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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
5 3 2 ( W3 I B C33 (W30/201,
Ofate 6 4!;- Signature of Contractor,, V-41,
i
OWNER -BUILDER DECL-AKAII 1UN
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) 1, 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).
( ) 1, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. . 7044, Business & Professionals
Code).
( ) 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 work for which this
.permit is issued. My workers' compensation insurance carrier & policy no. are:
Carder Policy No.
(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 3100 -of the Labor
Code, I shall forthwith comply with these provisi
D or's.
pte: 1 47 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 laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
.Signature (Owner/Agent) Date
PERMIT#
BUILDING PERMIT
M$414419
DATE VALUATION LOT TRACT
JOB SITE
ADDRESS M.451 CAWWO QUENfAINA
APN
OWNER
CONTRACTOR DESIGNER ENGINEER
T(VINNEITID L&;t. IOEIRAI DhN MAD
B'NF1t1T&.,AN J CYS'HIDA,
77351 CANIM0 QUIM-ANA
0,k% DESERT LILYOK
LAQUIM-A CA 9Z2,53
PAUM DE*81IRT CA 92M
g� I CRT 14
USE OF PERMIT
120 SY, RCKMI. AUDITION
C"(Wil" OF
MOOT FEK,
PLAN (11SIECK VFX i0IAXX)-4,W-M8 $76.0
rONS'rRfSi� .. f10V tf� I _4.M_J 1p,-(W)n 1% 11-7. VK 4
S*2 1.50
S19.1)
8"fRONG bRYr1f-M FE2,1 - RISS10 loi-WO-2414M 93
SUIVIYYVAL CXW�IRUCTJGN ANV) 111 -AN 1C*HVC*.K
W0,4NS
" P F
LESS h
'11f �AL PERM51 KE -S Obfi, NOW
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
I DATE .
I INSPECTOR
OPERATION
I DATE
I INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
160) /,,,1 e
.7
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
V,9
F.A.U.
Framing
Insulation
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
BLOCKWAL'I APOROVALS
Final
POOLS -SPAS
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
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
ShowerPans
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voftage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
1.1tility Notice (Perm)
COMMENTS:
ITS`---..--„�
- H99AEMOD,�EL
FOf Th`E - ",s rC �gf-H SAD
BUIL
RE5.IDENCE
7735:1 CALLE QUINA TANA
L/2II_ 11_011
P� y
nfrMM WALL W/6' SLI.D€R
21-711--4
v OFFICE
Ao r AREA
A ('IFI Inl(,
REMOVE EXISTING
8' SLIDER
I I 1_811 2•
MASTER BEDROOM
LU
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DRIP FLASK
(GRAVEL GUARD)
DRIP FLASHING
MATCH ALL EX15T1 NG
COLORS * TEXTURES- -
IN51DE t OUT
CAN LITE
STUCCO
(T'P • )
STUCCO
5CREED
EXISTING TILE
5LOPE 2% TO DRAIN
3 -PLY BUILT-UP ROOF
2x 12 CIELING J015T5
@IG"O.C. W/2x12
BLOCKING
2x4 TOP PL.
112" DRYWALL
2x4 STUD
SECTION -1
11211= 1 1-011
P.T. 2x4 BTM. PLATE
I0"A. B. EA. END (4 -REQ.)
EXISTING SLAB
20" #4 RE -BAR KEY WAY
(4 -REQUIRED)
1214
NEW 12x20 FOOTING
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June 2. 19199
Kell Vfoorhead
i -, 13, Old Post Roa'!
boulder. Colorado "'o'lA
;:e: e: 77-351 Camino Quintana
Dear N -b-. \ loorhead:
Your Architectural Variance dated Mav 12. 1999 reLmrdim., the master bedroom extension and french door
installation has been apprc.ved under the Colloxing stipulation(s):
• Actwl modification must conform to the plan,, and specifications submitted and approved.
s'�
• The color of the walls I- doors shall match the existing stucco.
• The xvindow and door ',,-.rdware shall match the exlstinL, hard*,Vare.
• Competent and license,! shall do -all work- In a work -manlike m.;irmer.
• All %.� orL is to be in with lova! buil-din-_,, codes and ordi nan,;es.
• A.11 electrical wit-irlL,. i'apolic--ible, must be contalneCl vvithin approved condui! ainted to match the surface it
• any damage to the common -ire-is resultln`,. from this modification and its construction will be repaired at the
(",,vner's -.�:ren.se
• All construction debris is to be removed from the site by the close -,)f each day to niaMt1in --xder ana.; retain the
fiesihet'os of the Sani,,i Rosa ove
• Anv alterations to the coninion area landscaping. if applicable. must be presented to the Association's
landscape contractor. C.1mar Garza of Shadow Palms Gardening.
• -4 Prior to the comilienCenlent of any work the contractor and their subcontractori.s'i must provide the
.Association proof of worker's comp.. liability and auto insurance: naming the Association as additionally
insur,d.
• Prior to the commencement of any work you or vour contractor must provide the names of the scheduled
workmen to the security zuards at the Mazatlan -.,ate. (�64--;414)1.
• Pilo;- to the commencement of anv work you or your contractor are required to pay a S-;(')(') refundable deposit
it
for the room addition.
0
• Pooi- to the commencement of any ,vork- yo * Li or your contractor are required to pay a one time fee of S.5 per
square foot for the new roof area, as well as provide a five year written guarantee coverinLa the new roof.
7Twe.
• The near roof is to be installed by Western Pacific Roofiniz. 77. 0
ee
'OFa
Please contact the Association office once your modifications are complete for a final inspection. A copy of
the approved variance \vIII be mailed to you after the inspection. If you have any questions, please call.
Very truly yours.
'/ / "Z J
Pamela S. Salinas
Association Manager
On Behalf of the Architectural Committee
THE S.k\-TA R(_)SA COVE ASSOCLATION
Cc: Mary Martin B S- M Distinctive Residential Interior Desist
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PROPOSED CLOSET W/8'DR.
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PROPOSED DESK 4 CABINETS
DESK
NOTE:
MATCH ALL EXISTING COLORS * TEXTURES
1 NSI DE * OUT
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PROPOSED CLOSET W/8'DR.
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G7 Drn
PROPOSED DESK 4 CABINETS
DESK
NOTE:
MATCH ALL EXISTING COLORS * TEXTURES
1 NSI DE * OUT
3 -PLY BUILT-UP ROOF
W/ FLASHING 3-5IDE5
SLOPE 2% TO DRAIN -��+-
K
DRIP FLASH TO MATCH OC
(GRAVEL GUARD) -+
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Cit�:.ST.Zip:
Telephone: jq3 1
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State Lic. 532 62 1
City Lic.
Arch.. Enur.. Designer:
Address:
City. ST. Zip:
Telephone:
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Construction Type:
Occupancy:
State Lic.
................
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.................................. ..................
Project type (circle one): New (Addn)
Alter Repair Demo
Name of Contact Person:
Sq. Ft.:
# Stories:
1
# Units:
Telephone # of Contact Person:
Estimated Value of Project:
40
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Notice:
Document Cannot Be Duplicated
Desert Sands Unified School District
47-950 Dune Palms Road
La Quinta, CA 92253
760-771-8515
CERTIFICATE OF COMPLIANCE
Date 8/18/99
No. 19207
Owner NameKenneth D & Geraldin Moorhead
No. 77-351 Street Camino Quintana
City La Quinta
Tract # Lot #
Type of Development Residential Addition
Comments
.20 sq. ft. room addition
APN # 631-700-060
Jurisdiction La Quinta
Permit #9908-109
Log #
Zip 92253 . Study Area
Square Footage 120
No. of Units
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:
Residential Addition 500 Sq Feet or Less
EXEMPT
This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of
0.00 X 120 or $ 0.00 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 N/A Brenden O'shea Telephone 862=193 J'r
Name on the check
By Dr. Doris Wilson ,
Superintendent �1<
Fee collected /exempted by Sylvia Carrasco Exempt $0.00
Signature
"'4
Check No. N/A
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
collect 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