9807-165 (AR)LICENSED CONTRACTOR DECLARATION
N^T ~J,hereby affirm under penalty of perjury that I am licensed under provisions of
F- :' Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
cv. W Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
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ICSignature 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.
(.) 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.
C'rr'V4W" uy
n�,af1.
. 4 s� #'tt 1'97{:1'
(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
Cede, I shall forthwith comply with those provisions.
Date: 1- Applicant., `�-
Warning: Failure to secure Workers' Compensation coverage is unlawfu) 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 thafihe 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
Jthe above-mentioned property for inspection purposes.. {
!cSignature (Owner/Agent)= p .J2, "ate'' 1 r,
BUILDING PERMIT PERM T#
DATE VALUATIONp� LOT TRACT
JOB SITE
ADDRESS 79,0877WAGO DRIVE,
OWNER
CONTRACTOR/DESIGNER/ENGINEER
rT?TSAf17 T+ 01VTPVQ
51.1 oa.V
' ilf T TAAq r1 i'.rTl'1"�
78097 l.AS. O DIL
6621, .SSL RD
LA. Q(ANTA, CA 02253
N401TIRCISi fr_10 811401
(970)7,49-97$6 (RLR 1.1'2.3
USE OF PERMIT
zua°iODERL uAr111-K0 aA'k ADD iii %SR tN) D MST iris ROCIF t,AM)s 65
S,.F. OF :f W.INQ EA"A) i
317 €1 s a� a s'fie� i_ug rR- htr it+ranra7 a r►e rr+ rrnr7
tnarac:axre:ariasn..ewars vea+
®rr�a� ,ctsn
MAN CHE POCK FIX-
1;_*tt1T $?ifl;TK)NFEE, 10.1_0t) 41!R -_0Q1
N) M%3 NNf_CA L X4100
rt �LL� 101.1000-4F
7�IC. AL �.l 7 E loo _ ISYI/"-�' 255 o4r 14..7,38
<i•�IJC. ;F:
PT UN93I"r+ G FTE 101-000-Al4-00.0 V3.00
Atli3ONOVt;9T1014r°AR-RES! D 1014100 -241 -MID $oas
r
AQ13-TOT M
AJ, CON
AUG 1 (� 19981."BS � ZE-PA IBES
foo.00
`ITY OF LA QUiNTA
RECEIPT
DATE
i
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 Wall Insulation
Condensate Lines
Party Wail 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:
Notice:
Document Cannot Be Duplicated
Date 8/10/98
No. 17471
Desert Sands Unified School District
47-950 Dune Palms Road
La Quinta, CA 92253
760-771-8515
CERTIFICATE OF COMPLIANCE
APN # 631-400-043
Jurisdiction La Quinta
Owner NameIrene L. Bourke Permit #
No. 78-087 Street Lago Drive Log #
City La Quinta zip 92253 Study Area
Tract # Lot # Square Footage 65
Type of Development Residential Addition No. of Units 1
Comments
sq. It. addition (remodel a oom .
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 65 or $ 0.00 the property listed above and t ai.bu.iIding
permits and/or Certificates of Occupancy for this square footage in this proposed.proie'et ma yr.no wbe issued
Fees Paid By N/A - William H. Fritz* �Telephne
Name on the check
By Dr. Doris Wilson f� r
Superintendent t T� 4
Fee collected /exempted by Juanita Green Exempt
Check No. N/A
Signature
$0.00
(NOTICE: Pursuant of A4dembly 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 I
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
tolled 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
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FROM
CABEC/C.0hi- isten sen
PHONE NO. : +909 763 0522 Jul. 06 1996 12:01PM P10 -
Greater than or equal to 500 ft2 nit less than
1000 f12; and
Greater than or equal to 1000 f12.
The compliance requirements for each
category are summarized in Table 7-1 and
described as follows:
Additions less than 100 ft2 may have up to
50 ft2 of fenestration with a U -value of no
more than 0.75. Any dual glazed skylight or
dual -glazed greenhouse window can be
assumed to meet this U-yelue requirement.
Insulation levels must meet or exceed the
WMr6N1r NT
Insulation_
,I ling V
j Wal12
Floor
Fenestration
M= U -Valu)
% of CFA
Shading
Thermal Mass
Space Heating
& Cooling
Water Heating
Replacement
Increase '
I.
2.
3.
4.
5.
6.
74
minimum mandatory requirements listed in
Chapter 2. Optionally. additions. f_less-than
loo 2 -can meet prtscriptive PRO a e
retluirementsSor_additigas gimpla Wall .Q
og6al to (>) 100 ft2 butless_than <)-5-0.0,2Z,
2. Additions greater than or equal to 100 ft2
and less than 500 ft2 shall meet all of tine
requirements of Prescriptive Package D (for
slab on grade buildings) or E (for raised floor
buildings) for the appropriate climate zone
except for the following:
Table 7-1: Prescriptive Compliance of Additions -
Summary of Section 152(a)l Requirements of the Standards
to {t2 > 100 hui c SO ftZ _400 l�ui^�IQOb Pt1 .1000 rt2
It -19 h;
R•13
YMendatory5
0.75
< 50 ft2
n/a
n/a
Mandatorys
(No electric)6
Packagel Package Package
R-13 1. R-13 Package
Package Package Package
0:75 Package Package
Pkg. + Removed4 Pkg. + Removed Package
Package
Package
Package
(No electric)
n/a n/a
See Table 7-2 1 See Table 7-2
Package
Package
Package
(No electric)
n/a
See Table 7.2
Package
Package
Package
(No electric)
n/a
See Table 7.2
Meet the component prescriptive requirement for Package D for slab -on -grade construction or Package G tier
raised floor construction (see Chapter 3) and all mandatory requirements.
"Heavy Mass" and "Light Mass` walls may meet the Package D or E requirements for mass wall insulation
instead of R-13 (see Chapter 3).
For compliance of additions and alterations only, dual glazed "greenhouse" windows and.skylights may be
assumed to meet this requirement.
The Package D or C fenestration area plus the area of any glazing removed because of the addition.
All applicable mandatory measures for insulation or HVAC systems must be met (see Chapter 2).
No electric resistance space heating may he installed.
March 1, 1996 Residential Manual