9512-008 (AR)LICENSED CONTRACTOR DECLARATION
I hereby affirm 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
Date Signatureof Contractor
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License 7Law for the
follow' g eason:
(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_-„SB&P.C. for this reason
Date �'Z. E_ it 1' Signature ofOwnef ``<=-�.1i1„` 1 �• ` `_
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.
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. 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
e, I shall forthwith comply with those.provisions,
Date: /', � ” / j Applicant _ •-�L�� - - °�, �-x” ,,,�":
t �f
11�`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, intarest 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 application agrees to, & shall, indemnify
& hold harmless the City of Indian Wells, 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)
AL"
...BUILDING
PERMIT J
PERM I Ost?r004
DATE IV 11Y0
VALUATION Lel ; `'8.1AJ
LOT TRACT
JOB SITE ADDRESS 53-340 AVENI:DA RAMIMZ
APN 774-032-005
OWNER
CONTRACTOR
OWNERML41MER
EDU.ARDO BRAMIRLI
53340 AVENIDA RAA MEM
LA+,Ql1IN A CA :2253
CBL#
0 1 "
DES16NEFVENGINEER
USE OF PERMITS 1 PJ
ADI) FANULY .ROONI
.FEE DESCRIPTION
FEES
t'RACT CONSTRUCTION 330.00 Sly
ESTLn',TA:`F U COST OF CONSTRUCTION
xa�G34.0t9
PIa;If3MI.T FEE E SUMMARY
PIAN CHECK RX 101-000-439-318 $140.40
CC:NSTRUC 'i ION FEE 101-000-418.000 $216.00
N ESCfHANICAI.1~EE 101-000,421.00() 11%21.90
i3LEC'TRI'S AL €gym ,. 101-000-420-000 $22.60
PLUMBING FEE [01410()-419-000 $33.00
STOI GA40110N FTE - RES1D .100-000-241-000 $2.06
SUB -TOTAL CONSTRUCTION AND PLAN CHECK
$435.96
LESS IRE -PAID FEES
O TOTAL )PERMIT FEf_+'.S DUE NOW
D
1 7995
3y
$0.00
$435.96
RECEIPT i
DATE'®'
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return -Air
Steel
Combustion Air
Roof Deck
/d (r
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
/
Compressor
Insulation aorp'
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL
APPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
J
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
/l� /.v5Er1 �i�$/L �/flDe %d GOA ;vir2O�
/
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)
I
Notice:
Document Cannot Be Duplicated
Date 12/1/95
Desert Sands Unified School District
82-879 Highway 111
Indio, CA 92201
619-775-3500
CERTIFICATE OF COMPLIANCE
No. 13925. Jurisdiction
Owner NameEdward B. Ramirez
No. 53340 Street Avenida Ramirez
City La Quints zip 92253
Tract #
Lot #
Type of Development Single Family Residence
Comments
APN #
La Quinta
Permit #
Log #
Study A: -ea 111
Square Footage 380
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 380 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 be issued.
Fees Paid By N/A ..� TelepnoneJ 564 ?8'.1.7
Name on the check
By. Dolores A. Ballesteros r6'.
Superintendent
Fee collected /exempted by Pauline Pearson $0.00
Check No. N/A
SignatureP.9\1 k A D P M
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
W11, 5a7 � 6 If V-
TYPE OF INSPECTION
'1
FOUNDATION 8 SETBAC ,
W11, 5a7 � 6 If V-
TYPE OF INSPECTION
DATE INSP. .
FOUNDATION 8 SETBAC ,
FOOTING STEEL,__
i
MAIN GROUND SYSTEM
GROUND PLUMBING
yJ�
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE SLAB
Z
JOISTS 8 GIRDERS
ELECTRICAL GROUND WORK
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS 8 GAS TEST
HEATING 8 VENT- A/C
FIREPLACE
ROOF
BOND BEAM
O.K. TO WRAP
GROUT ❑ 4' ❑ 8'
•
FRAMING
/
INSULATION 6,1n
PRE -ROOF
P
COVER NO WORK UNTIL ABOVE HAS j3EEN SIGNED
DRYWALL INTERIOR 14,1 lai
EXTERIOR LATH
POOL PRE PLASTER ;
POOL FENCE 8 GATE
SEWER SEPTIC TANK t
FINALS
FINAL" GAS TEST
.HEATING - A/C
HOUSE NUMBERS
JOB COMPLETED
TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO -
' 1/95 TURN ON UTILITIES OR OCCUPY BUILDING
-
._
t
4
78-495 CALLE TAMPICO — LA QUINTA, CALIFORNIA 92253 - (760) .777-7000
FAX (760).777-7101,
TDD (760) 777-1227
December 17, 1997
Eduardo B Ramirez
53-340 Avenida Ramirez
La Quinta, CA., 92253
RE: Family Room Addition Permit #9512-008
Dear Mr. Ramirez
The purpose of this letter is to inform you that your Family Room Addition Permit #9512-008,.
for the project at 53-340 Avenida Ramirez,. has expired. In accordance with'1994 UBC section
106.4.4., no further work may be performed until a new permit has been issued.
Please contact Daniel P. Crawford Jr., Building Inspector I, at (760) 777-7012 to obtain any
information you need regarding a new permit and/or any required inspections. Should you
choose not to complete the project, we would then have to pursue any or all of the following
actions:
1) Abatement of the project through the City Attorney's Office and Code Compliance Division.
2) Notice of non -conforming structure. placed upon property profile.
3) Action filed with Contractor State.License Board. Optional if Owner/Builder.
Please contact us at your earliest convenience prior to 10 working days to resolve this issue, and
for any questions you may have.
1.:
Sincerely, f;
Mark Harold
Buildin & Safety Manager h
Daniel P. Crawford Jr.
Building Inspector I
cc: file
dpc
MAILING ADDRESS - P.O. BOX 1504 LA OUINTA, CALIFORNIA 92253`t1
r.