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9805-079 (AR)IL LICENSED CONTRACTOR a'm ECLARATION affirm under penalty of perjury that I 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 tZ, � 949. ! R 581100 ate Signature of Contractor- . ontractor . 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. Se( ) I have and will maintain workers' compensation insurance, as required by ction 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. S•rT ' >atPN'® 1130:10'1-98 (This section nee 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. VDate: " 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 Safeijr for a permit subject to the conditions and restrictions set forth on h 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 thelabove-mentioned property for inspection purposes. O Signature (Owner/Agent) 'r -�^' Date BUILDINGPERMIT PERMIT# °°NTR°`# DATE f VALUATION LOT 9805,079 TRACT �i ` 1 qPa 5,14,259.60 JOB SITE f r APN ADDRESS 78-•021 LAGO IiDRIW, v 634-400-011. OWNER CONTRACTOR/DESIGNER/ENGINEER BARBARA P1:.7RIr' " s WILLIAM 1.4. FRITZ 78021 LAGO ISR 66261 DOSE RD LA QIJINI CA CA 92253 MONTROSE CO 81401 (970)249-9756. CBL# 1.123 USE OF PERMIT hi C0NVMT L. -X,1S TIt4Q COVERED PATIO TO 376 S.F. ADDITIONAL :LMNG SPA•C,'l; C:`UST©M1 CONVER81Ci14 ?6,289 -oil SYF LS7fMA'I'.ED COST OF ilJONST RVCTION a�,21a1.b38 PERMff FEE SVMMARA' PLAN 0MCK FSE 101-000-439-318 $163.80 Ci NTIRUC'TIONFEE 101-000-418-000 $252.00 MECRAMCLFRE : 101-000-421.000 $21.54 ElIficr RICAL FEE 101-5104=424-040 $22::52 :S'!'13.ONG MO 1'1ON FEE - R&SID 101-000-241-000 $2.43 S SUN B-9arAW. NSR_ .tMON A.NUPL N CHECK $462.25 � 9' + LESS PILE-PA1D FEES $01.00 ®FAYe. t; TOTAL PERA1I T FEES DUE NOAr s4,62.25 RECEIPT DATE BY / DATE FINALED INSPECTOR OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Fo6tings Ducts Slab Grade Retum Air Steel Combustion Air Roof Dec' Exhaust Fans O.K to Wrap F.A.U. Framing /f Compressor Insulation Vents _ Fireplace P.L. f Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath y 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 Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans OX 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 Vottage Wiring Fbdures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final tjufy Notice (Perm) Notice: �1 Document Cannot Be Duplicated e Date 5/15/98 No. 17033 Owner NameBarbara Petry Desert Sands Unified School District 82-879 Highway 111 Indio, CA 92201 619-775-3500 CERTIFICATE OF COMPLIANCE No. 78-021 Street Lago Drive City La Quinta Tract # Lot # Jurisdiction APN # 631-400-011 La Quinta Permit # Log # zip 92253 Study Area Square Footage 376 Type of Development Residential Addition No. of Units 1 Comments Convert existing patio to 376 sq. ft. additional iving space. 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 376 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 William H. Fritz Telephone'_. Name on the check •' ,�,�� ' r4 s By Dr. Doris Wilson Superintendent Fee collected /exempted by Juanita Green Payment Received 'O;,0;0'^'"-,:�.'� = Check No. N/A Signature ��,(�,/�� NOTICE: Pursuant of AssEobly 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 a j' op tA "Ap A Y, �'A ., � RF�O WILLIAM H. FRITZ iV GENERAL CONTRACTOR CA.LIC. #594854 66261 WEST'ROSE ROAD HOME RESTORATION - REMODELING -MONTROSE, CO 81401-8663 FINE HAND CRAFTED FURNITURE (970) 249-9756 FAX (970) 252-3054 xg y c rh TK. �CKwt if, ��c� y A4 ll:� "I 0�' CO 1 4r, fT 4-s14 01P r A L L- S46cf /\/C. Wl/ "W SV -0i r. f;) Z> a C':e.s' r. F- ......... ILI ,"'L—L- 8,-jNj2:5 V—' C4 6 VIA fir"- I t4 -e 'q %o/ Ar— L J 1-1 lis P? etc, f '"t Irto At i; p 0 r C, If ."36 6 � `tl, I �I .li r