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0110-289 (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 y#.y yy �ryLic.. ryClass 2g Exp. yDate }�ry)ry 6 CS it! d Date +'+' " : �'"° � f` Signature of Contractor �� ;% .. � I -16, 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&RC. 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 STAT Pi, ND Policy No. -229-01 09147;r (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: da 4 ..61< Applicant C-4 ---WaF"riing:-Failure•toasecure^Workers',•Compensationtcoverage 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 wit;:In 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) ••-•- "r'�-'"" Date PERMIT # BUILDING PERMIT 0114-21M) DATE vO��am VALUATION sTmnt1bD LOT TRACT JOB SITE ADDRESS %�iEw�iCst.��n' APNl� OWNER CONTRACTOR/DESIGNER/ENGINEER :S'O:DOX 12623 54310 AVEMDA.:It;',fL�e: RAIIIA JEt`1° 1AQL'.fmu f.& 9Z.353 USE OF PERMIT t 140 WADDtTIWI 'CO PAASTER k6.1!X)Rj:..:17M , ADDiTON 140.00 OF ��� c.�r Opt saarrc�s 7,002°0() : Fi In -71i XUAIMAcK Y PUN C1 ECK FEE 101 ^00t,"�3R-31s 56435 C 0114S.'R OC TId: N FU 1 -•�t?y�Q•Gy-p.1pF5-Sg?p(i�Ci S9n9.Ki yiyy+,,31 O EC1,11..W.L 10.10%WEE �:J1^i1taJRg�1"0.7€i0 �1�,�¢ I AMt"NO MOTION FRY • REOID 101"400-2411-000 OCT 2 9 2001 WYOFLAQUINTA FINiANCF- PEr/PT. y 9� y 5/� /�y q 7 RL �q �p eJ [y C3 iDi'•.t A.Y J•.`a irOF4�ii�.4!'.Sd•d`1JS'7 1�dA� Lp.LnP].i.V :�d:8:ii�h" (� y ¢ �P•G03.. i . LEV I a-.PAYD MUM $0.00 RECEIPT DATE/ DTE FINALED INSPECTOR1BY <11 INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs _ _ Forms & Footings Al gp ?Ducts Underground Ducts Slab Grade Return Air Steel Combustion Air Roof Deck ' i �Q O.K. to Wrap Exhaust Fans F.A.U. _ G Framing Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. _ _ T Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath D"11- Int. Lath 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 I I Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines Z 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: 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 At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patios/walkways, residential additions under 5 00 square feet, detached accessory structures (spaces that do not contain facilities for living, sleeping, cooling, eating or sanitation) or replacement mobile ho mes. It has been determined that 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 Education Code Section 17620 and Government Code 65995 Et Seq. in the amount of $0.00 X 322 S.F. or $0.00 have been paid for 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 N/A -Marvin Jordan Name on the check By Ar. Doris Wilson Superintendent Check No. N/A Telephone 760-564-4447 Funding Exempt Fee collected /exempted by Yolanda Garcia Payment Recd Over/Und'e`r Signature NOTICE: Pursuant to Government Code Section 66020(d)(1), this will serve to notify you that the 90 -day approval period in which you may protest the fees o r other payment identified above will begin to run from the date on which the building or installation permit for this project is issued, or from the date on which Mose amounts are paid to the Districts) or to another public entity authorized to collect them on the District(s) behalf, whichever is earlier. NOTICE: This Document NOT VALID if Duplicated Embossed Original -Building Department/Applicant Copy -Applicant/Receipt Copy - Accounting CERTIFICATE OF COMPLIANCE Desert Sands Unified School District �'Fs�, 47950 Dune Palms Road < BERMUDA DUNES Date 1/26/05 La Quinta, CA 92253 Cr RANCHO MIRAGE INDIANWELLS No. 26814 (760) 771-8515 d PALM DESERT LA QUINTA :V QINDIO y� Owner Glenn Olivier APN # 646-290-052 Address 49-185 Balada Ct. Jurisdiction La Quinta City La Quint Zip 92253 Permit # Tract # Study Area Type Residential Addition No. of Units Lot # No. Street S.F. Lot # No. Street S.F. Unit 1 49182 Balada Court 322 Unit 6 Unit 2 Unit 7 Unit 3 Unit 8 Unit 4 Unit 9 Unit 5 Unit 10 Comments At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patios/walkways, residential additions under 5 00 square feet, detached accessory structures (spaces that do not contain facilities for living, sleeping, cooling, eating or sanitation) or replacement mobile ho mes. It has been determined that 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 Education Code Section 17620 and Government Code 65995 Et Seq. in the amount of $0.00 X 322 S.F. or $0.00 have been paid for 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 N/A -Marvin Jordan Name on the check By Ar. Doris Wilson Superintendent Check No. N/A Telephone 760-564-4447 Funding Exempt Fee collected /exempted by Yolanda Garcia Payment Recd Over/Und'e`r Signature NOTICE: Pursuant to Government Code Section 66020(d)(1), this will serve to notify you that the 90 -day approval period in which you may protest the fees o r other payment identified above will begin to run from the date on which the building or installation permit for this project is issued, or from the date on which Mose amounts are paid to the Districts) or to another public entity authorized to collect them on the District(s) behalf, whichever is earlier. NOTICE: This Document NOT VALID if Duplicated Embossed Original -Building Department/Applicant Copy -Applicant/Receipt Copy - Accounting Desert Sands Unified School District 47-950 Dune Palms Road Notice: La Quinta, CA 92253 Document Cannot Be Duplicated 760-771-8515 Date 10/29/01 No. 22619 Owner NameGlenn Olivier No. 49-185 City La Quinta CERTIFICATE OF COMPLIANCE Street Balada Court Tract # Lot # Type of Development Residential Addition By Comments APN # 646-290-052 Jurisdiction La Ouinta Permit #0110-289 Log # Zip 92253 Study Area . _ .. square Footage 140 of 140 sq. ft. to master bedroom. No. of Units 1 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 140 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 be4ssued Fees Paid By EXEMPT - Marvin Jordan of ML Construction Telephone 760=564-4447 Name on the check k Dr. Doris Wilson Superintendent Fee collected /exempted by Annette Barlow Signature Exempt $0.00 Check No. IOTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1998) this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified ibove 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 ollect 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