9806-107 (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 Exp. Date
7+015410 B _ , 3/31.199
J l 7 r
(,pate 04 '' +" Signature of Contractor ! �r + + � � • 5
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).
O 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 workforowhich this
permit is issued. My workers' compensation insurance carrier & policy no. are:
,Carrier Policy No.
�:::���':;,��+:173w'Ii'1! 1:vSttF:r'l1.C`�' e�(1•+w'Jb,�3
(.This section need not be completed if the permit valuation is for $10.0.00 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
C/de, I shall forthwith comply with those provisions. f
,Pate: 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 ay
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.
/
tSignature (Owner/Agent) f Date
BUILDING PERMIT PERMIT# CONTROL#
9804- W7
O
DATE / VALUATION S,34f),617.20 LOT 27 TRACT 27l5 9JOB
SITIJ w
ADDRESS ltd+RJB �� J4 ��19ALE COURT
APN 749-1621-•001
f�n
OWNER
CONTRACTOR /ENGINEER
�][�y�� �T� y / +7
IMP ji7 �i ��V�l�+ i��i1.�i.'I �s �.
p/,DESIGNER
� ��
T(JP Plh 0,0Ni1T1 Y\ C`P.�N ICO,
78-120 CALLE ESTADO 4206
78#120 C,ALLk. FSTADO 11206
LA (7I.1INFA CA 92253
LA Q WA CA 92253
(760)777- 'fit t. 01LO. 3751
-
USE OF PERMIT
ti1N�,1,)' rA RLY DWRI-11-NO
M- J - NO B1,0CK WA[.LS 4011 POOL. CONIP .iANCF- VN.11TH A;' I, FEDEE tAL 6:
3't }l!) 1 Ay1i:>, 11v`t,'Ll�ii3Ci 1'H ENi3.A.tdt EPLED S#'Et; 1iS A1C."f' CYF 1973 06
U `;.C.. y 1531, V SFQ)1F .APP1JCAN1,F4 is RE(Aflit a).
CU.= 110,43'rR ,' T N 4,232.00 '
52x7.00 sF
GA.itA.(ik'JC:A1t!?f: RT 662.00 Sp
� IATA ';+;D C *0:Vf ��?1� C:OI`i�;`.1"z�.��3�'�'ION �
349, ;1'7.20
[��/, �l�q��Y■:g1-11��'
y yL, gg�y y* 'y` PUT,
.E�ERIVO 6 �SYUT, S3J.11�.�1i ft 3Y
-
CG11vti'T1tCiC"IClC71�f }%E13 lf:)1-OfS0-�S'133-OOU 51.5t�i-.St)
3�i1�l�f C iFf K'. C1yl; i0.1-O(3<3-ct V -3i $1,-:291121
, l�F.,0,sla 101-00i�-438-31;3 - :.0':)Et.UO
MECHAMC M. FER 10t -OW -421-000 $I -A6.00
Ei.irt- FRIC AL t:U,' 101 -OW -420 -OW S260114
pl "f'f1wsf101-OW-4.19-0010 �?nt,. ►
S'1'itot4t3(slClt'.tc3N}.115-12fa�3Tl1 101-X10-241-0,00
GR.A.t ING FEE qac 1111-000423-100 5`x'11.00
114MRAS°3'ftW III— FES 22.5-0111E-443-342
e -IRT W 0-4J1.1.f.1C, PLAC.'h'-1IRSIT, 701•-040-2,55-009 Mi24.04,
r
" R RI KI, CONSTRUMION, AND PLAN CHR-CK$X1,057
34
ISM 1'17.,1? -PAID SETS
41„000.00
P A:PERMIT MES FlCJE NOW
��qtt e7.�14
J 11
RECEIPT
DATE
BY .
DA E,
INSPECTOR
a
1/
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
t ce T
Exhaust Fans
O.K to Wrap
% -
F.A.U.
Framing
o .► i
Compressor
Insulation
- G — QQ SZ
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
r�-
Final
Final 52-
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
jJ
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
f
Final
Utility Notice (Gas) ( J/
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
l
Final _
Utility Notice (Perm)
COMMENTS:
Notice:
Document Cannot Be Duplicated
Date 9/2/98
No. 17635
Desert Sands Unified School District
47-950 Dune Palms Road
La Quinta, CA 92253
760-771-8515
CERTIFICATE OF COMPLIANCE
Owner NameTurpin Construction Co.
No. 78-253
City La Quinta
Tract #
Street Birkdale Court
Lot #
Type of Development Single Family Residence
Comments
APN # 769-162-001
Jurisdiction La Quinta
zip 92253
Permit #
Log #
Study Area
Square Footage 4,232
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 4,232 or $ 8,167.76 the property listed above and�lhai Building`
permits and/or Certificates of Occupancy for this square footage in this proposed project may no ;v be issued
Fees Paid By CC/1 st Community Bank/Ed 'p o6ohone, r�
Name on the check: w
By Dr. Doris Wilson `
Superintendent
Fee collected /exempted by Juanita Green
Signature
Payment Received $8,167.76
Check No. 081624
NOTICE: Pursuant of As i fnbly 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 fr rf 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 DistrLdt('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
C&t�t 0 4 "
P.O. BOX 1504
78-495 CALLE TAMPICO
_r)ALI; CFt LA QUINTA, CALIFORNIA 92253
.,..,, 7l12,0/N ('0'u571lac7r of i Lo t
Mailing
Address 7 l)
City �1 Zip Tel.
(14 WUI Qr/) IFIL ?a *.3, 777- _701
Contractor ' Sit,"
M
ity
State Lic.I City
& Classif.
Arch., Engr.,
Designer
Address Tel.
City (Zip (State I
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby afffrnl thaJI am licensed undety6rovisions of Chapter 9 (commencing with Section
7000) of DI isi—ori 3 of tl�,e usiness and Professlons Code, and my license is In full force and
effect. MTi // ! rS 1A" I1,
SIGNATURE `///////tV/��W//�,eC ���...11l III H DATE
Ir OWNER -BUILDER UECLARATION
I hereby affirm that 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 Nathe 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).
1] 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.)
11 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.)
17 I am exempt under Sec. B. 8 P.C. for this reason
Date Owner
1
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.
j
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.) d
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. j
Date Owner i
NOTICE TO APPLICANT: d, 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 dashed revoked.
II
I
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the pe or 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.
1 certify that I have read this application and state that the above information iscorrect.
I agree to comply with all city and county ordinances and state laws relatingsto building—
construction, and hereby authorize representatives -of this city to ente'r the—above-
mentioned property for inspection purposes.
Signature of applicant I Date
Mailing Address
City, State, Zip f
i
'5C80(� -107
APPLICATION ONLY
ILDING: TYPE'CONST. _,OCC. GRP.
Number
Description
;t Description 5 r `�7�
Sq. Ft. No. No. Dw.
Size?. Stories Units 1
New bar Add ❑ Alter ❑ Repair ❑ Demolition ❑
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
/ „j/(f•!%
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 FA.
FINAL DATE \ V INSPECTOR
1''�,''nn,, 1
°s11�d by: Date Permit
U
$1
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
l
i