0006-371 (AR)LICENSED CONTRACTOR DECLARATION
,.I hereby affirm .under penalty of perjury that I am licensed under provisions`of
Cha
pt?r• 9 (corrirriencing with Section 7000) of Division 3 of the Business and
P"rofes"sionals Code, and'my License is in full force and Aect.
License # r^ Lic. Class Si Exp. Date
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 If
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 Policy No. .
(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 man/Er so as to become subject to the
workers' compensation laws of Californiand agree that if I should become
subject to the workers' compensation p 91visions of Se6on 3700 of the Labor
�Cde,�t s�iajJ %rt?Wrth comply with tho pFOvisions.
)pate vy Applicant—
Warning:
pplicant 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 ofthis application becomes null and void. if 'r
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 applica io and state that the above information is
correct. I agree to comply with al ity, and State laws relating to the building
construction, and hereby autho)i a representatives of this City to enter upon
t above-mentioned propertyinspection purposes.,
Signature (Owner/Agent), Date 1
0 ` � BUILDING PER�MITy ' -
_PERMIT.#
DATE VALUATION 1. LOT TRACT"4,f45 450
I
JOB SITE LL L
ADDRESS i:� CA -MAT! Q"`OF-
APN
OWNER
CONTRACTOR / DESIGNER /.EN (NEER
MANa"JI7.E'Lpl��♦3�/ ZC�A��n
CiW1+TE13.1BU LBr}.R
JV+'/'.l
p
r3.5 CALL, �°JIIYM'.
1A QT11NTA ?i CA *P223
.-Q
,LA C1:3:ti A SL 92253
USE OF PERMIT.
r
Rru%L3MT1.7AT.; Ai./"Drr101 '�5
ADDITION & CUNI `ERTION 1155 S . F'C
APD)TION 1,183.00 SF
WMIATED COST OF CON91 t.'a IOR
64.3 1.5.50
PKT.'T FEE ti .r�`U ARY
PIAN MCK ME, 101-000-439--318 $313.30'
CONSTRUCITION ME 101-000 418-000
MECHANICAL FEE 101.000.421-000 Ss�.SO
ZLEC'iR.IM,IEEE 101-000-4203-000 $52.00
PLUMBING FEE 101 -000-419-0Q 1 395,01
STRONG MOTION FEE n RE IL` 101-006-241-000 $6.43
GRADING Fri+; 101-0004,u-000 $20100
s�
SI UT3=10 AL Cf-9MT:RUC ICJIri AWD PLAN s�l>�C.
$1,041.23
1mr, F, MPAW FESS
$0.00
'1'C1'CA1+ PEN"E k'If= VV �' NOW
$1,041 MI
RECEIPT
DATE
BY/
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
` BUILDING
APPROVALS
MECHANICAL APPROVALS
Set BacksL
Underground Ducts
Forms & Footings
_
Ducts
Slab Grade �-1
�i7–ev 57
Return Air
Steel
Combustion Air
Roof DeckrQ�
I
Exhaust Fans
O.K. to Wrap
_e? ,_00 ,S
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
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 I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
'1 G
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
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
Final
Utility Notice (Perm)
COMMENTS:
Desert .Sands Unified School District ,
47-950 Dune Palms Road - -
Notice: ,., La Quinta, CA 92253
Document Cannot Be Duplicated 760-77t-8515 +
CERTIFICATE OF COMPLIANCE
Date 6/29/00 APN # 770-095-008,
No. - 20631. Jurisdiction La Quinta
Owner NaineManuel Abarca , ` Permit # 0006-371
- r
No. 50-735 Street Calle Quinto Lo; #
+ city La Quinta Zip. 92253 Study Area
Tract # Lot # Square Footage 1185
Type bf Development Single Family Residence No. of Units "1
Comments' Addition and convertion 1185 sq. ft:
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 fallowing reason:
` EXEMPTION NOTAPPLICABLE.
This certifies that school facility feesimposed pursuant to Government Code 53080 i • in tlu amount of.
2.05 X 1,185 or $,2,429.25. - the property, listed above and that buidirig y ;
permits and/or Certificates of Occupaircy. for this square footage in this proposed project may now be issued
Fees Paid By Cash/Abarca_
' Telephone +564 1.813. •,:',
Name on the check t ".'
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Juanita Green . Payment Received - °' $2,429.25: 7 `
.. Check; No. Cashh
Signature ! ,
;FE: Pursuant of mbly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified
beginm the date onwhich the building or installation permit for this projectis sssued or ori which they are paid to the Districts) or to another public entity authorized to
t them on the Dis ct('s)(s') behalf, whichever is earlier.-
• -
Collector': Attach a copy of county or city• plan check application form to'district copy for all.waivem
Embossed Original= Building Dept./Applicant Copy.- Applicant/Receipt. , Copy : Accounting _ .