9612-042 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chr,,pter 9 (cnmmencing with Section 7000) of Division 3 of the Business and
Profes r�'onal C de, and my License is in full force and effect.
License # Lic. Class Exp. Date
y 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 et �ii Policy No.
11, � ,
(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 applicator 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.
Signature (Owner/Agent) Date
BUILDING PERMIT PERMIT# CONTROL#
4523
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CONTRACTOR / DESIGNER / ENGINEER
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USE OF PERMIT
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Notice:'
Document Cannot Be Duplicated
Date E12/11/96
No. 15074
Owner Name Mr. John Bradley
Desert Sands Unified School District
82-879 Highway 111
Indio, CA 92201
619-775-3500
CERTIFICATE OF COMPLIANCE
Jurisdiction
APN # 646-140-024
La Quinta
Permit #
0
No. 48720
City La Quinta
Tract #
Street San Dimas Log #
Zip 92253 Study Area 109
Lot # Square Footage 3124
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
1.84 X 3,124 or $ 5,748.16 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 B cc/ First Bank/John Bradley
By Y '�� Telephone ^
Name on the check
t
By Dr. Carol McGrew
Administrator in Charge
Fee collected /exempted by Pauline Pearson Payment Received $5,748.16
Check No. 37030
Signature , , �L4_
40TICE: Effective January 1, 1997, 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
Mar payment identified above will begin to run from the date on which the building or installation peril 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 CITY OF LA QUINTA
awbuf4& SAFETY DEPARTMENT
ti C 777-7012
PECTION REOUEST LINE
DEC 19 777-7153
EILEEN BRADLEY
Ow
trelctor RANCHO CAP1STRANO DEV:
Con
9617,942
Permit Nurrybef
= POST ON JACE
OB IGNONS A1PPLO AB EUs LSP CES
INSPECTOR MUST S
48-72Q SAN pI1V1AS STREET
JOB ADDRESS
SFD 'PERMIT DOES V�O, RCpLOOL ~
INCLUDE BLOCK �VAL�L
i DATE INSP.
TYPE OF INSPECTION `
t..
FOUNDATION & SETBA K
FOOTING STEEL
wn nvRTEM
GRUUnv
' PRE-GUNITE .
ONO POUR CONCRETE UNTIL ALL A OVE
CONCRETE SLAB t:
inlsTS & GIRDERS
DO
TOUR CONCRETE UNTIL ALL
`{ ROUGH ELECTRIC
. ROUGH PLUMBING
ROUGH GAS & GAS TEST
CHEATING & VENT = NC •
t ROOF
I
BOND 1—'BEA
O.K. TO WRAP
GROUT C3 N
FRAMING
• INSULATION
PRE -ROOF
l•
c
ii COVER N(
DRYWALL INTEF
i EXTERIOR LATH
POOL PRE PLAS
POOL FENCE &'
€PTIC
ELECTRICAL,
i PLUM
' FINA— TES
i HEATI— C
s HODSNUME
4 ,IOB CA
La Quinta Golf Estates ,
Community Amociation
P.O. Box 162
La Quinta, ca 92253
619/564-2177
December 4, 1996
Planning Department
CITY OF LA QUINTA
P. 0. Box 1504
La Quinta CA 92253
RE: Lots No. 28 & 29
La Quinta Golf.Estates
Gentlemen:
The'Architectural Committe of the La Quinta Golf Estates Community Association
has reviewed the proposed plans for construction of residences on Lots No. 28
and 29 submitted by Rancho Capistrano Development Company.
The plans comply with guidelines established by the Association and are,
therefore, approved as presented.
Yours truly,
4--���
TOM KENNEDY
Chairman
Architectural Committee
ti
CiTYY OF LA C LANTA
SAN 14 REC'Q JON TANDY
BUILDINGSAFETS580 Condalia Ave.
Yucca Valley, CA 92284
,SPECIAL INSPECTION SERVICE, (619) 365-5045
REGISTERED INSPECTOR'S WEEKLY REPORT
TYPE OF
INSPECTION
FPERFORMED
❑ REINFORCED CONCRETE STRUCT. STEEL ASSEMBLY
❑ POST TENSIONED CONCRETE ❑ ASPHALT
❑ REINFORCED MASONRY ❑ FIRE PROOFING
❑
❑ OTHER
JOB CAkNs 0 .. 1 n `
aT
REPORT SEQUENCE N0.
TYPE OF STRUCTURE
Y-� •
`
�v:� � � �
PERMIT NO.
DATE ,9_4q? �/
✓ _ 1
DAY OF WEEK
MATERIAL DESCRIPTION
`"?a /�J
ARCHITECT
INSP TO "Ir%
HRS. CHARGED
_
= i I
! I
ENGINEER
ASSISTANTS
HRS. CHARGED
INSPECTION
AL
GENER LKDTECONTRACTOR CONTRACTOR !
o CoN N e-C—k L o cJ 1A TtE75 "Zj
A -
COPY SENT TO CLIENT
CONT D ON NEXT PAGE O
PAGE OF
• CERTIFICATION OF COMPLIANCE /
I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MY
KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE
NOTED. I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED
PLANS. SPECIFICATIONS, AND APPLICABLE SECTIONS OF THE
GOVERNING BUILDING LAWS.
/— 10--/
SI AT- OF REGISTERED IN6 EC,. 0? ,�'7 ��
DATE of REPORT •y�— REGIS TER �NUMBER