9807-150 (SFD)LICENSED CONTRACTOR DECLARATION
hereby affirm under penalty of perjury that I am licensed under provisions of
Fes— Chapter 9 (commencing with Section 7000) of Division 3 of the. Business and
N W Professionals Code, and my License is in full force and effect.
:3 M License # Lic. Class Exp. Date
W Lo
lli 1i}r l 1.3 it"ijill/:.
cZ r— /bate `�� Signature of Contractor•'
CID O ti \\\
J U CD OWNER -BUILDER DECLARATION
W LULU r` I hereby affirm under penalty of perjury that I am exempt from the Contractor's
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 O I am exempt under Section , B&P.C. forthis reason
0
N Date Signature of Owner
O�
U Q 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 workJor which this permit is issued.
(y 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:
Carrier Policy No.
S
" 1'ik'tY's RIM.) t 371 W�Stl 11
(This section need not be completed R 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 3�Q0 of the Labor
Code, I sF�11 frhwith comply with those 11(t *ion . r
Applicant �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 comply with all City, and State laws relating to the building
construction, and hereby authorize reprepatives of this City to enter upon
the above-mentioned property for inW coon p ,rposes.
Signature ,(Owner/Agent)L- Date4�
PERMIT #
BUILDING PERMIT
99174541
DATE j%�� VALUATION I '1t f 73 6qy Mb LOT '44 TRACT S I q 1
JOB SITE
ADDRESS -
'C9b:�r5CXNAEJ��Y,II..It10 ADDRESS
tpQ1e-,f,9�-I➢�6
OWNER
CONTRACTOR/DESIGNER/ENGINEER
'1'11 �'s!7��:iti'i'I-tl`"C!'1.1 i`IfYq 11: b_'1.'
. c1 .-l..�l. ��, t 1✓ate r l."1,.�..1 11 I.I�Y ,
1.•t),�Ct L't:",t..i�fC"i-!r�!'*`f'!t'kA.i
lj9, f'{,1 t 4�I A_Vl lA! i \.tJS� a fL!lV
(760)77t -0-1f
USE OF PERMIT
SH) - PLAN V".3 1"'fs!<ltill I UA' ki- vU i IIVi`1.U1:11i �i,e iGl. fAlftl..l .`.i Uit
6!o(a'e.,. PLAN 0*.'CK F W4.0LICUL) 71%4.1, )A'At MUl..TII- t.l3 la3tillA.N:'IS Pih'
i;i1;:i/v��\.�,.+i'w.rl.'6�i,i�.�•,ji:ii� +!', i �
CIAlcAt3fJ�:;r+ltl�:iKY f,t �.txi :;!':
FS-IRTNIATED CONT OF (M-S'I'RUCTION
173,1657.311)
C(I)WITFROCIDON t7'i' 13 10100-4119-000 x3 $ mM.5tf
lift, i�A� Clif?i1K..l.'`f?!n ii 31.8^.H�s41
oa1ll(�(111��y!
Lv11�;x1Alhlc,21.1.1't:;t:. 101 -0100.421 -OW ST4' 00
il.k:�."t!?li,:r<il, alt, ltrl-tjtlCl-�l'xt)-th)1) 51:f�.i.:t
Pf,Ctf4iI1IP40 F13!i I li l-(10ti- 4 tti-f}l)if x t4 _i. t5
ST!i[;tiW1NICYTf.i►sVet".1T
oftiVANf; r"UL. 101-(I<1042;-000 2`20'(4)
t 1111ANYW jCT RE' r 1:1: 2.2 5-1)1ift-tWL 142 v o i ..4.!
ART IN P!►T3IAC PI AC ES- RES11 70t-000-25`.x-(i()f1 S184.Iit
_�N AW) sq,.tlnt r"�HEck
15 5615 R1
— l,tSs;
f..� � T, E�. '�` � ��c►��',a.r.��e�,�iw� �' I+tr:�:� I►�a I IH: •t�s�W
�:z,s�s�.�.s
RECEIPT
DATE By
DATE FINALED
INSPECTOR
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
Framing
.,
F.A.U.
Compressor
Insulation
5!
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
- 2
POOLS - SPAS
BLOCKWALL
APPROVALS
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
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
-
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low VoltageWiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors'
Temp. Use of Power
Final
Utility Notice (Perm) -2- ,��
CERTIFICATE OF COMPLIANCE
Desert Sands Unified School District
4,-
47950 Dune Palms Road < BERMUDA DUNES O
CA RANCHO MIRAGE I:;
Data 5/16/05 La Quinta, CA 62253 Y INDIAN WELLS
SLA' QU NTA 7
No. 27196 (760) 771-8515
J�Q INDIO yr,�
Owner Jill Price APN # e46-330-049
Address 49-155 Casa Del Rio Jurisdiction La Quinta
City La Quinta Zip 92253 Permit #
Tract # Study Area
Type Residential Addition No. of Units 1
Lot # No. Street
Unit 1 49155 Casa Del Rio
Unit 2
Unit 3
Unit 4
Unit 5
Comments
S.F. Lot # No.
241 Unit 6
Unit 7
Unit; 8
Unit 9
Unit 10
Street S.F.
At the present flare, the Desert Sends Unified School Dlsdiat does not coihect Fees on garagesAmports, covered pa* A4 aikways, reskWftl additions under 5
00 square Feet, detached aooessory sbuctures (spaces that do not carhtabh fadldies far 6vtng, sleeping, COMM. eating or sandatlon) orieplacena blle ho
me& It has been determined that the above4mmed 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 241 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 - Jill Price Check No.
Name on the check Telephone
By Dr. Doris Wilson
Superintendent
Fee collects
Signature
Funding Exempt
Payment Recd®
Over/Under
NOTICE: Pureuard to Government Code Section OW20(d)(1), this Will serveWiiotify you that the 904" approval period In which you may protest the Fees o
r other payment iderhM e l above w0 begin to run from the date on which the bu*ft or installation permit for this project is Issued, or from the date on which
those amounts are paid to the Diel ict(s) or to another public er9dy autlwr(aed to collect them on the Dfshio e) behalf, whichew is eadier.
NOTICE: This Document NOT VALID if Duplicated
Embossed Original - Building Department/Applicant Copy - ApplicanttReoeipt Copy - Accounting