9806-013 (AR)rLICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Fes-- Chapter 9 (commencing with Section 7000) of Division 3 -of the Business and
C''4 W "P�Dfessionals Code, and my License is in full,force and effect.
O =):;,) '* icense # Lic. Class ' Exp. Date
Ww t .1ii4
Z:� l3 I� *i:+iiiry
o Z /Date Signature of Contractor
co O
H CD OWNER -BUILDER DECLARATION
W W I hereby affirm under penalty of perjury that"f am exempt from the Contractor's
u)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).
( ) I am exempt under Section , B&P.C. for this reason
LO
N Date Signature of Owner
O N
CA
d
Q WORKER'S COMPENSATION DECLARATION
It Z I hereby affirm under penalty of perjury one of the following declarations:
LID O () 1 have and will maintain a certificate of consent to self -insure for workers'
X ui �L compensation, as provided for by Section 3700 of the Labor Code, for the
O � Q performance of the work for which this permit is issued.
CD Q L) (K) I have and will maintain workers' compensation insurance, as required by
O U Q Section 3700 of the Labor Code, for the performance of the work for which this
a �f— permit is issued. My workers' compensation insurance carrier & policy no, are:
Z Carrier Policy No.
Cb .,VF AIFIE, t• 0.1ND ILIE N't )fNO
J (This section need not be completed if the permit valuation is for $100.00 or less).
P
() 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 agreef that if I should become
subject to the workers' compensationprovisions'of Se tion 3700 of the Labor
3 ode, I shalhforthwith comply withzdse provisions
ate: (° 13 j r Applicant t +• 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'hisf
application. f
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 s a e that the above information is
• correct. I agree to comply with all City, rand State;iaws relating to the building,
construction, and hereby authorize representatives of this City to enter upo
' the above-mentioned property for inspection' purposes.
WSignature (Owner/Agent)�'I `�`�"`— �Date
PERMIT , CONTROL#
BUILDING PERMIT
i1,,11lht)is
DATE 61 119}4 VALUATION � �` �� LOT TRACT 7853
JOB SITE ADDRESS • 4.0.15 CE+>�iro i CIRCLE
0464M-049 046- M-0139
OWNER
CONTRACTOR/DESIGNER/ENGINEER
1 tst(t l IAM"-`
I—A, 004LAN• Al i' t "79r Ti
ZRA1 NV €€iG€i'Jl+AY 70
74311 € U rOrNW+_x; D DOVE
URANS4.)N k1t:) flNilo
PRIM DINEXI' CA 92200
1'160 F�1I►•+il��f'v 1;111,11 S 4R
USE OF PERMIT
442 AtANTiON
1Td1a.,L}(.at'h 1,FLUNI)XYI
C'U,';r0M E+ONUS 921h'NI CCiNb•F3 4,12Ai Si'
C,ilVi.tlC'sIUtWAitl'G�.ti't' 5�4ti.UU Sig
YXI
NiifvlA'3 ti EE'SUMMARY
PLAN CIIEi.'K FBI-, }fit-!!tk)-43u,3f i 32 14.10
CC) NeTV111011(.)N.11T" 1014n?firt.-11R-0(X) $3,�.Ofi
ME'CIU�N1CA1. F -13C 101 -OW -421t-000 $4 a..iii
171► G'MICAi. F116 IOIAYJ-420-OW S4I ,27
l+t,t.1MBINt1)+`):.13 101140-1111940) :S27.N)
STR4?Ji,1 h!rrr!( tv t` t 7 - RYA 9 101-1,100-241-W 3. a
.. fl't.:r�T. C"4?Al:s' 1TClJC."{ 1l?N A�jl_ TPLA r'�7 CHIECK.
5657 )1
LESS, VRE-PAID FEES:
T10.(X)
JUN 03 1998
.CITY ®F UA QUINTS,
RECEIPT
DATE ;1
BY
V
DATE FINALED
INSPECTOR
�
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Slab Grade /
Steel IFIA
41
/e
Ducts
Return Air
Combustion Air
Roof Deck
%� _
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulations
_
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls +
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
3 Q
Drywall - Int. Lath ez-
Final
Final _
BLOCKWALL APPROV LS
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
Low Voltage Wiring
FbQures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
My Notice (Perm)
COMMENTS: Q
o
^_' LICENSED CONTRACTOR DECLARATION
I her.R., 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 p Lic. Class Exp. Date
645369 B 5/31/00
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:
Carrier Policy No.
STATE FUND PENDING
(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
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, indemnity
& 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
-
BUILDING PERMIT PERMIT CONTROL/
9#306-013
DATE (0/3/98 VALUATION $36,352.60 LOT TRACT 7853
JOB SITE
ADDRESS 49-035 CEDROS CIRCLE
AP" 646-210-009
OWNER
CONTRACTOR/DESIGNER/ENGINEER
HOWARD A WILLIAMS
J.A. DOLAN CONSTRUCTION
2500 W HIGHWAY 76
74315 BUTTONWOOD DRIVE
BRANSON MO 65616
PALM DESERT CA 92260
(760)3404628 CBL# 5248
USE OF PERMIT
ADDN
442 S.F. GARAGE CONVERSION, 540 S.F. GARAGE ADDITION
(RELOCATE LAUNDRY)
CUSTOM BONUS ROOM CONVEF 442.00 SF
OARAGWICARPORT 340.00 SF
ESTIMATED COST OF CONSTRUCTION
36,352.60
PERMIT FEE SUMMARY
PLAN CHECK FEE 1014000-439-318 $214.50
CONSTRUCTION FEE 1014000-418-000 $330.00
MECHANICAL FEE 101-000-421-000 541.50
ELECTRICAL FEE 101-000-420-000 $41.27
PLUMBING FEE 1014000-419-000 527.00
STRONG MOTION FEE - RESID 101-000-241-000 S3.64
SUB -TOTAL CONSTRUCTION AND PLAN CHECK
$657.91
LESS PRE -PAID FEES
$0.00
TOTAL PERMIT FEES DUE NOW
$657.91
RECEIPT
DATE
By
DATE FINALED
INSPECTOR
1
= S LANDS HOMEOWNERS ASSOCIATION NO- I-
.................. ....
.•... ......... ....................
P.0.1271
La Quinta CA 92253
(7600564-2177 FAX (7600564-4882
April 30, 1998
Planning Department
CITY OF LA QUINTA
P. 0. Box 1504
La Quinta CA 92253 ;
RE: Construction at
49-035 Cedros Circle
La Quinta CA
Gentlemen:
The Board of Directors and Architectural Committee of Islands Homeowners
Association No. 1 has reviewed the plans for the addition to the home of Mr.
and Mrs. Andy Williams as referenced above.
We find these plans meet all the specifications and requirements as stated in
the CC&Rs of our Association and have, therefore, no objections to
construction of this addition.
If you have any questions, please feel free to contact the Association office
at 564-2177.
Yours truly, n
?IM BARICKMAN
President
Desert Sands Unified School District
Notice: 82-879 Highway 111
Document Cannot Be Duplicated Indio, CA 92201
619-775-3500
CERTIFICATE OF COMPLIANCE
Date 6/3/98
No. 17113
Owner NameHoward A. Williams
No. 49-035 Street Cedros Circle
city La Quinta
APN #
Jurisdiction La Quinta
646-210-009
Permit #
Log #
Zip 92253 Study Area
Tract # Lot # Square Footage 442
Type of Development Residential Addition No. of Units 1
Comments
Addition of 442 sq. ft. to existing construction; garage conversion.
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 442 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>neiw be isstaed
Fees Paid By J.A. Dolan Construction Telep oiae, -
Name on the check
l
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Juanita Green
Signature
Exempt
Check No. N/A
$0.00
NOTICE: Pursuant of Asserr) y 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 from a 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 District('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