9809-161 (RPL)LICENSED CONTRACTOR DECLARATION PERMIT# CONTROL#
I hereby affirm under penalty of perjury that I am licensed under provisions of BUILDING PERMIT �711►�-di3
F- Chapter 9'(commencing with Section 7000) of Division 3 of the Business and DATE VALUATION $154 }� (t( LOT TRACT 8 8 A
(/) r 1 yYJo.!)i� V 8 4
N w Professionals Code, and my License is in full force and effect. j //
License # Lic. Class Exp. Date
W / G 128 l J� , 10/31/38 ADDRESS JOB SIYEt 78-'700 (. AB I,LLONVA.V APN
} t L\ ���
Z r- wl0ate ice} `� I Signature of Contractor /?''� ` OWNER CONTRACTOR /DESIGNER /ENGINEER
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cfl O o T.C)1)i Si ; "f74 �'L�.!�P�1 1zIT CALIFORNIA POOLS & SPAS
�p OWNER -BUILDER DECLARATION •
-I U 79.295 I`U1NCHO LSA. QUINIA OR 74-725 JU.M lei IVI , -iA
W W I hereby affirm under penalty of perjury that I am exempt from the Contractor's ,� ,
~ License Law for the following reason: LA QU1NIVA. CA 92253 VA.LM DESC
I'
EKA 92260
Z_ ( ) I, as owner of the property, or my employees with wages as their sole (70)340•-91VO CCNU} 355
compensation, will do the work, and the structure is not intended or offered for
sale (Sec. 7044, Business & Professionals Code). USE OF PERMIT
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals POOL, OL, •MNUlCA SPA
CY)Code).
LO ( ) I am exempt under Section , B&P.C. for this reason POOL MAD SPA ONLY
N Date Signature of Owner
ON
0)
Z WORKER'S COMPENSATION DECLARATION
o Z I hereby affirm under penalty of perjury one of the following declarations:
LO O O 1 have and will maintain a certificate of consent to self -insure for workers' POOL OL tiMWOR 5PA d5,:�.00 LS
X W �= compensation, as provided for by Section 3700 of the Labor Code, for the
O J Q performance of the work for which this permit is issued.
m Q U ( Y) I have and will maintain workers' compensation insurance, as required by
p U Q Section 3700 of the Labor Code, for the performance of the work for which this
rn I- permit is issued. My workers' compensation insurance carrier & policy no. are:
't Z Carrier Policy No.
oo O :�:c. r..211"I ri''O (t 16-9810M, E%ITNIA•�i'D C01.'YF Ot' CONST .$tCTi:ON
J (This section need not be completed if the permit valuation is for $100.00 or less). ZIVA01101TF17 U SUMMARY
( ) I certify that in the performance of the work for which this permit is issued, PLAN C1.4EC IEEE 1.01.-000-433 ?lei
I shall not employ any person in any manner so as to become subject to the 01N;i'1IR 140N FEW 101 -WO -419-000 S!111.i1t)
workers' compensation laws of California, and agree that if I should become Tv113r if1A111AI, r1?ts'-- P001- 101 -WO -4111,11-000 =:00
3 subject to the workers' compensation provisionsof+'Section 3700 of the Labor
Code, I shalt forthwith`comply with those provisions GLEEC"1`€ ICAL F -HE --1'C 0f, It 0.1 "W5.00
(,Date:".
_ :Applicant �,s .- m* )'S.UM"EIiNO11:1--Ft'►f)L 101-(M?ii-404)U() 527.00
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. j? V
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, indemnifyPMON AX0 PJ.1 N CHECK
& hold harmless the City of La Quinta, its officers, agents and employees.9 LEE 1 RIE
FTSSS $11,00
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 t)`1AL.:4'.N',R1V3fC 1i•.ERS JAM NOW
permit, or cessation of work for 180 days will subject permit to cancellation. SEP 3..a 1998
I certify that I have read this application and state that the above information is �r)
correct.,! agree to comply with all City, and State laws relating to the building9! �y
construction, and hereby authorize representatives of this City to enter upon �� C UINNTA �
the%above-mentioned property for inspection purposes. --`"^� }
t X, RECEIPT DATE BY/� D F ED INSPECTOR
Signature (Owner/Agent) 1 #�� Date � .-
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
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
Steel
POOLS - SPAS
BLOCKWALL APPROVALS
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
�2—g
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
U -
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
C
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
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
s
t
Final
Utility Notice (Perm)
CERTIFICATE OF COMPLIANCE ��1VIEDSC
Desert Sands Unified School District 6N �o
47950 Dune Palms Road
BERMUDA DUNES
Date 10/7/03 La Quinta, CA 92253 Q
CIO RANCHO MIRAGE
N INDIAN WELLS
No. 25052 (760) 771-8515 ��: PALM LA QUINTAT
_yQINDIO
Owner Bob Runyan APN # 646-420-033
Address 78-700 Cabrillo Way Jurisdiction La Quinta
City La Quinta Zip 92253 Permit #
Tract # Study Area
Type Residential Addition No. of Units 1
Lot # No. Street S.F. Lot # No. Street S.F.
Unit 1 78700 Cabrillo Way 274 Unit 6
Unit 2 Unit 7
Unit 3 Unit 8
Unit 4 Unit 9
Unit 5 Unit 10
Comments
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 (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile
homes. It has been determined that 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
Education Code Section 17620 and Government Code 65995 Et Seq.
in the amount of $0.00 X 274 S.F. or $0.00 have been paid for 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 Exempt - Bob Runyan Check No.
Name on the check Telephone
Funding Exempt
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Sharon MCGilvrey Payment Recd 1$0.00
Over/Under
Signature
NOTICE: Pursuant to Government Code Section 66020(d)(1), 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 issued,, or from the date on which
those amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier.
NOTICE: This Document NOT VALID if Duplicated
Embossed Original - Building Department/Applicant Copy - Applicant/Receipt Copy - Accounting