9806-133 (RC)LICENSED CONTRACTOR DECLARATION
crjp; . -;1 hereby affirm under penalty of perjury that I am licensed under provisionsiof
F- ' Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
N W - Professionals Code, and my License is in full force and effect.
0 =) M License #,,1! Lic. Class Ezp. Date
r d t➢'?Jib7 B
o Z r- Date Signature of Contractor �E /
U
C OWNER -BUILDER DEO`LARATION
W W r- I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ License Law for the following reason:
Z_ ( ) 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).
M () I am exempt under Section
LO B&P.C. for this reason
N Date Signature of Owner
p N
rn
d Q WORKER'S COMPENSATION DECLARATION
oZ I hereby affirm under penalty of perjury one of the following declarations:
p () 1 have and will maintain a certificate of consent to self -insure for workers'
X W L compensation, as, provided for by Section 3700 of the Labor Code, for the
mJ JQ performance of the work for which this permit is issued.
Q U ( ) I have and will maintain workers' compensation insurance, as required by
O U Q Section 3700 of the Labor Code, for the performance of the work for which this
d Z permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
cb 5 ON, 111111r!
Q (This section need not be completed if the permit valuation is for $100.00 or less).
J N 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
3 s1ect to the workers' compensation provisions of Section 3700 of the Labor
Code, ho,11 forthwith comply with°those prlovi ions.
.Date: _ - `+Y Applicant-(
Warning: Failure to secure Wor ers' 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. `At g}
k* 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 authorize representatives of this City to enter upon
the above mentioned property for% inspect�io�n purp0"ses. _',i
"Signature (Owner/Agent)�0/ Date -�
BUILDING PERMIT PERMIT# CONTROL#
DATE 'S1I,101I'.00 LOT TRACT
18 03 .
JOB SITE
ADDRESS 51-370 �,WL:A IDA U ER. N U�DAN
APN 769-1,02-013
OWNER
CONTRACTOR/DESIGNER/ENGINEER
CFIAP, L ES, 13 s•'HYILI1?
4I.N. I.1A",I.)LIN ,'0.
BEIR.MUDA DtTNES CA 92201
t(70(11772-2(948
CKI 4512
USE OF PERMIT
�C01ONt-RENT
E,NC OSS M SJ'. F1: t �RUlAi, oUj' J j-17) i t i .dZldi� .'tlK� x l StJiV .
CONS'1'1tCtC'I. ION .11, 1:1:10 UTIL.W) PURSOA.N`,I' 1*0 UBC 107. ,.2 FOR !rI/OItK
i? �FSt°a.POR;f1+C60 VRJ OR TO ISS"t1r1N "E Cif .F.iLT.tI iJI.IVPd'P�J�M,f,'t.
v'AL11AMON i,100.00LS .
EISSpp9ryryTACOIS 11 CL; Sg)Ui .C..IT1VA�
I 0. 0,9 .0,9
P' sRM. ff .a1.1.! 1, SUMNI.miRV
T-11AN<;s LCT; PHE S,29,'5
("(1'INISI I fr,.,4,f IN FEE 1011-W-418-000 S90 00
INIECHANIC AL IT11, 101-000-427-000 $21.50
EI ECTIi1 U- Fffl, 1171-000-420-000 517.30
S 1`l2.0NQ MC) t flint i TIS - S:ONM 100-000-241-000 $.42
' �yryoj
Y � I by
1�
�trL'�-"t�i'r�1:,iCt'1►�IS"�'�? SJC'1'r�N :l:t??1 >at��lN' t,".i=t �'C�;
�.I �R .a7
JUL 0 2 1998 t LESS RIEU,-.PAIID Errs
Woo
+RECEIPTDATE
BY `
DATE FINALED
IN
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms 8 Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
-Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing 7
Insulation
Compressor
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 Plbg. Test
Final I I
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
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:
CONSTRUCTION ESTIMATE NO• ELECTRICAL FEES NO. PLUMBING FEES
NIT
:ST FL.
50 T. YF
VALUATION 4
Su FT
2ND FL.
MECHANICAL FEES
SO. FT.
POR
APPLrANCE
SO. FT
GAR
FLOOR SUSPENDED
SO. FT. •4
CAR P
ABSORPTION SYSTEM
SO. FT 4
WALL
GAS (ROUGH)
SO FT st
c
HEATING (FINALt
E US "EH
YAgD SPKLR SYSTEM
MOBILEHOME SVC. BAR SINK
POWER OUTLET ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL ' l'
ESTIMA'ED CONSTRUCTION
50 T. YF
VALUATION 4
NOTE: Not to Da usea as prooeny :ax vaaanon
A -C. UNIT
MECHANICAL FEES
VENT SYSTEM FAN
EVAP.COOL HOOD
APPLrANCE
DRYER
FURNACE UNIT MALL
FLOOR SUSPENDED
AIR HANDLING UNIT
CFM
ABSORPTION SYSTEM
B.T.U.
COMPRESSOR HP
HEATING SYSTEM FORCED GRAVITY
BOILER B.T.U.
MAX. HEATER OUTPUT. B.T.U.
TEMP USE PERMIT SVC,
POLE. TEM/PERM
AMPERES SERV ENT
SO. FT. e. c
SO. FT. 0 c
SU. FT. RESID rd 1+& c
SO.FT.GAR @ 14c
PERMIT FEE % PERMIT FEE
DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE I CONST. FEE
WATER PIPING
FLOOR DRAIN
WATER SOFTENER
W ASHERI AUTOµ DISH%
GARBAGE DISPOSAL
LAUNDRY TRAY
KITCHEN SINK
WATER CLOSET
LAVATORY
SHOWER
BATH TUB
WATER HEATER
SEWAGE DISPOSAL
HOUSE SEWER .
GAS PIPING
PERMIT FEE
ELECT. FEE SMI FEE PLUMB.
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR GOND. SOLAR
SETBACK
GROUND PLUMBING •,
UNDERGROUND
A -C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINALt
OTHER APP/EQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
-cu. yd.
_ pIUe Xi
o=
LUMBER GR. ,
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
1
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FFNCF FINN
1 11�iW CM 1 V /f J JIY/�II I V /ICi1A1 / 1/1W -- —
1111111 GARDEN WALL FINAL
CITY OF LA QUINTA SUB -CONTRACTOR LIST lr-
JOB ADDRESS 5t-310 AvctA0A 13EQ_#%wa5 PERMIT NUMBER JSo(o-133 OWNER BUILDER'J
This form shall be posted on the job with the Building Inspection Card at all times in a conspicuous place. Only, persons appearing on this list or their employees are authorized to work
on this job. Any changes'to this list must be approved by the Building Division prior to commencement of work.' Failure to comply will result in a stoppage of work and/or the voidance
of building permit. For each applicable trade, all information requested below must be completed by applicant. "On File" is not an acceptable response.
Trade /Classification ..:
Ir
Contractor . ,:
State.;Contractor.:s License,.,...........:, ,
Workers.Com ensat�on:,l.nsurance :;.;:
City Busmess`L�cense..
Company Name
Classification
(e.g. A, B, C-8)
License Number
(xxxxxx)
Exp. Date
(xx/xx/xx)
Carrier Name
(e.g. State Fund, CalComp)
Policy Number
(Format Varies)
Exp. Date
(xx/xx/xx)
License Number
(xxxx)
Exp. Date
(xx/xx/xx)
EARTHWORK (C=12)` :'::'
CONCRETE (C81':,
FRAMING (C-5)
�1i
�ioZS'
I13� qQ
1*72 Z�-S'%
10111"*-7�3
STRUCT STEEL
MASONRY. (C=291
PLUMBING IC -361 "
LATH, PLASTER (C 51 `"
, � . ..• �
MARtn►A�Cz�wa�� Pwsr�2I�ac.
�.
CFi c 35
_, __ �
x120(pR�}
_
�a�oo
- :� �
C1o�vEa Eow
�
NWC,419E2A0o
r
9� �`t�
'Irg4t :�
12 3� 98
% i
DRYWALL (C 91,��y,�,Q ::-h
7 r GU
C - p%
(f/ l0(��
����/Da
!(� C_o�✓t
c! �i it �1 D�p
/ /�i9
FS Z
HVAC '(C -20Y...,.
ELECTRICAL _IC 101
-y—
` /� �
/ G
5� � �/D �
3� Lro
L��'�'��Y.0 -�+� N%
?J3 l g� 0 /o
ROOFING(C39)x/
.fir ►N F
C-39
&990(11Z_430�ao
`�-��L7
Zg'&>RW -�'�
S
111199
SM METAL (C43)..-::"-:--"':'--.
FLOORING (C-151 $<
S1 !%/`� Cif L'''TA
C'� ►�
% ��1G ��
2 •29�Oo
��.�'�•P (`
'--
--
S�-4G�1
6�q.�g�
GLAZING
INSULATION ,(C 21
l/f� ,
13.
Ip�l�7g
�D ��
—
l Z
1 �9
SEWAGE'.DISP (C 42)
PAINTING (C33) f ►Q
D/Y( f} -/W'
,!
C- 33
j 7C���
6 30(00
pyo
(- � ' !�1H'i1a).tAL-
/
g2-7
CERAMIC :TILE .(C.-54)' "`_`"
CABINETS (C-
FENCING (.0:131
LANDSCAPING (C 27►...:.
POOL (C-53)::.
_
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 7/2/98
No. 17267
Owner NameCharles E. Phyle
No. 51-370 Street Avenida Bermudas
City La Quinta
Tract #
Lot #
Type of Development Residential Addition
Comments
mclose 84 sq. ft. atrium.
APN # 769-102-013
Jurisdiction La Quinta
Permit #
zip 92253
Square Footage
Log #
Study Area
84
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 84 or $ 0.00 the property listed above and that tuildirg-
permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued.'
Fees Paid By N/A-J.N. Hayden Co. Z clephone 772=2948
Name on the check
:,
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Juanita Green Exempt $0.00
Check No. N/A
Signature Cq,,IM��Y41
NOTICE: Pursuant of A#embly 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
will begin to run f m 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
collect 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
COMPOSITION ROOF-DF;A#N TO REAR WA1-�
FLASH $ COUNTER FLASH
Y
y_x•�HEADER
Qv
y • �
E RYWALL NEW
i ilk
OF
NEW LOBBY I EXISTING ROOM 54
US -FLOOR & CAR
Ar
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i t REMOVE EXISTING WA'_L
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FLOOR PLAN.
j� � r r +?' � � � .. ' .+ !r", +'• �- -� : .. 8 � fir. -. � �� ti � ���� rL - �
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