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0111-020 (BLCK)(!) 04 W O :)C ) W oZI� 0• H(D ~a Z M 1.0 N O0) �a It CL — Z LO -0 W X W — mUU O a MH v Z ob5 r, O 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 42:5391 B ,.+ 07131;X. Dater ignature 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: as owner o` 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&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. 1 , 1 have and will maintain workers' compensation insurance, as required by ,,S ction 3700 ol, the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier & policy no. are: Carrier VA't3& FUND 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 theworkers' compensation provisions of •S`ection 3700 of the Labor Code, I snail forthwith comply with,tNse 'rovisions. `^- Date: -✓' .. �"q:- CYApplicant {{ � Warning: Failure to secure Workers'`.Compensatioh 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 f'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 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 herebylauthorize representatives of this City to enter upon the above-mentioned property;for inspection pCirposes. `I Signature (Owner/Agent) Y I Date BUILDING PERMIT 4 PERMIT # DATE VALUATION LOT TRACT f f r� t� JOB SITE ADDRESS _.Z^Ww J?�.VF=ABK TMA& APN OWNER CONTRACTOR / DESIGNER / EN INEER DAVID 2 k TtS. R PAMFIC T' DEJ 120X:MT1171ON 51...i 3 S .AV• A :i1:�,�{`iL1/S'!':i W A 0 IlTa +QolTr 4�iYleq'i 4A, 9?258 9OCIE-AMt, irk. 92054 /r A (760,1967-0069 C'+ P 1955 USE OF PERMIT 1 ( (\ 7 LX 6' WAX)EN't1'AL1, • CITY* SS'ANOARI) r 6IM. WALL 7.00 LF Y4° S'k A ITM 4 OFf OF CONS'ERMNION PER:t?iU)E'FRE, SUNBURY CONi')'RIUCT10114 PEE. 101.000-418-0W ^• SISA klt NOV 0 5 2001 • CY OF LA QUINTA Li��lt"�\ai.1..�i{f-R^��./i'y(M''J}.k�.lr7Lr �.�,\1r�9 .4•�.1.YJ✓ �.7. �C"i 4r�•" �Y4 M+��'.CLt,'� 'I'UTAL MMU. "EnS DVE $7iSM) 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 Exhaust Fans O.K. to Wrap F.A.U. Framing Compressor Insulation 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 _a_ Electric Bond Footings Bond Beamy - /� • b fi Main Drain Approval to Cover Equipment Location Underground Electric Final �(� �.. Underground Plbg. Test 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: RC DISTRICT - PLANNING REVIEW FORM This form is to be used by CDD staff for review of single family dwellings in the RC (Cove Residential) District per Section 9.50.090 of the Zoning Code. Its purpose is to determine: 1) that the proposed house design does not duplicate the same architectural style of any house within 200 feet of the applicant, and/or 2) if there is a need for the applicant to file for Master Design Guidelines. If the applicant does need to file a Master Design Guideline, please transmitted this information to the Building and Safety Department as part of your correction list. Please attach additional explanations as necessary. APPLICANT SITE ADDRESS PACIFIC TRADE 51-535 Avenida Bermudas APN 773 - 145 - LEGAL: LOT 3 015 CASE NO.: 2001-532 BLOCK 110 � v! UNIT S.C.@ VQ. CHECK AND APPROVED BY: Greg Trousdell DATE: Inform the assigned Building plan checker upon your assignment to this case. The CDD Executive Secretary maintains a log book to track applications and assign case numbers. cpik ®.e REQUIRED ITEM Y N COMMENT/CORRECTION Verify legal and APN.information Consistent -with MDG on file (as applicable MDG filing required (5 filings since-©�- 9/3/98) Architectural variety within 200 feet of the surrounding area: D n t Co i �e. G o2 -a s owArchitectur �� Other Requirements.'r\�`�rGo�d��o Off` Desert Sands Unified School District 47-950 Dune Palms Road Notice: La Quinta, CA 92253 Document Cannot Be Duplicated 760-771-8515 Date 9/24/01 No. 22526 CERTIFICATE OF COMPLIANCE APN# 773-145-015 Jurisdiction La Quinta Owner NameDavid Miller No, 51-535 Street Avenida Bermudas City La Quinta zip 92253 Tract # BLK 110 Lot # 3 Type of Development Single Family Residence Comments Permit # 0107-344 Log # Study Area Square Footage 1382 of $32.80 a donation to DSUSD (per J.R. Rodriguez). 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: EXEMPTION NOT APPLICABLE This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of 2.05 X 1,382 or $ 2,833.10 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 Name on the check By Dr. Doris Wilson Superintendent Fee collected /exempted by Annette Barlow Signature b�'J Payment Received $2,865.90 Check No. 016985 40TICE: 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 above 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