0307-271 (AR)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
701039 B IRC
D,at'e-/Z-, J -Signature of Contractor•— t-�:_
OWNER -BUILDER DECLAR
I hereby affirm under penalty of perjury that I am-le-xempt from the Contractor's
License Law for the following reason:
( ) I, as owner of the property, or my emplgy`es with wages as their sole
compensation, will do the work, and the structure Isnot intended or offerN dhor
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).
( ) 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:
Carrier 9T.AITE i:'17ND Policy No. 0004649W -OI
(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 provision of -Section 3700 of the Labor
Code, I shall forthwith comply with*those provisions.
Warning: Failure to secure Workers' Cornpe'nsation co"verage is unlavvful'and. ,
shall subject an employer to criminal penalties and civil fines�p to $100,000, in
addition to the cost of compensation, damages as provided foSection 3706
of the Labor Code, interest and attorney's'fees.
IMPORTANT Application is hereby made to th�e,Director of Building and Safety
for a permit subject to the conditions and re`strictigns see 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) ""� "--�^-g-- h Date
r
BUILDING PERMIT PERMIT# '
003-27i
,
DATE F VALUATION LOT TRACT'
mob'
_.! /'��! /
! r� r
JOB SITE J ° f - y.. APN
ADDRESS 49-772 PAtfCWO SAN.VRANrInQU rO 649-IM401S
OWNER
CONTRACTOR/ DESIGNER/ EN INEER
'R!!t LA. QTHkTrA, X.. IC
TRAMSWESr EYOT7MIG Wt rc
9968 �T1t31?l T Ur., SlTL'i°t 1.02
78.401 :f+ .H'iC3HWAY 1 % 1
RM DIEGO CA 92131
LA Q•i7IA TA CA 92253
(760)771-31363 MW 4972
USE OF PERMIT
REM `.1' T, RKMODELT
SID . I,OT 63 312 SQ, FT. GAP kOe COW TO i,P4PYNG AT CASITA OF
PL.kW 4& PERMIT DOM>"iOT INCLUDE BLOCK WALL% POO - R---,
DRIVEWAY ..a. VPOACH. SUPPLEMENT TO PERMIT 0204.053
y JU
2 4 2003
CUOTOM BONUS ROOM tuONVF, 312,00 SF
- j CITY
OF LA QUINTA
FIN
kNCE DEPT.
:s,ST1LE'J9} -rE.I3 CC7sr OF Cara-nRETCI ON
18,189.60
PLAN CHECK "KE I01-000.439-31.8 SIX70
i"ONSTRUCTION FEE I01�,000-418-000 $I9f3.f30
il4FXHA141C.AL FEE 101-000-421-000 �Ig,sa
XLECT'RICAI.. 1:09 -OkI0,420-oat? $31.50
PL(FMBINO FEE 101 x000.419-f)00,� $21.00
S'I RONO MOTION YZE o RESID 101- 000-2I-666'<4 $I.13a
SUB-`P(MAL CONKRU(;':C OR AW PI AW CHOM
00.52 .
LESS PRE -PAZ) F.E. ct
$0.00
TOM F'ERMff FF.,EN DUE NOW
RECEIPT
DATE
BY
DATE FINALED
INSPECTO
r
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
2 g . 3
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
- 2 _
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
-
Final
Final —
BLOCKWALL APPROVALS
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
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewef Connection
V
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp.iPower Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors `
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
_
CERTIFICATE OF COMPLIANCE vF�Dsc
Desert Sands Unified School District 4�c�°
47950 Dune Palms Road °
:C BERMUDA DUNES r
Date 7/24/03 La Quinta f CA 92253 RANCHO MIRAGE d
� INDIAN WELLS �r
No. 24742 (760) 771-8515 PALM QU;NT �y
INDIO y�
0
Owner
PM La Quinta LLC
APN # 649100015
Address
9968 Hibert St., Ste. 102
Jurisdiction La Quinta
City
San Diego Zip 92131
Permit # 0307-271
Trait #
28964
Study Area
Type,
Residential Addition
No. of Units
Lot # No. Street
S.F.
Lot # No. Street S.F.
Unit 1 63
49772 Rancho San
312 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 312 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- David Trask Check No. N/A
Name on the check Telephone 619/843-3048
Funding Exempt
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Patricia Barbuzza 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