9609-123 (SFD)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
ave Hid
Dat)_,2- 'Signature of Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) 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).
( ) 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.
e(r� 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.
7
(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 ��Section 3700 of the Labor
Code Lshal�for Ith comply'P t�iose,P• ovisio - s.
Date- � ` 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
applioation.
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)''C �� �a,cY Date�� J�
PERMIT # CONTROL #
BUILDING PERMIT
wot)zi1.i 4435
DATE vi ��IJ VALUATION ¢��LOT TRACT
ADDRESS 51�lf"tJ a ���y�i.. Ovt i'JOB SITE
-
APN
OWNER
CONTRACTOR / DESIGNER / ENGINEER
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(10'C3t)INE11 ('f)^fS' .Itt of J1 )M
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Pos
USE OF PERMIT
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TOTAL -V 'OW
a
RTEIPT
DATE
Bye/[DATE
FINALED
INSPECTOR
AV-.
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs D G
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck c
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wali InsulationCondensate
Lines
Party Wall Firewall
Exterior Lath —
Drywall - Int. Lath
Final
FinalI M4
POOLS - SPAS
BLOCKWALL A VALS
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 /0
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 A P OVALS
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
Final
Utility Notice (Perm)
`t Notice:
Document Cannot Be Duplicated
Desert Sands Unified School District
82-879 Highway 111
Indio, CA 92201
619-775-3500
CERTIFICATE OF COMPLIANCE
Date 11/14/96 APN # -769-144-008
No. 15016 Jurisdiction La Quinta
Owner Name Coronel Construction Permit #
No. 51+460 Street Calle Quito Log #
City La Quinta zip 92253 Study Area 116
Tract # Lot #. Square Footage 3034
Type of Development Single Family Residence No. of Units 1 .
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 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:
EXEMPTION NOT APPLICABLE
This certifies .that school facility fees imposed pursuant to Government Code 53080.
in the amount of 1.84 X - 3,034. or, $ 5,582.56
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 ccNalley Independent Bank/Samuel & Olivia Acosta Telephone - 564-4604
Name on the check
By Dr. Carol McGrew
Administrator in Charge
Fee collected /exempted by Pauline Pearson Payment Received $5,582.56
Check No.'' 129414
Signature R1 140 AA i P��V nj A A )n/v,\-
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
1
JAMES D. FEIRO
CIVIL ENGINEER LAND SURVEYOR
P.O. Box 12980
PALM DESERT, CALIFORNIA 92255
16191 3 4 6-8 015
FAX 16191346-2548
Dec. 13, 1996
City of La Quinta
78-495 Calle Tampico
La Quinta, Ca. 92253
Attn: Public Works
RE: Lot 17.1 Desert Club Tr. #5
APN: 769-144-008
This letter will serve to state that on this date, I field checked the finished floor
forms of Lot 171, Desert Club Tract #5 and found them to be 1.25 ft. above
the highest adjacent existing top of curb.
QSGC E SS/p�Q Sincerely,
D.
C" �Q p
No. C-24176 aures D. Feiro
EXP. 12/31/97 x CE -LS
�Tq CIVIL
p - F C AL�F�
rl i L���( Irery�- �'L�iJlJlrl LITEJ
NOV-27-96 WED 9:27 P.01
November 26,1996
Mark Harold
Building.Department
,City of La Quinta
'
Ref: -Lot 17.1 CALLE QUITO
Dear Mark,
I have reviewed -the truss calculationspprovided by
WOODSTOCK TRUSS for the project and find them to be in
substantial conformance with. -the structural design`wit•h'
modifications attacked.
I also ,intend to provide structural observation per
UBC 1702.for the project.
Sincerel ,
Je f ey Young
v
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