0008-386 (AR)LICENSED CONTRACTOR DECLARATION
IG;,ereby affirm under penalty of perjury that I am licensed under provisions of
Chapter �-(comrrjencing with Section 7000) of Division 3 of the Business and
Professionals Code, and my License is in full force and effect.
License # Lid. Class Exp. Date
521353 BH8r ,/'1n.0/2
Date Signature of Contractor a _
OWNER -BUILDER DECLARA IT ON
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
,perfor ante 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 STATEFUND Policy No. 2291869600
(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 o Section 3700 of the Labor
Code, I shall forthwith comply with'ihoseprovisions.
Date: r— ° 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, 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 pur oses.
Signature (Owner/Agent) ^" Date
BUILDING PERMIT PERMITfJ
VALUATION LOT' TRACT
DATE;*, /'{j
/ffj
(✓` J � 1 �D c e�aa�.aiar l `.
JOB SITEr
APN
ADDRESS 015 (. Al of 1ZOSA.RUA
OWNER
CONTRACTOR/DESIGNER/EN INEER
WM BWKER
G. L. SCR1VEN:S 00NIMIC1101i
.50-015 CALLEROSAWA
61400 YUCCA ROAD 4260 7
LA QU1WrA CA 92 253
MOUNTAINCENTER CA 92561
(760)831-,7439 CSVI 2484
USE OF PERMIT
7: ZEIM 3'I'.i L ADDY ' ON
106 S:F. ROOM ADDITION AS PMAAP;P"RAVED PLANS U'N1.Y
ADDITION 106.01) UP
1f:g7CII MIND COST OF f'0.R15!<Rl*!i;`TJE0N
5,755.80
Pkfffldff FEE SUMfARY
F*L AN CHECK FEE 101.000.439-318
C014STRUCTIOId FEE 101-000-418-000 $81.40
MECHANICAL FEE 101-000.421.000 $15.04
ELECTRICAL FEE 101-000,420-000 $21.54
STRINHO MOTION ME REST 101.000.241.000
a
PSi io
n, AUG
3 0 zoog
X11719
Lv�
SUB -WfAL CC. NSTRUC°iION MD PPI X MWECK
LLS: PRE -PAID PMS
Y $0.00
'IYAlAL I-'EMM.KEEEI S DVk .t!3(7W
$170.81
r
`�'
RECEIPT
DATE
BY "'
DATE FINALED
INSPECTOR
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
Q - I V . ° • 5,7-
F.A.U.
Framing
Compressor
Insulation
$j - 60 S7-
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
9 ?tea �
Final
Final
BLOCKWALL APPROVALS
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
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
'N'&ice:
Document Cannot Be. Duplicated
Date 8/29/00
Desert Sands Unified School District
47-950 Dune Palms Road
La Quinta, CA 92253
760-771-8515
CERTIFICATE OF COMPLIANCE
No. 20949 Jurisdiction
Owner Name" Becker
No '50-0_,. 5� Street jC�l e RosaritaA
City La Quinta Zip 92253
APN # Not Available
La Quinta
Permit #0008-386
Lag#
Study A ---ea
Tract # : Lot # Square Footage 106
Type of Development Residential Addition No. of Units 1
Comments -
The addition is a bed room.
1.
At the present time, the Desert Sands Unified School District ' does not collect fees on gwages/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 • 106 or $ 0.00 the property listed above and that -iuilding
permits and/or Certificates of Occupancy for this square footage in this proposed project may_miw be issued
Fees Paid By N/A - G. L. ScrivensTelephone,' 760-`831-7439
Name on the check
By Dr. Doris Wilson�`�
Superintendent
Fee collected /exempted by Annette Barlow Exempt $0.00
1 ^, Check No. N/A
Signature
40TICE: Pursuant otAssembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 -day approval period in which you may pretest the fees or other payment Identified
rbove 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) cr to another public entity authorized to
wBect them on the Districtrs)(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
July 28, 2000
F. G: &.Margaret Becker
' 987 University`Avenue, Suite 3
Los Gatos, California 95030
Re: 50-015 Calle Rosarita
Dear Mr. & Mrs. Becker:
Your architectural variance dated July 13 regarding the master bedroom addition has been approved under the
following stipulations(s):
® ~Actual modification must conform to the plans and specifications submitted and approved'
® Competent and licensed professionals shall do all work in a workmanlike manner.
® All work is to be in compliance with local building codes and ordinances.
• All electrical wiring, -if applicable, must be contained within approved conduit painted to match the surface it
contacts. '
Any damage to the common'area resulting from this modification and its construction shall be repaired at the
Owner's expense.
e If a construction bin is rented through Waste Management it must be beige in color and stored, if possible, in '
the garage. All construction debris is to be removed from the site by the close of each day to maintain order and
retain the aesthetics of the Santa Rosa Cove. ,
s Prior to the commencement of any work the contractor and their subcontractor(s) must p_ *vide the Association
proof of worker's comp, liability and auto insurance; naming the Association as additionally insured.
a Prior to the commencement of any work you or your contractor must provide the names of the scheduled
workmen to the security guards at the Mazatlan gate, (564-5414).
® Prior to the commencement of any work your contractor must read and sign the Association's Contractor Rules, .
which has been faxed to their attention.
® Prior to the commencement of any work you are required to pay 'a S500 refimdable deposit for the room
addition.
o Prior to the commencement of any work you are required to pay a one-time fee of $5 per square foot for the new
roof area.
Please contact the Association office once your modifications are complete for a final in�-pection. A copy of the,
approved variance will be mailed to you after the inspection. If you have any questions, please call:
Very truly yours,
Pamela S. Salinas
Association Manager
On Behalf of the Architectural Committee
: 'THE SANTA ROSA COVE ASSOCIATION
Cc: w Greg Scrivens ! Scrivens Construction
tx