0012-014 (SFD)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
-778MO R� l i� __..,. 03131/2
ate q� �� 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:
( ) 1, 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 .(Seca 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.
EXEMPT
(This section need not be completed if the permit valuation is for $100.00 or less).
(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, fshall forthwith comply wiihithose proveslons:
�a{e 30 � ; I ' Applicant �l o
A` °✓
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 personat
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.
r�:.7jjl %
SI'gnature (Owner/Agent) r 1 •r i t�!; -` bate a
BUILDING PERMIT PERMIT#
DATE VALUATION LOT �a,'9-tip E TRACT
RIX78. U10
JOB SITE
APN
ADDRESS
OWNER
CONTRACTOR/DESIGNER/ENGINEER
LECIAC OMR,
7 �S5S ��A STA Ci Its
78-555 SA01AR0 ROAD
LA QVIINTA C:A, 92251.4
LA QUINTA C`.A 92253
(M)364-7820- -7820_ . CBIR
USE OF PERMIT
y IM1 012' F"BLY DWJ I.WG
SPI) . YS•21 MASTER PLAN (98) • PERMIT DOFS.NoT rNCLUnZ BiXXIC
W.AU, POOL &SPA OP., OrvLw1Y• APPROACH
TRACT COWS 1,46.5.00 ,SP
PORCWPAT10 0.40 S?
CS ^ MMPORT (OF) 819WAD
5 YET. WOOJD FfUXE ZOUOfD LY
EmbuTED COST OF' CMT9rJ1UCn0X
CONOTRUCTI(YN FEE 101000.41800€3 uolio "
PLAN CHECK Fly 1 A i •• Q39-31 �S $505.0.5
MECHANICAL PER 101 «efM421.000 $53,50
9.t,F::TPJCALPELF tftt-0t}0420-000
PLUMBING VC,9 10-000-1'1`:0-000
ST ON113 MOTION FFZ - RESM 101-000-241-000 V9,14
C3IiA131 'C9. � 101=L00-42.3.000.
DEVEWPERIMPAC y FIX $.1,907.00
PREC18f: PLAN 1011.000-441=345 00.0,00
.
FEE DEPOSIT 101 ••a00-439-318 '4250.00
r8 P.
'FI M-71�G'S'AL C W1109 AI'1'S9 P AW i.11EC;ilti
�3,Q3�f8.r3%3
I3IOTT-TAIDI ?•�
4-150.00
MS DUEVOW
DEC 0 6 2000
SIT Y vr.,Au��,
RECEIPT
DATE4
BYDATE
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 O l
Exhaust Fans
O.K. to Wrap • o L T
F.A.U.
Framing 3 !L •o (
Compressor
Insulation - 0
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final I
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:
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) p� —%
OC��z- o1y� � f�u%n,ICtI
P.O. BOX 1504
Building � Q j f� 7 }� �( E7 CALLE TAMPICO
Address. / Q NTA, CA LIFORNIA92253
f -
mauing
Addres
Zip
Tel.
State Lic. City
&CIass if. %�Q011) I Lic.#
Cen cln
Address I Tel.
City (Zip ( State I
Lic. #
LICENSED CONTRACTOR'S DECLARATION
1 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, Business 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 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-] 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. 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 the purpose of sale.) .
111, 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 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
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
f7 Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed it the permit Is for one hundred dollars ($100) valuation
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.
Date Owner
NOTICE TO APPLICANT: ll, 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 applicant Date
Mailing Address
City, State, Zip
APPLICATION ONLY
.DING: TYPE'CONST. OCC. GRP.
Number v%: 21-2-1 n 17
Description
Project Description
Sq. Ft./-.
Size I 1!��
No.
Stories
NoDw.
Units
NeW-J Add
Alltter ❑
Repair ❑
Demolition ❑
b/❑`
/
Estimated Valuation
r
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 I INSPECTOR_
Issued by: Date Per
tar a.
Validated by: NOV i 4 2099
Validation:
Ik" LA
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
it
Desert,Sands�Unif ed School District . ! �"
47 950'DuneKPalms;Road _
Notice:La Qumta'11 :CA=92253:
#' ;�
r Document Cannot Be Duplicated'. r,76941ft=8515 �
' CERTIFICATE'OF COMPLIANCE, .
Date 12/5/00 :`- APN # 773-221-012
No. 21288 ,jurisdiction't :La Quints '
Owner NameMr•'`&.Mrs. Bills Permit #0012=014
No. 52=015 street 'Avenida:Ramirez_ Log #_
City La Quints, t: zip 92253 StudyiArea
' M
Tract # BLK78U10• � Lot*, .1 Square Footage; `1465
Type of Development-giOgle Family'Residence k No. of Units 1
Comments r
„t ; •a.
! a
a
At the present time, 'the;Desert ,Sands 'Unified„ School Distt°fct. does not' collect fees on garages/carports, covered
patios/walkways, residential additions under 560"square feet, detached access6ry structures or replacement mobilehomes. It
has been determined the:above-,named,owner is exempt from •paymg'school fees:?at this iime due to the`following reason:
EXEMPTION. NOT APPLICABLE 4
This certifies that school facilityfees imposed pursuant to Government Code'53 ,80 . , in the `amount of
..
2.05 X 1,465 or $ 3;0,03.25 the property listed above and that building
permits and/or Certificates ofOccupancy for this square footage ✓n this proposed project'may now be issued
Fees Paid By CC / Ist'Bank / Sharon Bills: -564-7820
k.
' Telephone 760
Name. onthe.check`
By Dr. Doris Wilson
Superintendent-,`.
Fee collected /exempted 6y. - Annette,Barlow, ; Payment Received$3,003.25
,Check No: 571 -50 -
Signature
[N,O-.n!,E: Pursuant of Assembly Bill 3081. (CHAP:549 STATS 1996) this:will serve to,notrfy you that the 90�ay approval period in which you may protest the fees or other payment identified
ova will begin to run from the date on which the building or installation permit for this project isrsssuedof on which,they are.paid'tothe Districts) or to another public entityauthorized to
ollct them on the District (ts)(s') behalf, whichever is earlier. •-
Collector: Attach a copy of countyqr city;plan che&,applicatiooform`to district copy for all'waivers.
f; Embossed Original- Building Dept./Applicant Copy. Applf6a;l7R cetpt Copy Accounting
• i
•4`x - -.. ... -.. Y .. - .., x�.:' .A. ,a �c.,,. ...,.vim- =2.. ?`'a.. SN..:j4 ..
0-�4
RC DISTRICT 'PLANNING REVIEW FORM
• This form is to be used b CDD staff for review of.sin le'famil dwe11" sin the 'RC- Cove Residential
District, in order to determine thelicability,o--compatibility issues or.rieedto require the filing of Master
Design Guidelines by the applicant. It shall be. transmitted to the Building .arid- Safety Department as your
correction list. Please attach additional �expianations'as necessary: _
APPLICANT Legacy Homes `f
SITE ADDRESS ..52015. Ave. Ramirez
•
-90
APN 773 _ 221 _ 012. BIN NO.: CASE NO.:
LEGAL: LOT BLOCK.. UNIT S.C.@V.L.Q.
CHECKED BY: DATE: 11/16/2000
Inform the assigned Building .plan checker ,upon .your assignment. to : this case. The CDD Executive
Secretary maintains a log book to ack applicatioy'rs and,assign case numbers.
REQUIRED ITEM
Y ..N''.
COMMENT/CORRECTION
Compatibility Review
Case logged and number assigned
Verify legal and APN information
-
N g
Consistent with MDG on file (as.applicable .
.
MDG filing required (5 filings siince 9/3/98)
Consistency with street/surrouriding area:
Colors-'
o ' o Mater
�snn�
p
Ar hitectur
G
y / 4
Other Requirem ts:
�'�
0�h
14fCertficate of Occupancy
kc
Cit. of La u eta
Q
Building and .Safety Depar-
trnen--tMOFTNo
This Certificate. issued pursuant to the equirements.: of Section r 709' of the Uniform Bui/ding Code>,
certifying that, at th .time of issuance; this structure was in compliance with'the various ordinances__
of the',City regulating bui/ding construction or use. For the fol%wing:
BUILDING.ADDRESS: 52-4015 AV.ENIDA. RAM;IR.EZ.
Use Classification: ' SFD Bldg'. Permit No.: 0012=014
Occupancy Group: R> 3 Type of Construction: VN Land Use Zone: RC
Owner of Building: `M%.'BILLS
Building Official
Address:
78-555"SAGUARO ROAD
•.-City:
LA QUINTA, CA + 92253
By:
STEVE TRAXEL
Date:
06-08=01
POST IN A CONSPICUOUS PLACE
1 -