9904-153 (AR)LICENSED CONTRACTOR DECLARATION
U) I, hereby affirm under penalty of perjury that l am licensed under provisions of
E- - Gl'apter 9 (commencing with Section 7000) of Division 3 of the Business and
04 W Professionals Code, and my License is in full force and effect,-
-- `
License # Lic. Class ,' !
Exp. Date
W LO643369 }1 a { 05/31/20t
oZ � Date �' 'r Signature of Contractor'+
co ! !
r'- F;- O OWNER -BUILDER DECLARATION
W W I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ a 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
t t sale (Sec. 7044, Business & Prof essionals•Code). _
( ) I, as owner of the property, am exclusively contracting with licensed
r contractors to construct the project (Sec. 7044, Business & Professionals
w.' Code).
( ) I am exempt under Section , B&P.C. for this reason
LO
uN Date Signature of Owner
O' rn
a Q WORKER'S COMPENSATION DECLARATION
p cc I hereby affirm under penalty of perjury one of the following declarations:
Lo H. O (,) 1 have and will maintain a certificate of consent to self -insure for workers'
X W �= compensation, as provided for by Section 3700 of the Labor Code, for the
m J, Q performance of the work for which this permit is issued.
I have and will maintain,Workers' compensation insurance, as required by
O QSection 3700 of the Labor Code, for the performance of the work for which this
Il LO H permit is issued. My workers' compensation insurance carrier & policy no. are:
* Z Carrier Policy No.
cb
d ^ rLIVrE }''LTKV o:9-99 1,Nl l f' 007W)47
J (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
•i Code, I shall forthwith comply with those provisions.
VDate:. ' Applicant
Warnirig: 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.
- AS g ature (Owner/Agent) Date
i
BUILDING PERMIT
PERMIT #
"1)1;-1S:i
DATE VALUATION ,076.20
LOT TRACT
5 k 44i
JOB SITE ' APN
ADDRESS 49-0 t CEMIROS CIRCLE "6410-011
OWNER CONTRACTOR / DESIGNER / ENGINEER
PALM C)ESEKI' CA 92.260
(70(})340-4628 CRL. 5243
USE OF PERMIT
RE.S.1Dl?tvMAL ADD IT)N
'18't.T'.'t31U1A'KFASi' R0101vt A►,.+%�C3`ION
CUS TONS CONSIMOC "i1014
77100 3.1Z
T+;S'1'IM.riTIM C4 -,ST OF COlYSTRi?r�;
ION'
4,076.20
PT. AN CHECK FiT,
101-00"39-318
SSti • 5o
�; ftl t "rt(liC"?'T(�N ? 2..E
l tt 1. btllf) 1 fe-4tOt►
W tsf 4
i411~MANICrU.. FEE
101.000-42i• 0010
$15.00
k:LECICAL RE
101-000420-uiiii
$17.73
STRO'NO N3M'3ON ITE - RESiD
101-000-241.••000
$.151
c "I DING FW.,
(01-c.)4Q Q2 -000
ZI0
a,
Si Ii; T(YVAI, C10N 1'fittriiION AND PI -AN C142.,C,k $201 eta.
USS PRE -1A )AID .ji1J1+8 $0.00
RECEIPT I DATE I BY
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
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
—1
Drywall - Int. Lath
ZZ
-„
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
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:
s
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) a
Notice:
Document Cannot Be Duplicated
Date 4/25/99
No. 18620
Desert Sands Unified School District
47-950 Dune Palms Road
La Quinta, CA 92253
760-771-8515
CERTIFICATE OF COMPLIANCE
owner NamePhilip E. Swift
No. 49-055 Street Cedros Circle
City La Quinta
Tract # Lot #
Type of Development Residential Addition
Comments
Jurisdiction
zip 92253
sq. ft. addition to singe family residence.
APN # 646-210-011
La Quinta.
Permit #
Log #
Study Area
Square Footage 78
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 Z in ilie1 P.- cunt of
a;.
0.00 X 78 or $ 0.00 the property listed aboveland that building '
r
permits and/or Certificates of Occupancy for this square footage in this proposed project may row rbe- ssued
Fees Paid By N/A - Philip E. SwiftYT�leiahone�._ ;-_
Name on the check r
By Dr. Doris Wilson t,'''
Superintendent
Fee collected /exempted by Juanita Green Exempt
Signature
$0.00
Check No. N/A i
NOTICE: Pursuant�ssembly 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 n from 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 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
2 S LANDS HOMEOWNERS AS S O C 2AT I ON NO- 1
..................................................................................... .
• P. 0. Box 1271 La Quinta CA 92253
• (760)564-2177 FAX (760)564-4882
April 26, 1999
Building Department ;
City of La Quinta ;
P 0 Box 1504 ;
La Quinta, CA 92253 :
RE: Addition of 78sq.ft. in attrium area ;
49-055 Cedros Circle, La Quinta, CA 92253 '
Gentlemen: ;
The Architectural Committee of Islands Homeowners Association No. 1 has
reviewed the plans for the construction of the addition at said location.
The Committee finds that these plans meet all the criteria setforth in
the CC&Rs and have, therefore, approved them as presented.
If you have questions, please contact the office.
• Yours truly,
• A
• J es Barickman
President
JB/bc
CC: fl
n
LASZLO E. SANDOR, ARCHITECT A.I.A.
DESIGN - PLANNING - CONSTRUCTION MANAGEMENT
44$29 ORO GRANDE CIRCLE, INDIAN WELLS, CALIFORNIA 92210
TELEPHONE: (619) 340-3691
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