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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 amexemptfrom 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).
( ) 1, 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.
Srl'NIIi FUND 132_1621-n
(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, I shall forthwith comply with those provisions
Date: %� ' ��•�� Applicant 'r -
;%
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.- ---�,
Signature (Owner/Agent) _� Date
BUILDINGPERMIT PERMIT# CONTROL#
DATE VALUATION LOT �lliliA' 1% TRACT 7989
*
7�DRff �l�/r f�
810 0
591810100
JOB SITE
APN
ADDRESS "485 C.ei►i4iEO PALMS )SRUVE
(043-181-010
OWNER
CONTRACTOR/DESIGNER/ENGINEER
I:0I31:RT&I?R IN' UAP:I) LS
A4CO; GINIS, MUC ION
46483 CAM, E0 PALMS DR
2330 N. Sl' N ,Af\r.('UN10 RD.
LK 01119 A. CA 92253
PALM SPRINGS C.A. 9226.1
('160,023-9-191 C111AF 31*6
USE OF PERMIT
iJ1 iIki, D.i•.431G1tii
ADON
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M1DITION A9100 S
l iU.6J'.F�C1t��lti 4.400.00 f,S
Iu?SJT'MATI�D'.M.1' OF CONSTIt1.11,Yf100
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t. CltiiS`Ff2i.t�"f'k")1� i { e; 10140-411-000
11:t iC"• f RICAI. FU i 0l-000-420-000
t -000-41'9-x000
PLUMIANO .f; EX 10-000-41'9-000
STRONG ki(Yllf 13N IFFE - RIESIll 101-000-241-()t)() $.9$
F
cl'li-TrrIAL CIONSTRIXIIIO:N AND IPLAN rl-t iCK
s1
LV3S 1:1rOE`PA11.J PEES
x:0.00
T0TA1A#FRM1T.]?V,1?.S 00C NOW
REIPT
�� a /
DATE,�� ��)BY'
j I V 1
DA NAALLIE
INSPECTOR
�'
ll
Kr
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 / �_9
Exhaust Fans
O.K. to Wrap
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 /1 -
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings 1
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
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
l
Final
K1f11ity Notice (Perm)
COMMENTS:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
N0. PLUMBING FPES
tST FL. 30 FT ;- S
UNITS
SLAB GRADE
"`ROUGH PLUMB,
BONDING
YARD SPKLR SYSTEM
2ND FL. SO. FT..a
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR SO. FT FL
GAS (ROUGH)
METER LOOP
GAR $Q. FT. .q.
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P j0 FT ,I
GROUT
WATER HEATER
WALL SO FT %t
FINAL INSP.
DRINKING FOUNTAIN
SO �T. R
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION S
=S
WATER PIPING
NOTE: Net to be usea a5 proreny !ax +a!uanon
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASH ER(AUTOMDISHI
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FIRE ZONE ROOFING
KITCHEN SINK
ABSORPTION SYSTEM B.T.0
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE.TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. 4, c
BATH TUB
LATHING
SO. FT.:a c
WATER HEATER
MAX. HEATER OUTPUT. B.T.U.
SO. FT. RESID qf# 11/. c
SEWAGE DISPOSAL
SO.FT.GAR ,a x:c
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
OBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL MEA71NG IS AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL AREA
SLAB GRADE
"`ROUGH PLUMB,
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL).
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
= plus x$
=S
LUMBER GR. t
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
1 :
REMARKS
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONlSOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FFMr.P PINA1
INSPECTOR'S SIGNATURtWHIl'T1ALS
GARDEN WALL FINAL
Desert Sands Unified School District
47-950 Dune Palms Road
Notice: La Quinta, CA 92253
Document Cannot Be Duplicated 760-771-8515
CERTIFICATE OF COMPLIANCE
Date 11/5/98
No. 17959
Owner NameRobert & Erin Daniels
No. 46-485 Street Cameo Palms Drive
City La Quinta
Tract #
Lot #
Type of Development Residential Addition
Comments
APN # 643-181-010
Jurisdiction La Quinta
Permit #
Log #
Zip 92253 Study Area
Square Footage 100
100 sq. ft. addition to exisiting single family residence.
No. of Units 1
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:
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 100 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
it Y
Fees Paid By N/A - MCO Construction ` ' Telephone J23-8791
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by
Signature
Juanita Green Exempt $0.00
Check No. N/A
NOTICE: 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
above will begin to run f 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 another public entity authorized to
tolled them on the Dis ('s)(s') behalf, whichever is earlier.
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