0007-211 (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
t AExp.
. Date
425381 Til
lLn
Sign ature 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:
( ) 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
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 STATE FITOD Policy No. 1m'00490.00
(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
Code, I:shall forthwith comply with�thoseiprovislons.
Date: 10-, -, ! 4" Applicant V O
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 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 inspectionpurposes
Signature (Owner/Agent) I ""-' Date '
J
PERMIT PERMIT# .
OW7_2 1,
//BUILDING
DATEpk/ VALUATION LOT S TRACT
3�i>Gi;,3� 7.1713 13L1C.11 li
JOB SITE/
ADDRESS ,xl -%2. A unmnman-
APN
17;1�
OWNER
CONTRACTOR / DESIGNER / EN (NEER
DAVID ROSS ML.R
PACING 11W00 CONS' !JC_ 11!a IA_
9 OCEANS= CA 92054.
(76(3)961 4069 C, 1955
USE OvFy�PERMIT
SPD -PERMIT DOES NOT rNCI,'UDF; BLOCK WJ~ TAS OP. POOL.
TRACT CONSTRUCTION 1.353.00 8F
PCRC H/PATIO I13.00 Sir
(JARA11&VARPORT (Iff) 0,018.00
3 FT. WOOD FENCE 200.60 LF
ES'ITMTKD COBT OF CIOi'7STS2UMION
961337.00
Pywwr rn smam.Awsr
COMMUC•'TION "E 161 -DW -4) 8•'000 $501.00
PLAN CHECK FEE 101-000-439-318 $4Eb.26
MECHANICAL FEE 101-000.421.000 3WOO
ELECTRICAL IFFX; 101 -(MO -420-000 $130.63
PIA)MB11' G IEE 101.000.419-000 W1 M75
S'T RONQ MOTION FILL - RESID 101.0013-.241-000 $8.63
0ItADF90 RE, 101.000-423.000 $20.00
DEV P:i.OPER IMPACT F'I'EF 81,907.00
PRLCISE PLAN 101.000.441.345 $100.00
PEI: DEPOSIT 141-000.439-318 1$350.00
99i340TAL C<JWIMMYMMONT AND PLOT CUM CK
�3,396.2'I
LUS PRFs -7P AM, ' ..'7
4230100
DDE NOW
RECEIPT
DATE
BYDAT
INA
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Slab Grade
Ducts
Return Air
Steel
Combustion Air
Roof Deck
- O d (.
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
- 3/- oo S ?
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
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
Q S
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)
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 8/25/00
No. 20935 Jurisdiction
Owner NameDayid ROSS Miller
No. 51-725 street Avenida Bermudas
city La Quinta zip 92253
APN # 773-145-020
La Quinta
Permit # 0007-211
Log #
Study Area
Tract # Lot # Square Footage 1358
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
2.05 X 1,358 or $ 2,783.90 the property listed above and that building
permits and/or Certificates of Occupancy for this square footage in this proposed project may now=6e issued
Fees Paid By CC / Capital Bank of North County / David Miller Telephone
Name on the check
Jr
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Annette Barlow Payment Received $2,783.90
Check No. 077778
Signature
NOTICE: Pursuant of Assembly Bill 3081 (CHAP 509, STATS. 1996) this will serve to notify you that the gMay approval period In which you may protest the fees or other payment ident'rfied
above will begin to run from the date on which the building or installation permit for this project is essued or on which they are paid to the Oistrict(s) or to another public entity authorized to
milect them on the DistricIrs)(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 DeptJApplicant Copy - Applicant/Receipt Copy - Accounting
&r4ll oa L'a 2a6ta
PLAN CHECK CORRECTIONS
DATE: 811012000 PERMIT #0007-211
JOB ADDRESS: 51-725 Avenida Bermudas
CONTRACTOR: Pacific Trades
PLAN CHECKED BY.- Daniel P. Crawford Jr.
Dear Mr. Miller,
The Master plan review for the La Paz plan submitted has been completed. Please address the
following plan review corrections to approve your plans for construction:
].Provide Title 24 for the plan La Paz. La Quinta plan title 24 provided.
2. Provide school fees.
Please note that a 5 to 7 working day turn around may be expected for resubmitted plans when
the corrections are addressed. If I may be any further assistance please contact me at 777-7027,
thank you.
Since ly,
aniel 4Cr&lor
Building Inspector II
ff'Certificate of Occupancy
City of La.. Quinta
Building. and Safety'Depa'rtment
This. Certificate, issued pursuant to the requirements of Section 109 of the Uniform Building Code,
certifying that, at the time of issuance; this structure was in compliance with the various ordinances
of the City regul
a
ting bui/ding construction or use. For the following:
BUILDING ADDRESS: 51-725 AVENIDA BERMUDAS
Use Classification: SFD Bldg. Permit No.: 0007=211
Occupancy Group: R3 Type of Construction: VN. Land Use Zone: RC
Owner of Building: DAVID R. MILLER Address: 1719 S.. TREMONT
City: OCEANSIDE, CA 92054
By: STEVE TRAXEL
Date: 11-28-00
Building Official
POST IN A CONSPICUOUS PLACE