9811-144 (SFD)LICENSED CONTRACTOR DECLARATION.
I hereby affirm under penalty of perjury that I am licensed prider 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. C ass Exp. Date
.425381 .7;,11/ 00
Ra2111,15%/r c i
teignature of Contractor
OWNER -BUILDER DECLARA ION
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). r
( ,) 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
hereby affirm under penalty of perjury one of the following declarations:
t(°) 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.
;7 A,. H FL WD 12309910
(This section need not be completed if the permit valuation is for $100.00 or less).
() I certify that in the performance of the work for which this permit is issued,'
I shall not employ any person in any manner so as to become subject to the
workers' compensation laws of q alifornia, and agree that if I should become
subject to a workers' compensation provisions of Section 3700 of the Labor
Code, I sh4lj fort6%yith comply withtt�ose`pr$visi no s.
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
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 author a representatives of this City to enter upon
tSS1- above-mentioned property, fo Inspection purposes.
ignature (Owner/Agent) 1� Date
BUILDING PERMIT PERMITyx1.140 x +f'
7
DATE .VALUATION 4�9"r�?4/, 2® LOT • y (,TRACT, , "'S' i, 84,1 19
JOB SITE«•
ADDRESS.^ 53-499 A�+...�{ID A .R.UBIO
APN
! 774-4)72-0221
OWNER
CONTRACTOR / DESIGNER / ENGINEER
1 719 STRE i41ONT
179.9 8 TREMONT
S OCEANSIDE' Cry. 92054
S OCEANSIDE CA k054
(760)W/-0069 0131,11 1955
USE OF PERMIT
SNGLE FAMILY LJWE.idANG
aFD - PERMIT DiD . ' NOT INCLUDE BLOCK 'WALLS OR POOL
RiiG 3' 1.:C.ONSiRUC11GId 1.440-00 S1
PC CI.14PA IO 8-W 61”
OAl;iA.UWCARPORr 428,6 S.t'
6 31".7. WOOD FFNCE 130,00 LF
Gv }} yy**AA -g�g�t � n p g� i�n91YI.A'L`t4A 1..848 �-.V+,Y•l '+�1, ��.; iYi TRl3ON
9,ry5210
39,75210
CON '>'x` WCt iON Fit~5�!
!"I., AN r�1pp=Tf f"nC FE, 1011—(7gQ-41^9• 31!A $b
pp41)/9
0 S, 11111
r JECIIAMICAi,UVE [til -000-4231-000
kL 1 C•'FI C AL 11A 101-000420-000 fi124^
PY#�..CfA�9F?iNO F1 (n1 I -(011/))(1-4 1040
{F
q y II +(/y3�
2i zcn r,'- w"".01111.� 73:13-➢�.3S.1.ld 10.1-00]' 41 -OW
t:�.i�r�I�ING A%rr?A-s IN -000-423-000S20.00
4
MFRA.S, RUC"TURF, fF.11 X25.000-44�1-342.�3.vdJ'>. tY
5
P.rzi'ra�L,k�:t.AN i0t-(11X1-�tt.4'S S,zt11Li1t1
T
S1,fMIYTAL C ON!FrRUCTION AND PIAN CHFC'h
$3,514.42
LESS, 1?�''i1-('AJD 1-'F.117S
17250.00
TMAI,'t'f{:I M.AT E'.V,3 DUE N07W
3,26 4A
REC
IPT oLD,ATE
'VS
BY '•S
DATE FINALED
INSPECTOR
- 1
N.) y \N' ti
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
14
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
2
Compressor
Insulation
—
Vents
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 Pibg. Test
Final
F
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
—rte
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
57
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS !
Temp. Power Pole �(S
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:
AM'" ; ,, �..s• ••r^ "_z -r W _ *,rr+ •-K. �, :.. �71�.. 3..._•iCr9r✓ r%` r. tc `/°ti�5,.c k .'e,Nv !r'Tt' Wr'N► f
P.O. BOX 1504
Building 78-495 CALLE TAMPICO APPLICATION ONLY
Address 1�� -t)1511O LA QUINTA, CALIFORNIA 92253
Owner I
'" " " -' ' L I '' `—
Mailing
Address S -MCM]-7
BUILDING: TYPE'CONST.
A.P. Number
Legal Description
Project Description
OCC. GRP.
/ -7 `7 - ® -1 z ' b2 2
`
4
5 I�1
Ly A
,gAA�SIPC, L
Zip
-2-0'5 1%
Contractor,
I G'A TIrt
Address '
City
Zip
Tel.
State Lic.
City
& Classif. .L� 38
Lic. # S
Sq. Ft.
Size 14-7
No. No. Dw.
Stories Units
Arch., Engr.,
Designer
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
City
Zip
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
ellect
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
Estimated Valuation
'
permit to construct, alter. Improve, demolish, or repair any structure, prior to Its Issuance also
requires the applicant for such permit to file a signed statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
(� 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, Buisness and
Code: The Contractor's License Law does not apply to an owner of property who
PERMIT
AMOUNT
Plan Chk. Dep.
2
Plan Chk. Bal.
Const.
Mech.
builds or improves thereon and who does such work himself or through his own employees,
provided that such improvements are not intended or offered for sale. If, however, the building
or improvement is sold within one year of completion, the owner -builder will have the burden
of proving that he did not build or improve for rhe purpose of sale.)
Electrical
Plumbing
p
I'I I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner of property.who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
17 I am exempt under Sec. B. & P.C. for this reason
S.M.I.
e
'
Grading
a
Driveway Enc.
Date Owner
Infrastructure
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
_
Policy No. Company
❑ Copy is filed with the city. O Certified copy is hereby furnished.
TOTAL
CERTIFICATE OF EXEMPTION FROM---N6REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of lh@ 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.
jt on
((�
Date Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become
subject fo the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
ZONE: BY: N/y
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
Side Street Setback from Center Line
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Side Setback from Property Line
Lender's Name
FINAL DATE
INSPECTOR
-
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration it work thereunder is suspended for 180 days.
I certify that 1 have read this application and state that the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives -of this city to enter the above-
mentioned property for inspection purposes.
Issued by:
Validated by:
Date Permit
Signature of a0plicant Date
Mailing Address
Validation:
City, State, Zip
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
Desert 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. 2/16/99 APN # 774-072-022
No. 18370 Jurisdiction La Quinta
Owner NameDavid Ross Miller Permit #
No. 53495 Street Avenida RubioLog #
City La Quinta Zip 92253 Study Area
Tract # Lot # Square Footage 1440
Type of Development Single Family Residence No. of Units 1
Comments
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 l_'
reason:
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount
r
1.93 X 1,440 or $ 2,779.20 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/Capital Bank of North County/D.R. Miller Telephone
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Adriana Gauto Payment Received $2,779.20
Check No. 11724
Signature
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
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 Districts) or to another public entity authorized to
.,,actthem 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
This form is to be used b•y CDD staff for review of single family dwellings in the RC (Cove
Residential) District, in order to determine the applicability of compatibility issues or need
to require the filing of Master Design Guidelines by the applicant. It shall be transmitted to
Building & Safety as your correction list. Please attach additional explanations as necessary.
APPLICANT: PACIFIC' TRADES
PROJECT.
ADDRESS: Avenida Rubio
APN: ' 774-072-022
LEGAL: LOT' 12 , .BLOCK 184
UNIT S.C. @ V.L.Q.
C K' D BY: RFD RAKER
SIN NO: 5C CASE NO: 98-23 CHECK DATE:
Inform the .assigned Building plan checker upon your assignment to this case. The CDD
Executive Secretary maintains a log book to track applications and assign case numbers.
REQUIRED ITEMY I N COMMENT/.CORRECTION
Case logged and number assigned
Verify legal and APN information
Consistent with MDG on file (as applicable)
MDG filing required (5+ filings since 9/3/98)
Consistency with street/surrounding area:
Colors
Materials
Architecture
IIOTHER REQUIREMENTS:
The zoning code, architectural and landscaping manuals, and/or assigned inspector should
be consulted where uncertainties arise. The completed checklist shall be maintained in the
Building & Safety address file.
ff '
RC District
- Planning
Review Form
This form is to be used b•y CDD staff for review of single family dwellings in the RC (Cove
Residential) District, in order to determine the applicability of compatibility issues or need
to require the filing of Master Design Guidelines by the applicant. It shall be transmitted to
Building & Safety as your correction list. Please attach additional explanations as necessary.
APPLICANT: PACIFIC' TRADES
PROJECT.
ADDRESS: Avenida Rubio
APN: ' 774-072-022
LEGAL: LOT' 12 , .BLOCK 184
UNIT S.C. @ V.L.Q.
C K' D BY: RFD RAKER
SIN NO: 5C CASE NO: 98-23 CHECK DATE:
Inform the .assigned Building plan checker upon your assignment to this case. The CDD
Executive Secretary maintains a log book to track applications and assign case numbers.
REQUIRED ITEMY I N COMMENT/.CORRECTION
Case logged and number assigned
Verify legal and APN information
Consistent with MDG on file (as applicable)
MDG filing required (5+ filings since 9/3/98)
Consistency with street/surrounding area:
Colors
Materials
Architecture
IIOTHER REQUIREMENTS:
The zoning code, architectural and landscaping manuals, and/or assigned inspector should
be consulted where uncertainties arise. The completed checklist shall be maintained in the
Building & Safety address file.