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9801-057 (SFD)LICENSED CONTRACTOR DECLARATION I hereby 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 # Lic. Class Eiep. Date Dated �� Signature of CoCtr'cto 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). O 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 1297996 (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, Ishall not employ any person in any manner so as toFbecome subject to the workers' compensation laws of Califorriiaand agreIF fVhat if I should become subject to the workers' compensatoGisions oflSection 3700'of the Labor Code, I_ shall fort with comply with th • s rovisio s7 Warning: Failure to secure Workers' Compensati • n coverage is unlawful and sKell subject an employer to criminal penalties anNcivil 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. y� Signature (Owner/Agent) - DT/2 f BUILDINGPERMIT PERMITk °°NTR°`" DATE VALUATION LOT 9801-057 TRACT � 5 f! o $97,772.40 LO"f 21 i tai} JOB SITE }' APN ADDRESS 78-715SAGEBRUSH AVENUE 64&31.1-821 .OWNER CONTRACTOR / DESIGNER / ENGINEER JOHN CARPER APOLLOS CONS1"RUCTION PO SOX.9777 791410 OCOTIU,O LA QUWA CA 92253 LA 1. tWrA CA. 92253 (760)360-4335 CBL# 2131 USE OF PERMIT RFD SrF - PER1v11T DOES NOT .INCLUDE BLOCK WALLS OR POOL 75% PLAN CHECK RE REDUCTION .APPLIED ($401.40). . 3/2,60M TRACT C0N81*RU( r1Q.N 1:,.+„ii4tt 5F GARAG&CARPOR'T *111.00 SF 5 FT. WOOD FENCE 200.00 LF INTIMNFE1) COST OF CONSTRUCTION #7,772.40 PER1N7iT FEE SUMMARY rs* CONSTRUCTION FEE 101-000418-000 PLAN CHECK FEE 101-000-439-315 $535.40 MECHANICAL FEE 101-000-421.000 $x'*3 % EL13C1'R CAL FEE 101-0{10-423-0tlf1 $128.t3f3 PLUMBING FEE 101-000-119-000 $136.no ao STRONG 1V1OTION FEE - RESI17 101-000-241-000 $9.78 GRADING FRE 101-000-423-000 $20.00 lNNR.�3'CfilviC"i`UN1i r'f 1i 415-000-443-3412 $2,151.63 PRECISE PLAN 101-000-41<11-345 $250) LL� � FEE DEPOSIT 4250.00 M W PLAN CHECK FEE 101-000-439-318 4401.55 SUB -TOTAL CONSMUC'1'ION AND P1AN C14ECK ` �z,'?O,oy�C, ; PRE-PMD1'1<ES 41151.55 TOTAL. PERMIT FEES DUE rNONV 53,069.14 1, `u. S RECEIPT DATE BY /' DATE FINALED INSPECTOR SE1 ss ' 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 i 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 Drywall - Int. Lath Final Final POOLS - SPAS BLO'GKWALL APPROVAL 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 T 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 r� WK Final COMMENTS: I" 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 FinalTT Utility Notice (Perm) Tityl 4 4 Qgb& P.O. BOX 1504 Building /� ,�k� , ,�- ' L 78-495 CALLE TAMPICO Address �D -7 �` Lic t LA OUINTA, CALIFORNIA 92253 Adi�ress}''() 80,-- _i-%-% J City Zips Telma Contractor APO .-k(- S State Lic.1_ City & Classif. 15W 100 # Arch., Engr., Designer Lbe= Cv'J -. -r I? Address., ( � � Tel City Zip. State J A t,altl ► AJ'TA �x7-cj3 Lic. # 1 LICENSEDIONTRACTOR'S DECLARATION I hereby affirm that I yam Ilcens@@d nder provisions of Chapter 9 (commencing with Section 7tXX)) of D'IV'(Si0 3 of the Busina s and Professions Code, and my licen �' is in full force and effect. ` hd OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5.9usiness 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 the alleged 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 ($500). !: 1, 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 orimprovement 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.) II I, 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 contractors) licensed pursuant to the Contractor's License Law.) 17 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 Com ensation I urance, or a cart ifi d copy thereof. (S¢c. 3800, Labor Code.) Policy No. Company - t �1..) n Copy is file wit the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed i1 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 beco a subject to the Workers' Compensation Laws of California. ,, l late - NOTICE TO APPLICANT:\ lf, after making thi5y Certifi a e 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 I hereby 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 if 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 �So� -057 APPLICATION ONLY ILDING: TYPE'CONST. /� OCC. GRP. '. Number (o4& -' `/I ! - D 2- I )al Description! -I-- e"kVM MA�002 "fQ.A4T eject Description �-UT t*- Z -I G . Sq. Ft.No. No. Dw. Size (�d C Stories Units Newer Add ❑ Alter ❑ Repair ❑ Demolition ❑ Valuation PERMIT Plan Chk. Dep. Plan Chk. Bala Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL REMARKS AMOUNT ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side Setback from Property Line FINAL DATE INSPECTOR Issued by: Date Permit Validated by: Validation: WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION Desert Sands Uinified School District Notice: 82-879 Highway 111 Document Cannot Be Duplicated .-Indio, CA 92201.619-7,75-3500 CERTIFICATE OF COMPLIANCE Date 2/10/98 APN # 646-311-021 No. 16636 Jurisdiction La Quints Owner Name John Carper Permit # No. 78715 Street Sagebrush Ave. City La Quinta zip 92253 Tract # Lot # 21 Square Footage Type of Development Single Family Residence Comments Log # Study Area 1600 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 rained 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 1.84 X 1,600 or $'.2,944.00 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 oc/Hemet FederalSavings/Apollos Construction Telephone Name on the check By Dr. Doris Wilson Superintendent Fee collected /exempted by Pauline Pearson Signature Payment Received `$2,944.00 $2,944.00 Check No. 674984661 40TICE: Pursuant of Assembly 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 rbove will begin to run from the date on which the building or installation permit for thisproject is sssued or on which they are paid to the District(s) or to another public entity authorized to :ollecl 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 Co gyi- Applicant/Receipt Copy - Accounting ,4_, 00'' YrOF LA QU'INTA BUILDING & SAFETY DEPARTMENT 777-7012 INSPECTION. REQUEST LINE 777-7153 Owner JOCAR E HNR Contractor u�OS Cs)N Permit Number 9801-057 ' POST -ON JOB IN CONSPICUOUS PLACE INSPECTOR MUST _SIG N.ALL.AP_P_LICABLE _SPACES JOB ADDRES 7�715'.SAGLBii­:RUSItAVE , SFD ONLY 14/ TYPE OF INSPECTION DATE INSP. FOUNDATION &'SETBACK FOOTING. STEEL MAIN GROUND SYSTEM GROUND.PLUMBING. PRE-GUNITE 5 DO NOT POUR CONCRETE UNTIL ALL AB VE HAS BEE SIGNED CONCRETE SLAB JOISTS& GIRDERS i ELECTRICAL GROUND WORK DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED ROUGH ELECTRIC ROUGH PLUMBING ROUGH GAS & GAS TES HEATING & VENT - A/C FIREPLACE ROOF - �' 3 BOND BEAM O.K. TO WRAP 5/S GROUT ❑ 4' ❑ 8' FRAMING INSULATION j) PRE -ROOF COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED DRYWALL INTERIOR EXTERIOR LATH POOL PRE PLASTER'. SEWER(SEPTIC TANK` I -,31191vX . 11/i ' / FINALS ELECTRICAL — lS PLUMBING i. FINAL GAS TEST HEATING -A/C HOUSE NUMBERS JOB COMPLETED TEMP POWER Q• y ABOVE APPROVALS DO NOT INCk TURN ON UTILITIES OR•OCCW c RIGHT TO WILDING' Tit4t - 4 4a" 78-495 CALLE TAMPICO - LA QUINTA, CALIFORNIA 92253 - (760) 777-7000 FAX (760) 777-7101 TDD (760) 777-1227 July 22, 1998. Mr. John Carper P.O. Box 977 La Quinta, CA 92253 Dear Mr. -Carper: Please be advised that your permit #9801-057 for the dwelling located at 78-715 Sagebrush Avenue was issued without the Coachella Valley Fringe Toed Lizard fee. For your project #9801-057 the'fee equals $78.00. • Please contact Wallace Nesbit of the Community Development Department at (760) 777-7069 to make these arrangements. Thank you in advance for your attention to this matter. Sincerely, Mark Harold Building & Safety Manager c: Wallace Nesbit MAILING ADDRESS - P.O. BOX 1504 - LA OUINTA, CALIFORNIA 92253