The URL can be used to link to this page

9807-021 (SFD)LICENSED CONTRACTOR DECLARATION b ' gam_ 'licensed uncle' I hereby affirm under penalty of perjury that I amr provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and C'4 Ci Professionals Code, and my License is in full force and effect. _O �:M License # Lic. Class Exp. Date LU 12!31/98 oZr— Date f Signature off Contractor O `.V U OWNER -BINDER DECLARATION W w r- I hereby affirm under penalty of perjury that I am exempt from the Contractor's ~ U) License Law for the following reas3n: 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). co () I am exempt under Section B&P.C. for this reason L N Date Signatu're of Owner ON rn Q WORKER'S COMPENSATION DECLARATION' C:) Z I hereby affirm under penalty of;perjury one of the following declarations: O () 1 have and will maintain a certificate of consent to self insure for workers' X W �= compensa Ion, as provided for,by Section 3700 of the Laboi,Code, for the O J Q pe7o �Abe of the work for which this permit is issued. C0 Q U .�l-have and will maintain workers' compensation insurance, as required by O C) 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. Co o 911MIZ FUND M30.185-913 J (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 those provisions. Date: Applicant 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„flaws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property �in p'ectl n u"rposes. > Si nature—(OwnerlAgent) /r// �*^ --� . Date wt / BUILDINGPERMIT PERMITyCONTROL# , r DATE 9116/" VALUATION S470630.30 LOT TRACT 8.195 81 28470 n JOB SITE ADDRESS %}y-�,w1}� �� %I, CIO1JR :1 APN _ OWNER CONTRACTOR / DESIGNER /..w V — V 11 DA14 D1.Ti LA.P FEDDHRLYC4aMPAXIES 73768+ 1,.sVK R.E.A C'I"REET - USE OF PERMIT SINS 1 %IL:Y 1 1V.:LL(A7ta SF°i'► - Na 13LOCK W.ALLS O!i POOL. COMPLIANCE WIT .H ALL .PMERAL tZ STATH LAWS, EN'nANGEREI) SPECIES A(. f Of, 1973 (16 USX,-. 0,31, Irr SE Q) LrAPPLICABLE, ,IS RFQUIRFD. CUSTal: CONST RUC 110IN 5,565.00 ur POR.C.1411PKI110 I,180.00 SV UARAKOWCAEtPOkT 1,013.00 Sl7, . PERMIT FER, SCI6`:116.f.1.9.E1V # coNST. ucrION YEE 101-000418-000 $1,93£9A[) (n,,,\_Tf cm --CK 1. r 11)1-0€ . 4 9-318 S;,569.84 }.1 r y:1_l�t7w.1'I 1101-000-439-318 41,1100,00 It�ir:CHAN1CAL "FEE 401-000-421-000 516-2.50 y 4 EIEC IWCA;L. t EE 101-000-420-000 1315.6.4 Pi,1lNIPING b Y%W, 101.-000-414-000 S21SS,75 ST RaNG MOTION FEE -1tEM 101-000-2 41-000 $47.06 GRAt51M FFIc ' 1a1-�x;4�- ��(1 $20.00 ft'd.1 itpul`nV IC yLTRls :E'i± 225-000-44 .�-342 9�6.i1ut9,flu .�\.RT TN'PUB C PLAcE,S - RE Sir, 704-000-25.5-000- 000-25 -00c►,MA MA LESS i'R>?-1!AID 1 "ES -$1,000.00 ,N i'C1TM, PERM .1 FK S DUE NOW 510,, ,18.42 RECEIPT DATE y� BY Dr� F N LED INSPECTOR /�yrYy+ I INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings 2� Ducts Slab Grade Return Air Steel Combustion Air Roof Deck Exhaust Fans O.K. to Wrap -(2- F.A.U. Framing Compressor Insulation t Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Q D II - Int. Lath PAP Final g POOLS - SPAS BLOCKWALL PP OVALS Steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines 2 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 /� Encapsulation Gas Piping Gas Test 6-11 f , Appliances Final COMMENTS: /�g!9� e,�a�/•�� Final Utility Notice (Gas)Ar /'� �� ELECTRICAL APPROVALS 16 70-P Q 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) 6M Notice: . Document Cannot Be Duplicated Date 9/16/98 No. 17736 Owner NameDan Dunlap Desert Sands Unified School District 47-950 Dune Palms Road La Quinta, CA 92253 760-771-8515 CERTIFICATE OF COMPLIANCE No. 78-250 Street Birkdale Court City La Quinta Tract # Lot # Type of Development Single Family Residence Comments APN # 769-190-011 Jurisdiction La Quinta zip 92253 Permit # Log # Study Area Square Footage 5,565 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 1.93 X 5,565 or $ 10,740.45 the property listed above and ltliat building permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued Fees Paid By CC/1st Bank/Craig Williams • `4clepho6e • Name on the check �- By Dr. Doris Wilson Superintendent Y Fee collected /exempted by Juanita Green Signature Payment Received $10,740.45 Check No. 043918 NOTICE: Pursuant of Assem Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified above will begin to run from t date on wHich the building or installation permit for this project is sssued or on which they are paid to the District(s) or to another public entity authorized to collect them on the District('s) ') behalf, whichever is earlier. Collector: Attach a copy of county or city plan check application form to district copy for all waivers. Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting Qumto q8o'7 - 6r2. I —7$_ 250P.O. BOX 1504 APPLICATION ONLY Building78-495 CALLE TAMPICO Addres?�. I g k17AL. G C" r LA CUINTA, CALIFORNIA 92253 Owner �1410 0 ]BUILDING: TYPE CONST. OCC. GRP. Address ate Lic. ` 1 I City Classif. Lic. # Arch., Engr., Designer City 1 Zip State �J �(�j ' t ' Lic. # �i26 LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license Is in full force and effect. SIGNATURE DATE OWNER -BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5,Susiness 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). I_ 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, 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.) 1 1 I, 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.) f! I 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. O Certified copy is hereby furnished. 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 theperformance of th@ work for which this permit is issued, I shall not =any person in any manner so as to become subject to the Workers' Compensation Laws o1 California. Date Owner NOTICE TO APPLICANT: If, after 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 it work thereunder is suspended for 180 days. I certify that I 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 property for inspection purposes. Signature of a0plicant Date Mailing Address City, State, Zip A.P. Number % CPQ — / 40 — O / 1 Legal Description Project Description c Sq. Ft. 7� y No. Size 7 L Stories Stories Unitss New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ r Estimated Valuation PERMIT AMOUNT Plan Chk. Dep.�"— Plan Chk. Bal. Const. Mech. Electrical 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