0012-194 (AR)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
634981 'a 01 J3112(
Date - Signature of Contractor • l
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).
(F:D I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
(-),Lam exempt under Section
e + B&P.C. for this reason,-
t t .. ,> > �.
Date Signature of Owner - "i-«'•^��'�' �.�
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
pert rmance of the work for which this permit is issued..
(4 1 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 FUND Policy No.
(This section need not be completed if the permit valuation is for $100.00 or less).
("Y'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,- ' t I shall forthwith comply with those• provisions. r
Date: ) : Applicant `.. ; , • C _ k r
Warning: Failure to secure Workers' Compensation coverage i§ 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 is
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 hdeby authorize representatives of this City to enter. upon
the above-mentioned property for inspection purposes.
Signature (Owner/AgenGf"�"A "1'1 Datel�'l�
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 00.11"°�'I� TRACT
JOB SITE
APN
ADDRESS .52-775 AI f!,aRMA HERMWAS
773-33,5-014
OWNER
CONTRACTOR / DESIGNER / ENGINEER
�Jx l T 2 .1 1CPilt � ' VA
Cts}t.C>X111 t.°O31&M63Ll101i
LA. Q)T.J 4 A CA. 92253
(760)564-4604 4 €,;B:l'-* 2261
A
USE
'fO�F�PERMIT
StJZ�,P1,,1';Nlttl•J'P.A.t. TK} �`.Liw14+J1'1' JiA111Yi�ftl:1, �17OrSit4 :3'Y „d.1r. !t3 a�[G�%33+11' -
FLA'T CURIM.N TLY W415FR MRS'TRUC'1 ION,
AOUt`11ON F
�!:�'°.1I� IA.TED C".tC 41 E? ' E: .�7�r1 di(: MON
P.1r.'t OT FEE SirMMMY
PLA14 MULCK FEZ 101-000-439-319
C )NS R.UC'TXQN FLS 101 -000 -418 -ON) $54.0
Mk.CTRICAL FEE 101 _0001410 -ow STIM
YI'.1Ymbaia IvEg 10.1 -000-4 1 9%,000 $74.00
0TROAG X+!lOTION "s1A� - 111" 1001-000-241-000 Vii
r
d '
�A.11
GYto+..'Ca �'rt e;t'1%Tax13Y3C;'�"�owA?.�'GP1'AsC:.1xfs'",4.6,
$141.55
► ��' L1o.50 x'7t7E PAM I sS
$0100
DSC 2 .�� .� TOT -AA. YXIMMiTES D1.TE 14OW
$141—M
RECEIPT ,r}:
DATXAN f
BY
DATF NAL
INSPECTOR
f
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
61
Compressor
Insulation
s
Vents
Fireplace P.L.
_
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
p
Drywall - Int. Lath
/
Final
ow
Final it i D
BL06KWAL4 APPROVALS
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
_
/ 1S
Gas Piping
PLUMBIN
A PROVALS
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
i�f aowl
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 ?j
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 12/22/00
No. 21400
Owner NameFarrer-Avino/John Silva
No. 52-775 Street Avenida Bermudas
City La Quinta
Tract #
Lot #
APN # 773-335-014
Jurisdiction La Quinta
Permit #0012-194
Log #
Zip 92253 Study Area
Square Footage 37
Type of Development Residential Addition No. of Units 1
Comments
37 s.f to a detached granny flat currently under construction.
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:
Detached Accessory Structure
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of
2.05 X 37 or $ 75.85 the property listed above and thattbuilding
permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued
Fees Paid By CASH - Anita Avino 1Telephone
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exe ted by Annette Barlow
Signature
Payment Received
Check No. N/A
$75.85
NOTICE: Pursuant of Assembly 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 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
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 8/1/00
No. 20824
Owner NameFarrer-Avino/John Silva
No. 52-775 Street Avenida Bermudas
City La Quinta
Tract #
Lot #
Type of Development New Residential Addition
Comments
APN # 773-335-014
Jurisdiction La Quinta
zip 92253
ial addition is a granny house.
Permit #
Log #
Study Area
Square Footage 480
*Cashier's Checks Nos. 7377002181 & 7377002001
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:
Add. of Sq. Ft. to New Construction
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of
2.05 X 480 or $ 984.00 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 CC/Wells Fargo/Anita Avino 'Telephone
Name on the check
By Dr. Doris Wilson 14
Superintendent
Fee collected /exem ted by Annette Barlow
Signature
Payment Received $984.00
Check No. See Comments*
t
gOTICH: Pursuant of Assembly 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
tbove 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
Building
Address
Owner
Mailing
Address
P.O. BOX 1504
\ 78-495 CALLE TAMPICO
ti,LA QUINTA, CALIFORNIA 92253
Zip Tel.
apter 9 tcommencin with Section
an� ense i m full force and
�/� 4(
OWNER -BUILDER DECLARATION
I hereby astirm.4hat I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to file a signed statement that he is licensed pursuant to
the provisions of the Contractor's License{Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis
for the alleged exemption. Any violation 'of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
1I, 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, Buisness and
Professions Code: The Contractor's License Law does not apply to an owner of property who
builds or improves thereon and who does such work himself or through his own employees,
provided that such improvements are not intended or offered for sale. If, however, the building
or improvement is sold within one year of completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose of sale.)
I 11, as owner of the property, am exclusively contracting with licensed contractors to con.
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner of property who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
1-1 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
(7 Copy is filed with the city. ❑ Certified copy is hereby furnished.
4n
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
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.
Date Owner
NOTICE TO APPLICANT: If, atter making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certify that 1 have read this application and state that the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives -of this city to enter the above-
mentioned properly for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
APPLICATION ONLY
BUILDING: TYPE'CONST. OCC. GRP.
A.P. Number
Legal DescriptionL--. • \ tZ� �W��
Project Description r,
BY:
Minimum Setback
Contractor
,
t
Sq. iz Ft. �\ Stories
Sizey StoNo'ries t
No. s
Units
Address
Repair ❑ Demolition ❑
Side Street Setback from Center Line
�t
Side Setback from Property Line
City
FINAL DATE
Zip
Tel.
State Lic.
& Classif. \` C +i
��
City
Lic. # ;).4 ,
Arch., Engr.,
PERMIT
AMOUNT
Designer
Plan Chk. Bal.
Address
Const.
Tel.
City
Zip
State
Plumbing
S.M.I. `
Lic. If
/ LICENSED CONT94CT6R'1CLAAR TJON
apter 9 tcommencin with Section
an� ense i m full force and
�/� 4(
OWNER -BUILDER DECLARATION
I hereby astirm.4hat I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to file a signed statement that he is licensed pursuant to
the provisions of the Contractor's License{Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis
for the alleged exemption. Any violation 'of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
1I, 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, Buisness and
Professions Code: The Contractor's License Law does not apply to an owner of property who
builds or improves thereon and who does such work himself or through his own employees,
provided that such improvements are not intended or offered for sale. If, however, the building
or improvement is sold within one year of completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose of sale.)
I 11, as owner of the property, am exclusively contracting with licensed contractors to con.
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner of property who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
1-1 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
(7 Copy is filed with the city. ❑ Certified copy is hereby furnished.
4n
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
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.
Date Owner
NOTICE TO APPLICANT: If, atter making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certify that 1 have read this application and state that the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives -of this city to enter the above-
mentioned properly for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
APPLICATION ONLY
BUILDING: TYPE'CONST. OCC. GRP.
A.P. Number
Legal DescriptionL--. • \ tZ� �W��
Project Description r,
REMARKS
ZONE:
BY:
Minimum Setback
Distances:
t
Sq. iz Ft. �\ Stories
Sizey StoNo'ries t
No. s
Units
New S) Add ❑ Alter ❑
Repair ❑ Demolition ❑
Side Street Setback from Center Line
�t
Side Setback from Property Line
FINAL DATE
INSPECTOR
Issued by:
Date Permit
Validated by:
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electric
Plumbing
S.M.I. `
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
ZONE:
BY:
Minimum Setback
Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE
INSPECTOR
Issued by:
Date Permit
Validated by:
Validation:
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION