0111-018 (SFD)LICENSED CONTRACTOR DECLARATION
`al hereby affirm under penalty of perjury that I am licensed under provisions of,-
Chapter
f-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
04
11012(
Dated/"" 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 (56c../U44, lousiness & NPoti'ssi6nals Uode).
( ) I, as owner of the property, am exclusively ',contracting with licensed
contractors to _construct the project (Sec. 7044, Business '& Professionals'"
Code). ` ` e • `
( ) I.am exempt under Section , B&P.C: for this reason
Date Signature of I 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.
5/) 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 Irlt1`1'g p1✓1'g1) Policy No. 16t�5'7ifa^Oi
(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 Ahgse•provi'sions. r
Applican't
Warning: Failure to secure Workers' Compensation coverage is unlawful and
'shall subject an employer to criminal penalties and civil fines up to $100,000; in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor'Code, interest and attorney's fees. p
s
-<,IMPORTANT Application is hereby made to the Director of Building and=Safety
for' a permit subject to the conditions and restrictions set forth on hiss
application.
1. Each person upon whose behalf this application.is made & each person
whose request and for whose benefit work is performed under or pursua
any permit issued as a result of this applicaton agrees to, & shall, index, fy
&.hold•harmless the City of La Quinta, its officers, agents and emplo)� s.
2. Any permit issued as a result of this application becomes null and vMid if "
work is not commenced within 180 days from date of issuance of luch
,,,.�; permit, of/cessation of work for 180 days will subject permit to cancella ib
I certify that I have read this application and state that the above informatioVs
correct. I agree to comply with all City, and State laws relating to the building
cohstruction, and hereby authorize representatives of this City to enter upon
the;abo've-mentioned property fertihspectio 7purposes.
/Signature (Owner/Agent) . !:�J.r , t••r �' Dat'33- -3-02 L
'4 -
V
f BUILDING PERMIT PERMIT#
1A.
DATE_ j VALUATION }v p� j/g9'��7'j}yypp LOT y�} TRACT
_
IIf..�41�piYd1^{SLR !, 1
,/ 02,:,- _
JOB SITE `• .
APN
ADDRESS 46-429,TLANK
OWNER
CONTRACTOR / DESIGNER / EN (NEER
.lid 1aly..F.8
E"L ORA DO 10P)dS''1RUCA-014
4z011 PAfl
45=651 PE'�Ck
'DO.�:
NfL% V8LA.Vy6-0161.1
INJd(U7A :2 2 10 '
a U a 6 �.'�sIA fZ94
USE OF PERMIT
SINGLE RANMIDWEA.1,11461
M. - P.8.Rta IT Wry NOT 3N0LU.17t iw3UXK:WALI, PO -CIL OP -DRIVEWAY
'1'f;$ NOT CONS T RI:fCTION 2,40oxg V
CARlAWf.ARPOBeP d'L-1%OtC .F
- �oJ Ad�.vai+� ��.,.i� %:if`�.r � �:s �� .�,; +• .J..Y ��+x0.��:.a: s.+�,rt.c:
.s �.1�. y�' g�.�:��,+ ..
Fr%E$i1@W F!ST NO MARY
e:C.kN`TRUC'!'YONFEE 101.000-4.18m000 $746. Q
s € LAN t Rik IC FM
RE .DEPOSIT 101.000-439.318 420.01t
s
MCHAMCA.IL. t+WK 101-000-421-000 $P13,a0
Ial�.tr"12If;A1. :(? 101 x.000.420,-,000 .o* 10,6(1
16'1„ i11b AiB IG FEE 1 W -tTW41 S`'-000 13p.lit�
ST110.14(3 3ti OTM14 fr l• F, - RMI D 101 m000N24 I'-,-000 S 14. 18
GRJkFP41vC4 ��.r,- _ 101-,000-423--W0 $XOD
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}Z33 1�-i>-`�'A'�d.r.l+ kES,
1y 250.00
tf c7 L.�IJL
4R 'x
�1Y®�it��4at!�R/� MAL;F►: r�a� MIG DUE How 1' .,
� + 2_ S.03 .
FIMAHMMIrl
41
4"
RECEIPT
DATE/ .7.1
BY "`' -�,
DAT FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
I INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
— —_-
Underground Ducts
Forms & Footings—
Slab Grade
Ducts
Return Air
Steel
j /q — Zi
Combustion Air
Roof Deck
..
Exhaust Fans
O.K. to Wrap.//
_ 2
F.A.U.
Framing
_ z -- iZ
Compressor
Insulation
— 2 —
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
BLOCKWALL APPROVALS
Final
POOLS - SPAS
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
Z Z C ;_7
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) �8�
COMMENTS:
Building
'Address
Owner
�l It l
Mailing
Address? j (p
City
_iIf 1 f r1 {.� ✓'
c_ 1>c-%' A
Zip Tel.
r .
,�a"< -
P.O. BOX 1504 . APPLICATION ONLY
78-495 CALLE TAMPICO
QUINTA, CALIFORNIA 92253 -)/,q
City Zip ti _
fig Jul.' I.tJ /_okz
State Lic. City
& Classif. Z 37(119-149 4 Lic. #
Arch., Engr.,� /
Designer I��
Address Tel.
City Zip State
�Y 7'�� Lic. #
1145
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapte�(commencing with Section
7000) of_,Division 3 of the Business and Profeessions'Code, and my license is in full force and
effect. J_
SIGNATURE ' - �� DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, alter, improve, demolish, or repair any structure, prior to 'its Issuance also
requires the applicant for such permit to file a signed statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis
for thealleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars (8500).
[] 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, Buisness and
Professions Code: The Contractor's License Law does not apply to an owner of property who
builds or improves thereon and who does such work himself or through his own employees,
provided that such improvements are not intended or offered for sale. If, however, the building
or improvement is sold within one year of completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose of sale.)
I II'
as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner of property who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
7 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
r7 Copy is filed with the city. O Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed it the permit is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of thg 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. b
Date Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become`
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
Ihereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration it work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information is correct.
I agree to comply with *all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives -of this city to enter the above-
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address '
City, State, Zip
BUILDING: TYP//E"CONST.. OCC. GRP.
A.P. Number b Y Ci. - 0
Legal Description (,of 11 -ret L 6 b 7
Project Description `11 ii::: i
SqFtFt.�J � 21 StoNo.ries
/ Units
Size 4� v Stories !
New C�' Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
AMOUNT
21 jt
3 t -
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback fron Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE 111SPECTOR
Issued by: Date Permit
Validated by:
Validation:
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING D171SION
Desert Sands Unified School District
j 47-950 Dune Palms Road
Notice: La Quinta, CA 92253
Document Cannot Be Duplicated 760-771-8515
CERTIFICATE OF COMPLIANCE
Date 3/13/02 APN # C49-052-014
No. 23046 Jurisdiction La Quinta '
Owner.NameJim Reyes Perr3it #0111-018
No. 46-429 Street Roadrunner Lane Lo; #
city La Quinta Zip 92253 Study A.ea 1
Tract # 2667. Lot # 19 Square Footage 2460
Type of Development Single Family Residence No. of Units 1
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 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:
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of
2.14 X - 2,460 or $ 5,264.40 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 CC -Cal Fed -Richard Rands Telephone • 760-836-0167
Name on the check
By Dr. Doris Wilson
Superintendent v
Fee collected /exempted by Yolanda Garcia Payment Received $5,264.40 ••
Check No. 7254451946
Signature
NOTICE: Pursuant to Assembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 -day approval period in which you may protes. 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.sssued or on which they are paid to the District(s) or to another public entity authorized to
collect 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
a
�5
Certificate
of Occupancy-
City of La Qdinta
s
,w
Building and Safety,Department 0::
This Certificate issued pursuant to- the requirements of Section 109 of the Uniform Building Code,
certifying that, at the time of issuance, this structure' was in compliance with the various ordinances
of the. City regulating building construction or use. For the following:
BUILDING ADDRESS: 46-429 ROADRUNNER LANE
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0111-018
Occupancy Group: R-3 Type of Construction:. VN Land Use Zone: RL
Owner of Building: JIM REYES Address: 46-651 PASEO CORONADO
City: INDIAN WELLS, CA •
By: STEVE TRAXEL
Date: 4-30-2003
Building Official
POST IN A CONSPICUOUS PLACE,