0212-077 (AR)LICENSED CONTRACTOR DECLARATION
- I`hereby affirm under penalty of perjury that I am licensed under provisions of
H Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
W+ Professionals Code, and my License is in full force and effect.
&=) M License # Lic. Class Exp. Date
W
t`ly
oZ r-- Date Signature of Contractor
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F` �p OWNER -BUILDER DECLARATION
J
W W r- I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ Cl) 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).
LM() I am exempt under Section B&P.C. for this reason
0
N �� Die &_i� 11 _ e3 Z Signature of Owner + �
Orn / JF t�
Q WORKER'S COMPENSATION` DECLARATION
EL C:) Z I hereby affirm under penalty of perjury o e of the following declarations:
LO
H p () 1 have and will maintain a certificate of consent to self -insure for workers'
X W �L- compensation, as provided for by Section 3700 of the Labor Code, for the
m� Q performance of the work for which this permit is issued.
Q () ( ) I have and will maintain workers' compensation insurance, as required by
O U Section 3700 of the Labor Code, for the performance of the work for which this
LO a rn H permit is issued. My workers' compensation insurance carrier & policy no:"are:
,<? Z Carrier Policy No.
co. 5
,Q y (This section need not be completed if the permit valuation is for $100.00 or less).
v. J ( ) 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
3 r subject to the workers' compensation provisions 'of Section 3700 of the Labor
Code, I shall forthwith comply with ttio'se,provision;rr
Date: - Applicant—C,)�-�-�
1
/ 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 prope rty9,for inspection purposes.
I
Signature (Owner/Agent) r �'r� _ .�l,7 B!6r.. 4 Date ` 1 ` eo
BUILDING PERMIT PERMIT t/ r
`
tP2A2-47'➢
DATE VALUATION rqo, w LOT 3478 TRACT 2N.3
JOB SITE
ADDRESS 4&3'10 WO )PAL ES .Irj1'�'�VE
O..
APN
64X181=019
OWNER
CONTRACTOR / DESIGNER / EN 1NEER
JAMES A C'11� ,SM,
OWNER Billy—DFA
46.365 WA` I.41NUK014 UIRM'
U, QUDITA CA92233
USE OF PERMIT
f7ZTA.CHE0 OtRST HOUSE, (03P S.F.1 OA.RAOF. CK S. F.) STORAZaZ
.I d 0,F) PER APF3ROV15D PUNS, 200.1 c*e
TRACTCONSTRUCTION OF
MVUGFICARPORT 2,310.00 :vp
U) cols° -c��4 C�aM�r; UC1110.11
W WX-4.70
�,gyv� �i c �y��yl'{�p9FIyS�
P
Y StiJI.7.. 9. s E b7`GAY,Ri'V�Elt1 R Y
C•O1r1Ii'TRUC7ION PEE 101-(1ti0-4.19.000. X599,00
PLAN CI�1WX FEE 101-000-439-;313 $508.30
X19CHANICAL FU 101-000-4-21-000 SS?A
F.i.F.09`i ICAL FEE 101-000-40.000 $135.57
FLU tFllla�3'f F I019b000 $132.00
.
:3TI owf MOTION mm. - RESID 101-000-24.1-000 %9.08
Cl�l'+l7ikd!(3.1�I? 1 �yX »t)i1Q-�#?� aOU�J 51:4.114
-1Y3M CONSTRUMO,N AND PI -W CREC1t
'
_ €
IX -3 3 FRE -PAID hMM
MOO
e 1'� PFRIM ? IMS DUE NOW
S1,451..45
APR.. 1.1 2003
RECElT FIN BY DATE FINAL ED INSPECTOR
DEP,Te j _ t
,)A
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
(,
Ducts
Slab Grade X.,
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
—9
Compressor
Insulation
Vents
Fireplace P.L. doGrills
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
Plumbing Final
Plumbing Top Out
7,77
Equipment Enclosure
Shower Pans
OX for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
. 0�-3 -016
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Pourer 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:
Comments
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patiostwalkways, 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:
This certifies that school facility fees imposed pursuant to
Education Code Section 17620 and Government Code 65995 Et Seq.
in the amount of $2.14 X 839 S.F. or $1,795.46 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 C/C California Bank, James Chester Check No. 02311
Name on the check Telephone 340-9930
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Patricia Barbuzza
Signature � -, , J lsa�
($1795.46)
Payment Recd Over/Under
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
CERTIFICATE OF COMPLIANCE
Desert Sands Unified School District
47950 Dune Palms Road
Z4BERmUDA Eroo
Date
4/11/03
La Quinta , CA 92253DU
RAN HO IANWE LS d
��. 'PAIN �
No.
24316
(760) 771-8515
DESERT
,��3Q�NooTA :V
0
Owner
James Chester
APN #
643-181-019
Address
46-365 Washington St.
Jurisdiction
City
La Quinta Zip 92253
Permit #
0212-077
Tract #
2043
Study Area
Type
Single Family Residence
No. of Units
Lot # No. Street
S.F. Lot # No.
Street S.F.
Unit 1 3478 46370 Cameo Palms Drive 839 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 patiostwalkways, 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:
This certifies that school facility fees imposed pursuant to
Education Code Section 17620 and Government Code 65995 Et Seq.
in the amount of $2.14 X 839 S.F. or $1,795.46 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 C/C California Bank, James Chester Check No. 02311
Name on the check Telephone 340-9930
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Patricia Barbuzza
Signature � -, , J lsa�
($1795.46)
Payment Recd Over/Under
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