0001-104 (RPL)ED CONTRACTOR DECLARATION
I hereby affir eng naltyrof perjury that I am licensed under provisions of
Chapter 9 (c with Section 7000) of Division 3 of the Business and
Professionals Code, and my License Js in full force and effect.
License # Lic. Class Exp. Date
[q/ r {
� 1
t
r t
DateJ i'� ` �' Signature of Contractors "^
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 (Seca 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.
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 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 370of bor
Code, I shill forthwith comply with those provisions.
Date: f (Info Applicant i ` A ?...- � ; • .,
Warning: Failure to secure Workers`&mpensation coverag'p-Is unlawful and
shall subject an employer to criminal penalties and civil fines tip to $100;000, in
addition to the cost of compensation, damages as provided forin 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 authoriie representatives of this City to enter upon
the above-mentioned property for inspection purbo
Signature (Owner/Agent) Date j .,
Y
PERMIT #
DATE rr/�BUILDINGVALUATION�PERMIToT JgM�1-104 TRACT
JOB SITE ADDRESS 79 EQ� v, t�.SA SAWOA CiRCIL.L APN ^
OWNER
1•I 1.1�C QV0'r P1T,"I' I t` T1AiT7NF'1•
A l_.._tl...A\ t ._01, v •- V. 11
PO BOX 1 r 16
LA Q[TINTA
USE OF PERMIT
P(A_t1, ANLYOk SPA
CONTRACTOR / DESIGNER / ENGINEER
i t T1.'0-,13101 n nr�r,s
74-72 z; 111 'Ni OR V
CA 92 253 }'At.Ail J J9 s'[itt "i
PCwi�t;t+r1/13i3 (A1N&O 2213 095) SHALL BE
IN, PLAL:r /Vt f4t_tt PiyASTEf. i'10N
Olvi• ANDn,OR JYA
n
1412(10-011) L:1
rI N d aM{.'AI O v.iiN;• at �:r1jZ' a•9lr;.rQ.`n gtiil�:
t'I..AN 01f't! K F�X $J _7110
r•'()'Nfi'rl (lr @ WN FFN ifi! •{tllf!-ellfti••�ili1
1ati11'4tA,'(:CAlrJ4't; ._V0rel.i01400,4'.'.r 2100
F-LE+:JRWAL FFA_--1'O(A. 1103-030-420-0it
PLUINUMNO hUE, -- tet:r )!. 101.-(lt,1(}-41,9-000
tg(t_it/t
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tiftft_'rY7(_ar,("0N',17R1.h J1 NANF) Pf.AN(`r(rCJ�
C'N.F:-I"A.(D FE, S
CA 9_1260
c-'i�ll,ii '455
16, n4.00
$3u; (}(1
W,00
_$J93.00
RECEIPT DATE BY I Dg�FINAof INSPEC�22: /,'
ININS PEGTI�NN IEC JVD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
& Footings
Ducts
forms
flab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
OX 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
Final
Final
SLOC:KWALL APPROVALS
Steel
POOLS _ SPAS
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. 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
2_7
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:
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 1/10/00 APN # 649-210-007
No. 19893 Jurisdiction La Quinta
owner NameTD Desert Development Permit .#
No.
City La Quinta
Tfact#
Type of Development
Street SEE BELOW
zip 92253
Lot#
Log #
Study Area
Square Footage 1088
New Residential Addition No. of Units 4
Comments CASA VIDA CIRCLE: 79-100, 272 sq. ft, addition of optional attached guest suite to house
der construction (Lot 66); and 79--111, 272 sq. ft., addition of optional attached guest suite
o house under construction (Lot 68). MONTANA WAY: 49-452, 272 sq. ft., addition of
optional attached guest suite to house under construction (Lot 52); and 49-563, 272 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 following reason:
Add. of Sq. Ft. to New Construction
EXEMPTION NOT APPLICABLE
This certifies that school .facility fees imposed pursuant to Government Code 53080
in the amount of
1.93 X 1,088 or $ 2,099.84 the property listed above and that building
permits and/or Certificates of Occupancy for this square footage irrthis proposed project may "now be issued
Fees Paid By CC/ Palm Desert National Bank/Judy Halpain
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /eaem ted by Ellen Patino
Signature
Payment Received
telephone'
�1!
Check No. 81519
$2,099.84
NOTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1998).this will serve to notify you that the W4&y 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 assued or on which they are paid to the District(s) or to another public entity authorized to
collect them on the Districq'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 DeptJApplicant Copy - Applicant/Receipt Copy - Accounting