The URL can be used to link to this page

0105-233 (SFD)' LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of H Chapter 9 (commencing with Section 7000) of Division 3 of the Business and c4 W Professionals Code, and my License is in full force and effect. O =) ch License # Lic. Class Exp. Date ir� 0 U 6Z Date Signature of Contractor i FF (p 0 li f J V2 -,OWNER -BUILDER DECLARATION Wa I hereby affirm under penalty of perjury that I am exempt from the Contractor's In License Law for the following reason: 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). C'') () I am exempt under Section , B&P.C. for this reason LID N Date Signature of Owner O N Q7 Q WORKER'S COMPENSATION DECLARATION CL p 2 Z I hereby affirm under penalty of perjury one of the following declarations: LO _ O () 1 have and will maintain a certificate of consent to self insure for workers' X U compensation, as provided for by Section 3700 of the Labor Code, for the mJ Q performance of the work for which this permit is issued. Q U ( ) I have and will maintain workers' compensation insurance, as required by O UQ Section 3700 of the Labor Code, for the performance of the work for which this d rn H permit is issued. My workers' compensation insurance carrier & policy no. are: It Z Carrier Policy No. aoo O RATE C'O'h4P:ki3 FIT 0424"_00 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 3 subject to Vie-, workers' compensation p ovl ipns of Section 3700 of the Labor Date. atde C I's, , o J� comply with t revisions. ,r} 1 Applicant��,,fd w Warning: air 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,e. the above-mentioned property fo in 'Vection purposes. i Signature (Owner/Agenti I (Owner/AgentDatedlgf BUILDING PERMIT PERMIT# DATE VALUATION LOT 33 TRACT CE''irg/20C. 9105.1ri,6.0 70 JOB SITE APN ADDRESS +� a,2� y�� p;��y9 ? g� �y� t y�� I&"7fd5.F3( '.17 . RVSF[WUV.9 OWNER CONTRACTOR / DESIGNER / EN INFER NOR ;17' W991--80t)M-1WZ1 1''LiFVi.CS:� MEN -1 NORTH -44M 30U !-1WHr,9T D`F°iT1:0P . rlt�'ZVr 77-564-A COf TIMY CLUB DR. 4.113 77-564-A (70UN RY CLUD DR. #113 3?ATM 3:)1�,s�E Z1r CA, 93211 PALM 1315' R7' CA. 02211 (160)408-3,1495 CMO 6133 USE OF PERMIT S.NME AWYLY ISWMLNG . 1r:0 d� :i�+ll'd' OC? S EJU'f Il'd�r'1�t30f3 f3:t;CX 113A.Z.,LdS'PA1 0OL -O TRACT irOAlS'PRUCTION 1,'7bS.Q4 SA SP S�PYY(p71�°?C/;1�igf6aATi�yC3y��y �+ y S(0IM ^0J iS.LB.,7.R."'A'6S �AL1�.i�L,P. LW) F9'13 'MM COW r,T' OF (.0M7Ni7C110N CONSCITRUCyTION PEZ, 101.000410.000 S640.i0 PLAN CHECt.C.FER 101.000.4395 31 8 FRE DEPOSI'T 101-000.439.3/1119 A'IVA T<A.NICAL I'lpi? VLECTIUCAL FIRM 101.0001.420.000 d'':.:i,sUli11+10 l;k:. - 10'1-0.100-419•-M 8 T R(;' (1 ki0Tf0'H FEK - USID )01-000-341-000 Si tb.S`7 L RADING YEF, 103 -0004.23-Wil DORLOPPR. IMPACT IRs. SUS. -TOTAL CONE .T1C110,11C AIM) AL.a? W CHECK fj;3,A111 S LFAM PRE -MD FEES 4250.00 .MAL PETtiiW YM MIT NOW RECEIPT DATEJ r /�) / BY DTE NA LE o INSPECTOR / I INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs a Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck 8 l O 1 Exhaust Fans 0. K. to Wrap 8 —� . �L T F.A.U. Framing Insulation-�� _c _ S7 Compressor Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath _ _ Final g/: BLOCKWALL AP ROVALS Final POOLS - SPAS Steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Pibg. Test Final Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste lanes Water Piping _ l / n� _ Heater Final Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection �_ . d .... �i/ Encapsulation Gas Piping Gas Test fly_/ Appliances 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 (f�� Utility Notice (Perm) TleK r 677r COMMENTS: VAINel, ' Building Mailing Address City lit c&t " �44QL__78 P.O. BOX 1504 APPLICATION ONLY d 7 Me F*ucA OR—LA QU NTACCALIFORNIA 92253 r0 r- ( L -J C/t✓��. City Zjp BUILDING: TYPE"CONST. OCC. GRP. A.P. Number Te `Lf1 (� aft V Legal Description p lo r'I a,., � Project Description � .S rl2 State Lic.�—% City & Classif. ? Q� / 01 L Lic. p Arch., Engr., l. Designer lel. Zip (� State Lic. q LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (comma Ing wll Section 7000) of Divisiom the 8 Iness and rot ssions Code, and my Iicens s In full ce a d effect. NAT F ATE OWNER -BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractors 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, dei(aolish, or repair any structure, prior to its Issuance also requires the applicant for such permit to rile 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). 1! 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not inlended'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 or completion, the owner -builder will have the burden of proving that he did not build or improve for the purpose of sale.) I 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.) 11 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 (l Copy is filed with the city. ❑ 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 Thal 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, after making this Certificate of Exemption you should become subiect 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 Ihereby'effirm 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 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 aOplicant Date Mailing Address City, State, Zip Sq. Ft.G No. No. Dw. Size l-1; n Stories l Units New Add ❑ Alter ❑ Repair ❑ Demolition ❑ :stimated 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 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 5/31/01 No.",' .22072 Owner Name Westcoast Construction:& Investments APN # 646-312-020 Jurisdiction La Quinta No. 78-705 Street Bottlebrush City La Quinta Zip 92253 Tract # "Lot # Square Footage Type of Development Single Family, Residence Comments Permit # Log # Study Area 1,768 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 ! 2.05 X 1,768 or $ 3,624.40 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/ Mountain View Federal - Dick Scott Telephone Name on the check By Dr: Doris -Wilson Superintendent Fee collected /exempted by Paula Ruiz ` Payment Received '',$3,624.40 Check No. 101049 Signature NOTICE: Pursuant of Assembly 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 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 collect them on the Oistrict('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 ) • r