- License # Lic. Class Exp. Date " f ' t Date / ,Signature of Contractor:�Pr�"�°� �✓y'r""`' OWNER -BUILDER DECLARATION 1L, 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). () 1. I am exempt under Section B&P.C. for this reason Date �l 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. w3v 5 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. (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 wor ers' compensation laws of California a'ndagree that if I should become sybject to the workers' compensation prov ions of Section 3700 of the -Labor ode,,I,,s all fovthV�h comply with ose�y s,00nns. `• ~ yDate:l� /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 k, 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 alCity,>ntl State laws relating to the building construction, and hereby authorize representatives of this City to enter _upon e above-mentioned property7forinspection purposes-+��j` Signature (Owner/Agent) }'� �1��'~-��<-'s�Date ✓`�% f r/ PERMIT # CONTROL # BUILDING PERMIT-:§���;; -5647 DATE "1/3f)/97 VALUATION S 4,1013," LOT TRACT JOB SITE ADDRESS - iS i£isCa . d �(bl�Ci .dire rA�.fi �@, APN 643-1 j -007 OWNER CONTRACTOR /DESIGNER /ENGINEER f �J� 17 t.^17OR RtR TOL{.is CONSTRUCTIONii' . 28211LJ1A RD 43a.09 i Vi�3LYiR s 44i✓7/0AA4L`YyU` 41 9 V[1 PR{.kBN,i)4i' .i CA, 922,60 f76IX)' 46-7'767 C831ff 7649 USE OF PERMIT z�i'i �l'>~f't.f1�,.t41iIV'7� Uu�tc+�c�i1, a �Ah s :rf:a.. P1,,AfrfCtft.?CKf7VZ &Z% $4.1 ='IUCAL 1nw lio 000-470-00 + ! irAtF�tfv�rk£E 101-010"—.19-000,s3"�qd �_ J �s��1�t'�+rr� t��i�l•7 �1��-O�ttT-423>t��+ ��.�a.;� U 0 � a ` �+q p (•��?C �+ti t nxri 7� x�,r r �v/��/ dA;Vyyi. da{'ri ,• 16 . y�.�i ��•,, ����t�gy C�'+ gyti ,��i pp.1iiN!'-'h ++'�.. a�ppli',�, / RECEIPT DATE BY DATE FINALED ' INSPECTOR OPERATION DATE INSPECTOR OPERATION DATE TINSPECTOR 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 61 F.A.U. Framing A7, Compressor Insulation IVents 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 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 Notice: 82-879 Highway 111 Document Cannot Be Duplicated Indio, CA 92201 619-775-3500 CERTIFICATE OF COMPLIANCE Date 7/30/97 No. 15896 Owner NameGeorge Cruz/M. Vandenabel No. 46-875 city La Quinta Tract # Street Highland Palms Dr. Lot # APN # 643-191-007 Jurisdiction La Quinta Permit # Log # Zip 92253 Study Area 123 Square Footage 323 Type of Development Residential Addition No. of Units 1 Comments Addition to garage and sunroom 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 EXEMPT This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of 0.00 X 323 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 Telephone Name on the check By Dr. Doris Wilson Superintendent Fee collected /exempted by Ellen Patino Signature f� Exempt ..30:00`• ,u , Check No. N/A 40TICE: 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 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 tilled them on the Distrid('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 CITY OF LA QUINTA SUB -LIST CONTRACTOR 1e ��,v 7r ADDRESS /w ReVTJ V. OWNERa i S JOB ADDRESS - ' Q�y�z This form shall be posted on the job with the Building Inspection Card at all times in a conspicuous place. Itis the responsibility of the General Contractor or the Owner/Builder to monitor the sub -contractors that are on this list are the same persons performing the work. Any changes to this list must be approved the City of La Quinta Department of Building & Safety Wior to work being performed by a changed sub- contractor. Failure to comply will result in a stoppage of work and/or the voidance of building permit. CITY :SUB CONTRACTOR:.S:::: ,.:: .:; :.. TYPE QF ,::>;;::;:.:::.> ....: STATE ::::::.:::::::::::::.:::::::::::: :;:::<.;;:.;::.::.>::.:..::.:.:..;::..; <:::.;,;; W .. .;::::>::::>::::>:;:.;::.: .;:.:;::,ORKER 5.::.;:.;:.;;:::.:.::::SUSIN'ESS.::........................ TRADE: NAME::: ,::::::;;.: ::;:; .::::;;: ;:;:. ......:::..:..::::.::::.::: .::...............:.................LI.CENSE.:::::::::::::::::::::::::::::.:::,::.::.:::::.:.:::::.:::::::.........................:...:........ CONTRACTOR:>S.:::>::::::: ;:C.OMP 'NAME ., .. C1�1...: .....:.. .:::::::::::.::::.. I\IUMBER ON FILE:: 111UMBE,RI:::::>::>::::>:::.:.>:.. _ ..::::::.:::::.:::.:.: MATE.:::::::::::: GRADE/ A/C -12 EXCAVATE: PIPELINES_ C-34 CONCRETE! - _. C-8 2538( 3 98 rATG FOUNDATIONS....G G 96 5� ASPHALT A FRAMING..'.lye B 3 AT6 v q7 STEEL/ C-51 STRUCTURAL . MASONRY*C-29 PLUMBING: n(1. �`R� C-36 �i584q 5-q qb 314 s o90 LATHING C-26 DRYWALL C-9 PLASTERING C-36 HVAC C-20 ELECTRICAL. ),�� `0 1 C-10 (General) f '7` S l ROOFING.: OG� T % Spec tc� l C-39 SHEET METAL. C-43 FLOORING: C-15 GLASS/ C-17 GLAZING:. INSULATION C-2 SEWAGE DISP: C-42 PAINTING/' C-33 DECORAT!':=.:: , TILE C-54 CABINETS/ C-6 INSTALLATION' FENCING C-13 LANDSCAPING:.. -C-27 POOLS C-53 OTHER ., 1 51 (I re . 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