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0205-139 (RER)LICENSED CONTRACTOR DECLARATION U) I hereby affirm under penalty of perjury that I am licensed under provisions of F— Chapter 9 (commencing with Section 7000) of Division 3 of the Business and CN LU Professionals Code, and my License is in full force and effect. O =) M License # Lic. Class Exp. Date r- d u7 LU oZ r.- Date f ' �`'� Signature of Contractor l -•'��� ~OWNER -BUILDER DECLARATION `\ Ha I hereby affirm under penalty of perjury that I am exempt from the Contractor's U) 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). M() I am exempt under Section B&P.C. for this reason LO N Date Signature of Owner ON rn Q WORKER'S COMPENSATION DECLARATION C Q Z I hereby affirm under penalty of perjury one of the following declarations: r O () 1 have and will maintain a certificate of consent to self -insure for workers' X W u compensation, as provided for by Section 3700 of the Labor Code, for the Om _ Q performance of the work for which this permit is issued. Q (� (',,r)� I have and will maintain workers' compensation insurance, as required by O U Q Section 3700 of the Labor Code, for the performance of the work for which this li Z permit is issued. My workers' compensation insurance carrier & policy no. are: Carrier Tpt,rj1 InSI^iD Policy No. M=4►2400742 d 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^ag'reeithat if I should)become 3 subject to the workers' compensation provisions of Section 3700 of te Labor Code, I shall forthwith comply with those provisions. / Date: 0 � ��' 7+ r i - Applicant ".—'—" -- .. 1 r' 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 com`ply�with all�ty,.a,�nd State laws relating to the building construction, and hereby authorize representatives -16i thi City to enter upon J the above-mentioned propeAy,for inspection purposes. ¢ Signature (Ower/Agent) yDate.:',+ BUILDING PERMIT PERMIT# WIMS-139 DATE _ VALUATION LOT TRACT tea' /7-( .'1.75.�fb I65?/t JOB SITE APN ADDRESS 79-IW5 B.+ROOMMU& OWNER CONTRACTOR/DESIGNER/EN (NEER LAQVINTA0,11MARDPATtDME. SPARKS�ti;:'�TS7FIf1�'Sif7 "I9m293 RANCT-10 LA. 4;UIVIADIL 79-295 RAI~i'MO 1A Q'LM7'�',�.ER LA Q11119TA. CA 97,253 ct, (760)771-1541 MVP 299,6 USE OF PERMIT ?'&S.177EN'SI'A?' RTEMO wy n, . II7i:N t 1AL it19.+thC DEL. - C.`C)NVLERT ONE Ci/I "LOE 13AY TO NV INQ SPAC36 BONUS ROOM 514.00 SY Cti 7 'I"1 d� C:d 'Eat P'•(:?N1ti?; � +vIfIlON ;tc'X1«d"ry.,11KIs S" gMWARY COt rTFd.UCT1V14 f*ZE 101-0130.41S-000 $WOO PIAN CHECK FELF, 1.11-000-439--318 $166A2 MECHANICALMES 101 _0001421-0100 x9.4 M..Is.CTRIC A). PI:1' $37.45 PLt_3p�i.I~31N�II�B1s 101-000-41 '-000 ST3zOHO 1'uElil'ION Aff, •, RF 1D 141-WJ••241-000 MA- WAL RECEIPT DATEY /7-V��.2 IBY 7. IAS-19ED4� IINSPECT I 'I gmsmu $482.:x:5 $4€b:2.35S INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Z Combustion Air Roof Deck Exhaust Fans 0. K. to Wrap F.A.U. _ Framing - Compressor Insulation - o'Z Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall . Exterior Lath Drywall - Int. Lath Final 412, Final POOLS - SPAS BLOCKWALL APPROVALS steel Set Backs Electric Bond Footings Main Drain Bond Beam - vZ Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final - - 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 Encapsulation Gas Piping 15, Gas Test Appliances Final COMMENTS: Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring -3� QZ n Low Voltage Wiring Fixtures Main Service Sub Panels 1,2 Exterior Receptacles G.F.I. C7 7 - Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) Bin # City of La Quinta Building a Safety Division P.O. Box 1504 78-495 Calle Tampico La Quinta, CA 92253 Building Permit Application and Tracking Sheet Permit # q a�0 %S / Project Address: p 61tLoo4411 iF Owner's Name: 11,17 Qte., td,t, EAf A. P. Number: 6, 2 7 %O co 7 Address: ' / 71 Legal Description: T/n 2,1, 5-1"4 ZO 7 1,7 Contractor: Zo jJ7 /✓L City,ST. Zip: , ejol 9L Telephone: �% -7 Address: P9 5 / 7/6 Project Description: Cit-..ST. Zip: 44 2 2 t 4 a d >o/ � e X/ 5//) Telephone: "? ? r r 4 1411,1 s 4 State Lic. Z : 4, 7 VO 77` City Lic. #: Z7 76 Arch.. Ener.. Designer: I /� rCy I/ _f_/ Address: �/ /v Djj/v z_0 Cite. ST. Zip: ` i�c/ 64 1 7 7Z / Telephone: 3 (o p p 2 FO Construction Type: Occupancy: State Lic. 9: Project type (circle one): New Add'n Alter Repair Demo Name of Contact Person: p 44N S�A.1 /cS Sq. Ft.: :P54 # Stories: # Units: Telephone = of Contact Person: 7 7/ Estimated Value of Project: H 2A APPLICANT: O© NOT WFdTE BELOW THIS LINE # Submittal 'A2W— Reed TRAE3MG PER. MT FEES Plan Sets �/tr{ Plan Ch"k submitted // Item Amount Structural Cafes. Reviewed, ready for corrections !{ Plan Check Deposit Truss Catcs. Called Contact Person Y R-Plan Cbeck Balance Title 24 Cala. Plans.picked up y.10 . p Constraetioa Grant Deed Plans resubmitted Z 9/oZ Mechanical School Pees Renegued, ready to iasae 3 v Electrical Subconaetor hist Called contatt Person. Plumbing Contactor Into: 'Date of permit issue S.M L Ciy Business Lic. Grading vgwleess�Gonrpr l Ufrastraeftre Planning Approval Pub. Wks. Appr. H.O.A Approval Fire Mar. Appr. H. Dept. Approval AR. Approval Date offinalInspection, f T*WPeradtFees 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 5/14/02 APN # 772-040-007 No. 23217 Jurisdiction La Quinta Owner NameLa Quinta Orchard Partners Permit # 0205-139 No. 79-405 Street Brookville city La Quinta Tract # 26524 Lot # 19 Type of Development Residential Addition Comments Log # Zip 92253 Study Area one garage bay into living space Square Footage 514 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 2.14 X 514 or $ 1,099.96 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 California Bank - Judy Halpin Name on the check By Dr. Doris Wilson Superintendent Fee collected /exempted by Crystal Scott Signature Telephone Payment Received $1,099.96 Check No. 01179 40TICE: Pursuant to 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 milect them on the DistrictCs)(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