003452 (RR)T4ht 4 4 Q"
Buildin
Address 78-220 Calle Cadiz
matting
Address 52-042 Avenida Herrera
City Zip ' Tel.
La Quinta 1 92253
Contractor
ress
Zip
State Lic. I City
& Classif. Lic. #
Arch., Engr.,
Designer
Address Tel.
tyI Zip I State
Lic. N
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Susiness 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
Of' 'ion 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis
Ualleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit
the applicant to a civil penalty of not more than five hundred dollars (5500).
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.)
❑ 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.)
❑ 1 am exempt under Sec. B. & P.C. for this reason
Date h j Z' , ' / Owner '" �GliG rvv
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
❑ Copy Is filed with the city. ❑ Certified copy is hereby furnished.
I CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
his section need not be completed If the
R p permit is /or one hundred dollars (E700) valuation
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.
Date Owner
NOTICE TO APPLICANT.- If, 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 deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm 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
(4qJrAddress
isIsa building permit when properly filled out, signed and validated, and is subject to
if work thereunder is suspended for 180 days.
"J.:n
ify that I have read this application and state that the above information Is correct.
ragree to comply with all city and county ordinances and state laws relating to building
E and hereby authorize representatives -of this city to enter the above.
mentioned property for Inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
BUILfOk", DIVISION
No. 003452
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number 769-105-010
Legal Description
Project Description
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add)O Alter ❑ Repair ❑ Demolition ❑
and re lacing roof
Estimated Valuation
$54,294.00
PERMIT AMOUNT
Plan Chk. Dep.
Plan Chk. Bal. C s.
Const. 298.00,--
Mech.
98.00,--
Mech. 27.00
Electrical 62.28I:
Plumbing 47,00,
S.M.I. 3.82
Grading
Driveway Enc.
Infrastructure
TOTAL $631,80
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 10 / 15 / 8?ermit
Validated by:
Validation:
Desert Sands Unified School District
CERTIFICATION OF PAYMENT
OF
SCHOOL FACILITY FEES
TO: City of La Quinta DATE:
Department of Community Development
78-105 Calle Estado
La Quinta, CA 92253 NOTICE: THIS DOCUMENT CANNOT
BE DUPLICATED.
.4
This is to certify that `/'
developer of
located at
this District, has paid school facility ee
authority genera by Government Code Sect
covering a total of square
( ) industrial/commercial development and
this footage in this development may now be
141--e151�1"_4:_
LA
CA
na
which is
/S within
imposed pursuan to the
ion 53080 in the aim nt
e-10-12, � 0 Oma
fee r( residential or'
that building permits for
issued by your jurisdiction.
a/
for DESERT SANDS•UNI IED SCHOOL DISTRICT
White - Building Department • Yellow - Facilities Planning • Pink - Accounting • Gold -Developer
C� . 1,-,2 lJ,F (10)-37