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9902-019 (SOTB)U) N U) W Ouch t- d u7 W r C:) Z (Do I - cO W U) Z co N ON U °) Nt CL Q Z �aCr 0 XW 0 _J m < O MH ,t Z W O J WY, 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 425381 B "'IX lf31/f •� ,� - V©ate � �� Signature of Contractor V)---- 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 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 e t)ion 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 4rytp Policy No. 1 y Y'F 1'1133 LeS� f�jia1� (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 Cd'de, I sh&ll forthwith comply withlthoepro"Visions. ,Kate:fix i k Applicant Warning: Failure to secure Workers' Co pensation 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 persoll 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 inspection purposes. Signature (Owner/Agent) �et� c_ Date -�:? ► �' BUILDING PERMIT PERMIT# ...,-. "02-011.9 DATE V,5/99 VALUATION . LOT TRACT JOB SITE ADDRESS 51-:5.,51. AVE -NIDA APN _ OWNER CONTRACTOR / DESIGNER / ENGINEER 3aEn C, �S rte." : «�I.a��"�:`r� .[719 S'1'1 EIN-10 r 1719 S TREK ON11' S 00_': C.ANS*t1: E CA 92,054 S OCE ANSID CA 92054 (7f f);+ *7-0069 "BLIP 1155 USE OF PERMIT 3�l:�..���t.I.S.ttVL:i• s,, s� NSTALL 30 L.F. 6: Y-' 0A,S LIM TO FiRl"PLACL � i'.LUN031NO FEE 101-00-419-000 $18.00 A. PAID FEB 0 3 1999 3ITV LA QUIN A SUB -10 TAT, CON Kf RUM _7101-4 AN OPLAN CH FICK $18M LESS PRE -PAID FETS $0.00 RECEIPT DATE BY DAT FI A E 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 Wail 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 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 A Encapsulation Gas Piping Gas Test Appliances Final Final Utility Notice (Gas) K4Pq At ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fbctures Main Service Sub Panels Exterior Receptacles G. F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) COMMENTS: 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 9/8/98 APN # No. 17656 Jurisdiction La Quinta Owner NameDavid Ross Miller No. 51-551 City La Quinta Tract # Street Bermudas Lot # 773-145-016 Permit # Log # Zip 92253 Study Area Square Footage 1,646 Type of Development Single Family Residence No. of units 1 Comments 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 1`.V :k J.f y, 1.93 X 1,646 or $ 3,176.78 the property listed above and' `that;building'.� permits and/or Certificates of Occupancy for this square footage in this proposed project'may nuw be'`issued �y Fees Paid B CC/Ca ital Bank of North County/David /David Miller ; ' . y ' Y P tY `TeYephone 96is ;0069 Name on the check 13y Dr. Doris Wilson Superintendent Fee collected /exempted by Juanita Green Payment Received $3,176.78 Check No. 055912 Signature NOTICE: Pursuant of A$s$mbly 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 above will begin to run MOM 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