0010-007 (CSCS)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that 1• 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.
32V35 0714612r.
VDate 1 r / � of=f Signature of Contractor
OWNER -BUILDER DECLARATION t '
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.
( J,,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.
l'.D?i�EOl�i IY�3�3. 'S�'C3 1ISI•���
(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 an,y�manner so as to become subject to the
workers' compensation laws of Callfo6a, and agree that iAl should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.
Date: -)Applicant--/
/q
VWarning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,006, 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, appli
correct. I agree to complyiwith ja1
construction, and hereby, auuthon;
the above-mentioned property for
Signature (Owne
ation and state that t
City, and State laws
representatives of
Zs
above information is
ating to the building
3 City to enter upon
f
�Date/2
BUILDING PERMIT PERM'TP/�u
'u�.
DATE VALUATION LOT M007 TRACT
JOB SITE
ADDRESS
APN
78-:575 WWWAY 1.11.
643,020-W2
OWNER
CONTRACTOR / DESIGNER? ENGINEER
t
JDD UZ
G. `f. .IfiTHY WIMRIXTiON'
1121-1164'4J� l.i` itS
WA 99027
CA 92,260
(760)340-94.23 .05.430
USE OF PERMIT
COA>atCVU
CC.,1ai1b1ERCIAI., Btdi'wliia ;; rv. SQUA€IA FEET. BUILD174CI 3 t7,?A.
PORCH tIO I'moo OF
SP I1dI<~LER It, 3+S.tl0 SF
CONTRAWT-AMOUNT 2A,225,16 L19
Egrw ,A.m Con by comnort"i` oN.
PMJJl T Val i11uittnulzy 4'
CONSTRUC'I"1014 FER 101-000-416,-;000
PLAN >uF1=K WK 101-000.439-:318 $1,001.03
FEE DM- 1 811 ' 101-000-439-318 -SI'moo
oo '
PIdUMiiINd ff' "I B 103 rOOO-419-000 103100
TrAONG MOTION FELI - COMM 100-000-2411 -M $65.71
E}F ADINO A.FZ 101-000-423-000 $aa.01I
DE!'REJ PER. IMPACT RX Y9,In m .
,?SRT ITI PLIBL-IC' PLACES • CCOWt ,t 01.4000-235-000 5)1„565;94
STIR -T MAL CONITMUCITON AND KAM t MCK
TMs PlIZE-1,11AX) PY,n
41,0( oo
1.1MA,t[.a FFIR I:' IM -16131%, 1%, NOW
RECEIPT
DATE
BY
DATE FINALED'
INSPECTOR
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
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wali Insulation
Condensate Lines
Party Wali 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) 701,2
COMMENTS:
Notice:
Document Cannot Be Duplicated
Date 12/13/00
No. 21350
Desert Sands Unified School District
47-950 Dune Palms Road
La Quinta, CA 92253
760-771-8515
CERTIFICATE OF COMPLIANCE
::/�•'�ZIG�II►.I131I1y.1
Jurisdiction La Quinta
Owner NameLa Quint Court Permit #
No. 78=5754- Street Highway 111
City La Quinta zip 92253
Tract # Lot #
Type of Development Commercial
Comments
Log #
Study Area
Square Footage 8234
No. of Units 1
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, ;cgvere11,d
patios/walkways, residential additions under 500 square feet, detached accessory structures or replacement mohilehomes. 1't
has been determined the above-named owner is exempt from paying school fees at this time due to the folio ng reason:
r + ...
Commercial Building -
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount'of -
.33 X 8,234 or. $ 2,717.22 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/First Community Bank/Rod Murphy Telephone
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Olivia Aguirre Payment Received $2,717.22
Check No. 098037
Signature
NOTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified
above will begin to run from the date on which the building or installation permit for this project is sssued or on which they are paid to the District(s) or to another public entity authorized to
collect them on the District('s)(s') behalf, whichever is earlier.
Collector: Attach a copy of county or city plan check application form to district copy for all waivers.
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting
v��tpiptiq 9p'.ge,9yMWr +t$hH., r.v.r rx,, ... - .. ..cNo:v.'Yr.WnM+:d ...-:..ar +..t •9 :e 'x,
11 _ 37630 Medjool Ave. t
Palm Desert, CA 92211
Office (760) 772-7192
INSPECTION SERVICEFax (760) 772-7193
REGISTERED INSPECTOR'S WEEKLY REPORT Pager (760) 776-3338
TYPE OF
INSPECTION
PERFORMED
❑ REINFORCED CONCRETE
❑ POST TENSIONED CONCRETE
❑ REINFORCED MASONRY
❑ STRUCT. STEEL ASSEMBLY
❑ ASPHALT -
❑ FIRE PROOFING
❑
W(OTHER
JOB LOCATION
S ti
\C
REPORT SEQUENCE NO.
TYPE OF STRUCTURE
aM .
LR Qv,L
PERMIT 0.
I - l -
DATE
10-i -c61
DAY OF WEEK
MATERIAL DESCRIPTION
ARC �TECT
INSPECTOR
NRS. CHARGED
ENGINEER
ASSISTCANT$
, IN
HRS. CHARGED
INSPECTION
DATE
GENERALSUB
- CONTRACTOR �S
Q -'CONTRACTOR -S
-�
KJ' i -o
/D-19-0
b
'
Z
Now
U S t
�
NJ a 1,3o
reS1 \-N T e
COPY SENT TO CLIENT ❑
CONTINUED ON NEXT PAGE ❑
PAGE OF
CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MY'
KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE
NOTED. I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED
PLANS. SPECIFICATIONS. AND APPLICABLE SECTIONS OF THE
GOVERNING BUILDING LAWS.
Q . T� 3)�A )
SIGNATURTEFIED INSPECTOR
is
U6 cs0'w%ktt37„b-yq
DAtTE OF REPORT REGISTER NUMRFR
LICENSED CONTRACTOR DECLARATION Y
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
'JVIIV '
Date •r .. .r,; _ !Signature of Contractor �_ ' Y
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). .
( )'af; 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. .
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 STATv,pU1q;:; Policy No. 1634612-01
(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.
Date: I �/. Applicant �' a• ... ,� ��
(Naming: 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 becomesnull 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"
the above-mentioned property for inspection purposes.
Signature (Owner/Agent)-`�•: -• Date •-> >:� 11�r
fir a;�„+,3r"'tr•
BUILDING PERMIT PERMIT #
cyz-x�x
DATE VALUATION LOT TRACT
J68 $ITE" r
APN
ADDRESS7C,,UJPf1 ,yI,` I
OWNER
CONTRACTOR I DDEESIG t EN NNFFERW
((`�1. ii��
(NE}R
•r
C.
1.1(31)18TH A' T MKITE
55 74 S 'MIA IMMMIC, T1 Y-MP&M C..{a, 99.2'74
2-SAQUAR WA. 98027
ITIVUSt4W PALMS CA. 92T26
(769)399-5461 C RLR' 6556
USE OF PERMIT .
C;HX:%KlZ Ori COta TR.A .°T0R
COST OF
3l•'�',� ':fi'ae�:;�"���Ce+ii:��4'�'
1•�-tq..T"winuval
Au30151LqqIVVE01.16�±ty
dV.tn4iVV'�'J'd?r.T"TJVt� 0�`�I Jt'
NOV 14- 2001 -
� R f� QVrINZA
s��P.811T�rms
$0,00
KC
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
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
Exhaust Fans
O.K to Wrap.
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wali 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 Y
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. 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) 1
COMMENTS:
.�
P',