0401-126 (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
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:
(max 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 underPSection B&RC. forJhis reason
Date of �J-y -f Signature of Owner ,,`:��r!-"✓;�-'`
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one 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).
( NW 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 agrepsthat if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code,,l shall forthwith'comply with those pro6slon�
Date: `� i u ' .1 APPlicant � • r L...� ii C,i t7\
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to crimal 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. ,
~
Slanature (Owner/Agent) _'`), - f
I `—" i Lf- (Date
1
BUILDING PERMIT PERMIT#
DATE - y VALUATION LOT�1 TRACT
j f j (lr �F 3 ei,i3:�,+DcJ
34-78 7043
JOB SITE APN
ADDRESS 464170 C:A.NTE0 PkLAIIS UkT.VJE f13#,9
OWNER CONTRACTOR/DESIGNER/ENGINEER
415.365 S,vASIM. 4=14
U. QUINTA. CA 922.1`< !
USE OF PERMIT
3058 SRADJXT10WI312 SP REI3L IA) OF F'i''ZV10VS1_X DE11011SHO-l7
SQU.ARt' FO;-_3TAC'1F PER DEMO PERMIT 40401-125. 2001 COC.
TRACT CONSTRUCTION 21053.00 8F
f�e3i'LC•k;J>�A?'10 383.O1a it+
Ei��.[L9'.dATJrD C1.i�7.Y. 'LJ�a 'l.4/Ei6�.Cl.Yi6r.4.tlV.✓11
••��,,�•� ����psf p� �yy-p� +�q�
dd",F1.S WIT 9? �.r..iryv AS fJ.Ai'9.4Yttf.9.RY
CONSTRUIC.11NON FU
101.000-4'113R000
$699.00
PLAN CBECfa, FEE
101-000-434-318
55913.42
Mt(`11M11CAL FEE
301-000.421-000
SKSO
FL C`fAX.AL, FRE
101-000-420-000
V47.03
PLidfv4ZeING RZ
101-000-419-000
$151.00
STt;.( 240 MOT1J1d FEE - RSM0
101-000-2.41-000
I
W8. TO'Tn. C'01ASTRUCUON ASI) PLAW CIE=
– 1s3S PIRE-FA1,13 FM.
F`WK1,11'' FR sDUN .r+TOW
MAR 181004
CITY OF LA QUINTA
DEPT. I--- -
DATE / fBY DATE FINALED
INSPECTOR
$1,703.63
$0,00
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 74 is
F.A.U.
Framin 2-0/
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 3 0 '7
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
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
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 APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring ,t i
Low Voltage Wiring
Fodures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Witty Notice (Perm)
CERTIFICATE OF COMPLIANCE
Desert Sands Unified School District
47950 Dune Palms Road ¢ gERMUDADUNES r
Date 3/18/04 La Quinta, CA 92253 RANCHO MIRAGE C7
'INDIAN WELLS ti
No. 25710 (760) 771-8515 .LM , P LA QUINTDESEAT-:V
QINDIO
O
Owner
James Chester
APN #
Address
46370 Cameo Palms Drive
Jurisdiction
City
La Quinta Zip 92253
Permit #
Tract #
Study Area
Type
Residential Addition
No. of Units
Lot # No. Street S.F.
Lot # No. Street S.F.
Unit 1
46370 Cameo Palms Dr. 746
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:
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to
Education Code Section 17620 and Government Code 65995 Et Seq.
in the amount of $2.24 X 746 S.F. or $1,671.04 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 Check No. 231 02435
Name on the check Telephone 345-1155
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Patricia Barbuzza Payment Recd 1$0.00
$1,671.04 Over/Under
SignatureLn�
/
NOTICE: Pursuant to Government Code Section 660/4 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
r
CUM
Architecture, Interiors, Space and Land Planning
Structural Calculations
2 July 2003
The City of La Quinta
Department of Building and Safety
78.495 Calle Tampico
La Quinta, CA 92253
Project: Single Family Residence for:
` Chester
46-370 Cameo Palms
La Quinta, California
Regarding: Project Observation and Field Revisions
10
To Whom it May Concern,
40
On this date I visited the noted project site to perform code required structural observations. At
the time I noted only minor blocking, nailing and strapping issues that were resolved at the time of
my visit.
j..
Therefore, I hereby state that the project's structure is in substantial conformance with the
structural design intent as represented in the construction documents.
If you have any further questions regarding this project please do not hesitate in contacting me.
Charles D. Garland s WMM
Architect OF C��-�ti®��
I 74854 Velie Way, Suite 5 o Palm Desert, CA 92260 o Phone: (760) 340.3528 o Facsimile: (760) 340.3728 aF
oa/a-o77