9706-010 (SFD)- • LICENSED CONTRACTOR DECLARATION
I hereby, affirm. under penalty of perjury that I am licensed under. provisions of
Chapter §.•(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
Date Signature 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
ode).
1 -am- ea 'e/m`ppt under Section B&P.C..ffor this reason
Date "/ , ,'''� Signature of Owner-*�"� �_- � ✓!tel
WORKER'S COMPENSATION DECLARATION
I hereby affirmiunder•'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.
(This section neednot be completed if the permit valuation is for $100.00 or less).
1 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 toI the workers' compensation provisions of Section.3700 of the Labor
Code-Tshall foy�thw .S comply with-those;provisions. f'
6i'�../Applicant�s� I
Date:,
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 applicator 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
type above-mentioned prroperty` r inspection purposes.
Si nature (Owner/Agent)
9
BUILDING PERMIT PERMIT# � '.� •� CONTROL# ' + •
�7W01. {' 5261,'
e�L-STONG
DATE 7 Zq VALUATION 6'� LOT ; TRACT 1
rl� r.
llfsJOB
,
SITE
ADDRESS .`51-160 AMNIDA DA Cdrli0�IREZ
APN 773-1655-015
OWNER
CONTRACTOR / DESIGNER / ENGINEER
t: 'SCA.2 MOR-11iGA
OkVN('R CBU1LDER "I�tTITI (NVIC
46745 ..%K.)N 170E ti 1' 0194
45701 i� ONROE S SCF Ci
iND10 CIA �s2201.
MDR) CA 92201
(760)..47-3157
USE OF PERMIT
Sih'.0
SO) 4.�1:.�t:tb IT DOES NOT INCLUM AI �7CK WALLS OR POOL 1� ..F'lN r
I Hf•C.K FFIE REI)IUCED BY 7 -'W/o FOR fv I I"[P E ISSUE OF SAME P1,AN
' ry
TRACT f: _1Ni S1 ai3i. rI0 i 1.210.60 SF
i' ►ie di/k'AT1Ci M.00 SF
C;ARACFlIC:J1R1't.}R.'( S'm.00 .5fa
r
M. 'I'.I15 XIIeD C`C '%T �It 'i�t��i;Y����iC IOC
I''1��tR�g"1A'i€11I�� S1111Ii�'�tt R
Ct���I;t'1'f�i► 31t�N>H'1>1S 101-000-41:t 04 $.54,.51)
.PLAN QJTX'%. WE 10000-439-311, $114.111
NJEC1. NIC",AL F� 101 dJt1Q-4�1-000 �rl.SJ
�.i:;�C>`T`�:C`''�.L t�i::� ltll-Cr�r-�2�,-i�►t't �i.��.�17
,
1:ClEv1331NE31 1i 101-000-419-000 'Sn'u-1?
144O110N FIT- = REM 101 -MO -241 -WO
di.7,A1. wc,1 101 -000 -423 -OVA)
t4WT]Yt7C�'!'.:Mr, FEE -000442 X142 s1,7,Vl '.as
+.
PREC:fSE PLAN 401-000-441-A45
f -"1�)T 1.. ("QJPdS�1�IJC°1'I()N AND PLAN C.'1.113CK
$ry.Ci95 csp
LESS PRE-1'�liD FRES
TOTAL PF-il UI �� I� EE -S 01IM- !t1W
$2,69..90
J U L 241997
`
RECEIPT
DATE
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 1,711w.Exhaust
Fans
OX to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wail Insulation
Condensate Lines
Party Wail Firewal
Exterior Lath X
Drywall - Int. Lath
Final
Final /
BLOCKWALL APPROVALS
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings O
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. 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
ewer
Connection r
Pool Cover
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: -y
141P -
Utility
Twit
"
P.O. BOX 1504 APPLICATION ONLY
Addriss4ri � �/r UINT CACALIFORNIATAMPIO
Address d i%}'r J ifE�-1A OUINTA, AIORNIA 92253
�wner
C 6
Mailing
Address
Cit�IV Ol > I ZiplA
City / Zi L `v Tel. _ .-3/
�
St to Lic. City
& Classif. I Lic. #
Arch., Engr.,
Designer
Address Tel.
City IZip I Sta
Liate
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
effect.
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,8usiness and Professions Code: Any city or county which requires a
permit to construct, alter, improve, demolish, or repair any structure, prior to 'Its issuance also
requires the applicant /or such permit to file a signed statement that he is licensed pursuant to
the provisions of the Contractors 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 penally o! not more than live 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
Professions Code: The Contractor's License Law does not apply to an owner of property who
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. I/, however, the bullding
or improvement is sold within one year of completion, the owner -builder will have the burden
of v/ng that he did not build or improve for the purpose of sale.)
as owner of the property, am exclusively contracting with licensed contractors to con-
stru project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not ply to an owner of property who builds or improves thereon, and who contracts /or
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
17 1 am ex4mp`under Sec. B. 8 P.C. for this reason
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
n Copy is filed with the city. O Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
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 thq 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.
Date Owner
NOTICE TO APPLICANT., d, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
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.)
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certify that I 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.
Signature of a0plicant Date
Mailing Address
City, State, Zip
BUILDING: TYPE'CONST. > OCC. GRP.
A.P. Number~ % —/7 3 (G �' Q16 -
Legal
16 -
Legal Description'' VL
Project Description do
Sq. Ft. /� / D No. No. Dw.
SiZk Stories Units
New 2S Add ❑ Alter ❑ Repair ❑ Demolition ❑
PERMIT AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
Notice:
Document Cannot Be Duplicated
Desert Sands; Unified School District
'• $2-879 Highway 1`11
Indio, CA, 9210t
619-775=3500 .
CERTIFICATE .OF COMPLIANCE
Date 6/5/97 APN # 773-165-015
No. 15606 Jurisdiction La Quinta
Owner Name.Oscar Noriega Permit #
No."51805 Street Avenida Ramirez .
City La Quinta zip 92253
Tract # Lot # Square Footage
Type of Development Single Fainily<Residence
Comments
Log #
'Study Area 113
1210
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 additioris 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:
EXEIVIPTION .NOT APPLICABLE
This certifies that school facility fees imposed pursuant to Government Code 53080. in the amount of
1.84 X 1,210 or $ 2;226:40 - the;property listed above and that building
permits and/or Certificates of Occupancy for this square foofage in this proposed project may now be issued
Fees Paid By oc/Bank of Ainerica/Coachella Valley Housing Telephone .-347-31.57
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Pauline Pearson
SignaturePte X IQ ;t1.,lA/4-' '
Payment Received $2,226.40
Check No. 20033;1,8233
40TICE: Pursuant of Assembly Bill 3081(CHAP 549„ STATS. 1996).this will serve to notify you lhal'the 9o4dy 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 which they are paid to the Districts) or to another public entity authorized to
bllect them on the District('s)(s') behalf, whichever,is earlier'
%-MICUwr: rCuacH a CUpy Ui UUMILY HrCny plan CHUCK appucauUH >;HnH w,utSLUILL CUpy lur au waivers.
Embossed. Original- Building Dept./Applicant Copy - Applicant/Receipt Copy. - Accounting
Coachella Valley'Housin*g,.Cd..alition
plaza 1, 45-701 Monroe`Street,'Su*ie . G'.; IndioCA'92201 —
TEL: (760) 347-3157 FAX: (769). 342-6466 f
ATTORNEY-IN-FACT AGREEIVIEN.T
I/We hereby appoint COACH ELLAVALLEY HOUSING COALITION, and/or
any of its authorized'age;nts "as my/our attorney in fact for the purpose of
executing any notices of completion; waiver, �of, Bens ' n:dlor executing
contracts with subco:ntractors," and/or. release of .liens and/or handling
building permits relating to that certain: real property described below.
All that certain land located and"being in the County
Riverside, State
of California; described as follows:
LOT 3 BLOCK ' 58.OF "UNIT, 5 OF SANTA CARMELITA AT VALE LA
QUINTA, AS -SHOWN BY MAP RECORDED- IN`BOOK��18, PAGE 63 OF
MAPS, RIVERSIDE C"OUNTY RECORDS. ,
Date -Oscar, Rene Noriega
Date Carissa.Lynn Peck_ "
b
'Certificate' toof
Occupancy
,a
CL% .
O� G
-C►tQ
.o.f La .u►nta
Buildin,, ani Saafet DepartmentOF
This, -Certificate issued pursuant to the requirements. of Section 109 of the- Uniform Building Code,,
certify -In in that, at the time of issuance, this structure. was in compliance with the.varrous ordinances
Y g
of. the City -regulating building construction or use. For the fo/%wing-
BUILDINGADDRESS: 59-80.5 AVENIDA RAMIREZ
.Use Classification. SINGLE FAMILY DWELLING Bldg..Fermit No: 9706=010,
Occupancy Group:. R-3 Type of Construction: VN Land Use Zone: RC
Owner of`Building. OSCAR NORIEGA Address:. 46745 MONRO:E: ST #.1'99
City: INDIO,-CA., 92201
By: DANIEL P. CRAWFORD JR.
Date: 7/31/98
Building Official
POST IN A CONSPICUOUS PLACE