0206-159 (AR). 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 in full force and effect.
License # Lic. Class Exp. Date
53367th $ 21iC 0102
Date l 7 Signature of Contractor ��''r J"'�' >
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.0%'four 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 OTATU MD Policy No. 07152
(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: r r n Applicant+•lr'"�' •``�
'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, interest8and 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 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) � �-"�"""'"" Datet�^+
PERMIT#
BUILDING PERMIT 61-1
[DATE r� f VALUATION -LOT' TRACT
0125w,1
JOB ADDRESS -77-935 �1.�R�5`.DO COVW , APN . - A
OWN��EyyR�y;.�yy yy�yyA 7f/y7� �y^t�(!y9
Saye!O VA1101\�JJ'.aa7 .
PALMI iD EKIT * CA 5 221 t
USE OF PERMIT
CONTRACTOR / DESIGNER / ENGINEER
9UNP-0.8, .YN
,iyAi,RiA:C3MMt CA .92260
(76( )772.822 M14 1137
STlPPLF.ME@fTAL TO PERMIT 9 0204.0ft C:GW"=1v'1QN OF [ CAR
PER.
APPROVED PL AM
CUSTOM C0N:►TRla'€".TaC3N X0.00 S
P.IS'MU")i,'FER MMMA. V,
R:W? IN PUBLIC P>s.&I.L"S - )Z?Zlr 270-000-445-000
p:�,AII CiI1uC 3 1•t10C� 3 »; t `. .« .
ISTItC�NOtiOTIO. 'hg ESI 1:E1•�t9D-.�4?:-O€�0
P,FJU-N 2 i roar �
CITff0F AQUINTA
Nr.
L_ L
-TOTAL.ED, it-
CCJI.:
d
' 'OTA. r1m'rirns 7Dw xow $121.07
RECEIPTI D� E -S I BY ! I 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 Wali Firewall
Exterior Lath
Drywall - Int. Lath
r
Final
I -
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
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
/!
C�os�
0.0
��3ST
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)
')esert 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 6/21/02 APN #
No. 23318 Jurisdiction La Quinta
Owner NameSedona Homes
No. Street
City La Quinta
Tract# 30125-1
Zip 92253
,.o
2 BERMUDA DUNES V
RANCHO MIRAGE b
Y� INDIAN WELLS
PALM DESERT ,y
`
LA
QUINTA
INDIO
773-022-021
Permit #
Log #
Study Area
Lot # Square Footage 600
Type of Development New Residential Addition
Comments
additions to new construction: Addition of Hobby Room
7_7965 Laredo Court - 200 sq. ft.
77935 Laredo Court ;200 sq. ft.
50095 Granada Court - 200 sq. ft.
No. of Units 3
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:
Add. of Sq. Ft. to New Construction
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of
2.14 X 600 or $ 1,284.00 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 1 st Bank - Lance Alacano
Name on the check
Telephone
7
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Crystal Scott
Signature Kq�
Payment Received. $1,284.00
Check No. 64988
;E: Pursuant to 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
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
: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
J
L_o _ 13
4'-6
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10,
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4050 SL
U=.55 20 SF
OFFICE 4a
Imo' -I" GLG.
5'-&°
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POWDER
a' --I° GLG.
(2 -LAYERS
a GLG.)
� 48
b' GARAGE
U„m c/y, T
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FLOOR PLAN 2629 S.F.
HOBBY OPTION 112 S.F.
N REN 4/30/03 \Q
OF CA�\��Q�' TOTAL W/O PTI O N 2741 S. F.
GARAGE 710 S.F.
OFFICE - GARAGE W/ OPTION 630 S.F.
SCALE: 1/4” = I' -O"
PEKAREK-CRANDELL, Inc.
SEDONA HOMES, INC.
HACIENDAS
&2
architecture - planning
288
oI
LA QUINTA
1 -16 -rat
31872 camino Capistrano, suite100 (949)487-2320
SE
PALM DESERT, CA 92211
LA�.�,mF.-;
JOB" .
--�-;
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TH 3
GLG. ji ��
01- I1
I I
U„m c/y, T
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FLOOR PLAN 2629 S.F.
HOBBY OPTION 112 S.F.
N REN 4/30/03 \Q
OF CA�\��Q�' TOTAL W/O PTI O N 2741 S. F.
GARAGE 710 S.F.
OFFICE - GARAGE W/ OPTION 630 S.F.
SCALE: 1/4” = I' -O"
PEKAREK-CRANDELL, Inc.
SEDONA HOMES, INC.
HACIENDAS
A-1
architecture - planning
77564 COUNTRY CLUB DRIVE
SUITE #1
LA QUINTA
1 -16 -rat
31872 camino Capistrano, suite100 (949)487-2320
SE
PALM DESERT, CA 92211
PLAN #3
JOB" .
san juen capistrano, ca. 92675 fax (949) 487-2321
TEL: ((760) 772-8224
OFFICE REVISION
01- I1