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0803-143 (AR)LICENSED CONTRACTOR DECLARATION hereby>jffirm 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 lsi71 08/314 20( If 16ate +t �,�Signature of Contractors ,Ii 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. 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. 04,,tt 1•-'t1k1r% nI nr ^1 .Y9., 011 AY: I'4•SYL a .4-.7.1., (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 of Section 3700 of the Labor Code,1 shall forthwith comply with hose provlsions.l Lf�ate ri r' f �' 7 iApplicant )"/Y d A 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 representatives of this City to enter upon the above-mentioned property -for Inspection purposes. j6 Seat e (Owner/Agent)'A? t Date PERMIT # BUILDING PERMIT 0413-143 DATE �j VALUATION S10,127.4 if) LOT TRACT JOB SITEI ADDRESS 4 _010 11IMSE0 TH111MV41) .il �l�t�' E APN OWNER CONTRACTOR / DESIGNER / ENGINEER nr('!t.^.HID �'r& 1,1111r.1 YN ;? STF M1111a8 RV EST.,YNCf?NMR1 it 1_"1'!`0N ,18010 RA80 `f` E Vi O LN 30o-10 Vii LAS .RALZ1r'01i ,AQUINTA C'A 9125:5 '1'€10UN.AND P,tlGM8 CA. 922Y0 f,7601343-5500 USE OF PERMIT It.11:�1C)11V i 1i11, k�l��J �`It�iRl JSQ.Y.1100MFi1..O.i.ii0fVq:JE\iSltN6IkL- 0WL1Y.P1li, APYR( PLANS ru r�7-� na a •�A•y� n.*oiu• ((''��:�• s+t�yr1[,' •��Y wx #1 s �y i�6 kl pB�Yra.l.i 9! A:i.��s k►PJ�1YA�,rG Il ISI . AN C UEC:k: F8F 1 U1-dkl0 39-31.8 5?(r !N! r��•n^AAi�rrru-�rr��,r�F•,:. I'13�E�►�,at4-f.�il��rl(1� t%1VCaT i+MCAI. 17 ( 0 J -000 421. -000 1 f.t "i1t1i rif, l.trt iUi-000-42tmoo a!'JC(` N(1; N4 ION K,_ , ki S10 101-000-241-000 'SIMI nP.Ar ,140 rwV 01_000-12'3-(N 0 d F 41 1R:rC fI'A1. V(INSTRI VT -1N, A1N1-1 PI AN I11,t '11 %16() 46 dYV 110 'RYA'A,i, PERMIT YCEN MW N0W 5769.96 RECEIPT DATE Bi- DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs 6 C40 "Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck Crd Exhaust Fans O.K. to Wrap 411 F.A.U. Framing C;Q 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 — 4j 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 Sewer Connection Encapsulation Gas Piping Gas Test Appliances Final Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Law Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) COMMENTS: 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 It Lic. Class Exp. Date 538171 B 08/31/20( 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 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: Cartier Policy No. STATE FUND 22921938 (This section need not be completed if the permit valuation is for $100.00 or less). ( ) [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 3700 of the Labor Code, I shall forthwith comply with those provisions. Dater 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 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 Ouinta, 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) Date BUILDING, PERMIT PERM 0003-143 DATE VALUATION 510,127.00 LOT TRACT JOB SITE ADDRESS 48-010 PASEO TIEMPO LANE AP" OWNER CONTRACTOR / DESIGNER / ENGINEER RICHARD G & EVELYN E STEBBINS RICKLYN CONSTRUCTION 48010 PASO TIEMPO LN 30640 VIA LAS PALMAS LA QUINTA CA 92253 THOUSAND PALMS CA 92276 (760)343-5500 CBL# USE OF PERMIT RESIDENTIAL ADDITION 130 S.F. ROOM ADDITION TO EXISTING RESIDENCE ONLY PER APPROVED PLANS CUSTOM CONSTRUCTION 130.00 SF ESTIMATED COST OF CONSTRUCTION 10,127.00 PERMIT FEE SUMMARY PLAN CHECK FEE I 101-000-439-318 S8i.90 CONSTRUCTION FEE 101-000-418-000 $126.00 MECHANICAL FEE 10i-000-421-000 $21.50 ELECTRICAL FEE 101-000-420-000 519.55 STRONG MOTION FEE - RESID 101-000-241-000 $1.01 GRADING FEE - 101-000-423-000 $20.00 SUB -TOTAL CONSTRUCTION AND PLAN CHECK $269.96 LESS PRE -PAID FEES $0.00 TOTAL PERMIT FEES DUE NOW $269.96 RECEIPT DATE By DATE FINALED INSPECTOR Notice: Document Cannot Be Duplicated Desert Sands Unified School District 47-950 Dune Palms Road La Quinta, CA 92253 760-771-8515 CERTIFICATE OF COMPLIANCE Date 3/15/00 No. 20162 Owner NameRichard G. & Evelyn Stebbins No. 48-010 Street Paso Tiempo Lane r, APN # Not Available Jurisdiction' La Quinta Pern-it #0003-143 Log # city La Quints zip 92253 Study Area ' Tract # Lot # Square Footage 130 Type of Development Residential Addition No. of Units 1 Comments ,30 sq. ft. room addition 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 replacerrent mobilehomes. It has been determined 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 Government Code 53080 in the. amount of 0.00 X 130 or $ 0.00 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 N/A - Gaylynn Page Telepl ne.- 760-343-5500 Name on the check By Dr. Doris Wilson =Y. Superintendent , V r,, �. k Fee collected /exempted by Mary Ann L. Borja Exempt �$0 00 ��r 4 , f � f 1' �. • Check No. N/A Signature4 Am A ' NOTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 -day approval period in which you may protest tfra fees or other payment identified above will begin to run from the date on which the building or installation permit for this project is sssued or on which they are paid to the District(s) or to an-ther public entity authorized to N them on the District('s)(s') behalf, whichever is earlier. Collector: �ttach a copy of county or city plan check application form to district copy for all waivers. E Embossed Original- Building DeptJApplicant Copy - Applicant/Receipt Copy,- Accounting r `•� , `\'` ' 4 . o °-- � �.. `*-'•=`�''L�I�.ir,;;�,di5�..,a .LY.� Y �:+^� �rr..e ♦ i �- ' ` T '. .. t. -.� �r r .�• ' t.,[r• _��_ - t �,�i_ H- • r� r,'1,} �* �.+ y+.��"'4`'"`Cd"�"".lti"e.p'.sy�. i• i G - Mar- 15-l' 00 07:20A, STEBB I NS ; . R.& E 1+619+564+3737: P ? O l NV /Cert to ` wt . title November 17, 1999 Mr. Richard Stebbins 48-010 Paso Tiempolane La Ouinta, CA 92253 Dear qtr. Stebbins. Thank you t6r your attendance at the arcl itectural committee rneetinc, held last v;(.e . V+'e are in '-j receipt of the_ approval ofihe remodel in writing from your adjacent neighbors. 'Vt'e have reviewed the site plan of Nour'residerice., You have agreed to match all exterior finishes, (he remodel plans were approved as submitted We have received the sinned grading and dralna l plal front :v0i1. P!CaS+ Subr7lil til _)f the. construction revUlatlons signed by your contractor once VUu have selected one. 51.i'llCtlpn cannot begin until N.ve have a check r.'or $2,500.00 for the'refundable construction. deposit. Please make the check payable io The Master association for- Rancho La Quinta• We appreciate your patience to our review of the plans.. I look .for-:. and to v,,ork.iny With you tort ie r on (his f; . improvement to yotir hone. m Sincereiv. Mindy Gutierrez. 'rtp rty Manager ,.� The easter Association for rancho La Quinta = h� A . r • ,�rffjj --5 ;7! + )61 ,f ' Professional Cutnmunit ~ 7t ylManagement J Deseft Resort••%ar6' gemeni: •ti 4fi , Post Office Bc.z 4772 e Palm Desert, CA 9226' '772 r+ 3 -SSU Alessanrtr'o, Suite J I'alYn L7esert,'Cali i F !-4 f�Mia (760)•346 • ;�F4Xx' � `-1�1"61• ..�,3j 346••9. 1$;, , ! _ _ _ _ _ _ _f- . _ _ _. .. _ _ _ _ _ _+ _ _ _. 'r'�""y.l 'Y:•y'._ �+�" • iii •,