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9908-176 (AR)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 Exp. Date Date T 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 Policy No. at„• (This section need not be completed if the permit valuation is for $100.00 or less). (*a) 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 su oct 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 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. Signature (Owner/Agent) Date 4 BUILDING PERMIT PERMT# DATE VALUATION LOT TRACT JOB SITE APN ADDRESS OWNER CONTRACTOR / DESIGNER / ENGINEER a a a:,.,�..au.�. r♦ .+ a+r. zja �.ta t.i..i a,..va.. ... ... as �..a� �.ta.r a..aa.,{ a..n•. ��.. ,. - i(i��i i 7t��4)1`�i>.q. r•�i i i °t�1;If fit g USE OF PERMIT 4. ; z�i b ;;:t,i. i 51.td .ai!g1S e.!`d t+,.'L.e L 1+e�..:: t♦1<.,..: i, '1'1!,`i+.: id.i'.e�.�L..E.�`1i,. s,.>✓'y, i.♦,I%, :i � i°a L. !. .,1 •;1 5 r>," ii 1 N ii4/tl 14) L A,iii+`i. i?laRNU 1, FEE S% ii#gvi.ikkv i>I . tk.!�s +_"•t-iF',(:�, i;'�:E i! 4,? i-i3(}tM-� �+;0 .;� 134 ?:,',ti�.�:} i ar}?. 31'R1T('.'t'1d: N V f°V 1411 4X)A_ iA4" io R'ff' 0IXNICAI,14M, I:��.!tt•' 3..1.;�A,`t'it.li.;.rii, i~I�:: iQi•-�/tJf).,��tH11'�!() U ", :i; 11'a't' O N(i 14,K)TICON FFT - R11,"tpl1 lfid-f;if)i1- i -41t ,i1r! `,t T14--lytt'fAt i-()t )"frMI V-11 yN AN!) VI A..yN f 6.fF( I., p.4"l:fib, 9'Y:6�;14t11;:' VC�:i"S 011E NOW RECEIPT DATE ` BY DA I E D INSPECTOR INSPECTION RECORD OPERATION I DATE I INSPECTOR BUILDING APPROVALS Set Backs Forms & Footings Slab Grade Steel Roof Deck O.K. to Wrap Framing Insulation Fireplace P.L. Fireplace T.O. Party Wall Insulation Party Wall Firewall Exterior Lath Drywall - Int. Lath Final OPERATION I DATE I INSPECTOR MECHANICAL APPROVALS Underground Ducts Ducts Return Air Combustion Air Exhaust Fans F.A.U. Compressor Vents Grills Fans & Controls Condensate Lines Final POOLS - SPAS BLOCKWALL APPROVALS steel Set Hacks Electric Bond Footings Main Drain J 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 I Final COMMENTS; Final �j ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit / Low Voltage Wiring Q V , I<y— Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power I Final Utility Notice Bin # City of La Quinta Building asz Safety Division P.O. Box 1504 Permit # 78-495 Calle Tampico La Quinta, CA 92253 Building Permit Application and Tracking Project Address: p p T ri /Sheet Owner's Name: A. P. Number: Address: L�¢�Z Ll Yl,LVJ"�C-"�" (^ Legal Description: L City.ST. Zip: V 61\vv Contractor: J Telephone: Address: Project Description: Cil/! V City.ST. Zip: G Telephone: State Lic. _ : City Lic. #: Arch.. Engr.. Designer:i��Jl/G �J Address:14 ( 7 l tw A-�Ez ( Cin. ST. Zip: n Telephone: 8tp Construction Type: jOccupancy: State Lic. 2- Project type (circle one): New dd'n Alter Repair Demo Name of Contact Person: Sq. Ft.: 3 # Sto 'es: # Units: �7 Telephone = of Contact Person: Estimated Value of Proj �`�0 s - 'APPUCANT.:OU`N©T-ilyRll .E`a3E 0W—::`TH[S.UN :.. kSubmittal Rsq'tl -; ._ Plan Sets Plaaiteeltsttbttiiited `' item . Amarst' } Structural Calcs.Reviewekreadrforcotaeeiwas : � f Pb*VfieckDeptnit Truss Cates.Galted:Carsiact'Peraen 5 i►Iaa:fet�c:Ba�ee a: Title 24 Cala. Plaas:pieked:up tJ Ctystsuc6olE; w Grant Deed Plattcrsoubmitled $ Mec�attical g School Fees Retrte�red, Heady to txn4 'FaegwiW 25.3 Subcontacter.LIM Gf1ENE.Coataci:Pertron .:>... Pla ittG .... 3� 5740 Contractor Info ; : Date; afTermitAme . 5MY • Ci,- Business Lic :: g .-I .: Planning Apprava) :: i1.3! Pub. Wks. Appr. ; H -0-A. Approval Fire Mar. Appr. H. Dept. App ceval Ag. Approval Date:af nAHnsPecdort Tatat ernsJfFees Notice: Document Cannot Be Duplicated Date 9/l/99 No. 19272 Desert Sands Unified School District 47-950 Dune Palms Road La Quinta, CA, 92253 760-771-8515 CERTIFICATE OF COMPLIANCE APN # Jurisdiction La Quinta .y 646-160-029, Owner NameFrederick A & Karen Augusta Permit # No. 78024 Street San Timoteo Log# . City La Quinta Zip 92253 Study Area Tract # Lot # Square Footage 395 f Type of Development Residential Addition No. of Units 1 Comments ;95 sq. ft. ResidentialAddition Ili 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 in the amount of 0.00 X 395 or $ 0.00 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 N/A - Jack Clark Telephone ''r Name on the check n c By Dr. Doris Wilson K Superintendent 4, 1RI Fee collected b Sylvia /exempted Carrasco Exempt p Y Y p $0.00 .n :'c t Check No. N/A Signature 10TICE: 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 bove 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 ollect 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 r Lar- Communtty AzzocZatton P.. O. Box 162 La Quinta Ca 92253 Telephone: 760/564-2177 FAX: 760/564-4882 August .5, 1999 Department of Building & Safety CITY OF LA QUINTA P. 0. Box 1504 La Quinta CA 92253 RE: Remodel - August Residence 78-024 San Timoteo Gentlemen: Please be advised that plans submitted for the above referenced remodel have been reviewed by the Architectural Committee and found to meet all criteria setforth in the Association governing documents. If you have any.:questions,'please contact the office at 564-2177. Yours truly, BARBARA REED _ Commiteeperson/ Treasurer r Contractor: State�Contractofs License' : .< .: Workersom ensation Insurance: . Cit Business License `' Company Name r License Number fxxxxxXI Exp. Date (xx/xx/xx) Carrier Name le.g. State Fund, CalComp) ( CITY OF LA QUINTA SUB -CONTRACTOR !LIST JOB ADDRESS ����`� -&-L��'-►"1, 1#116LO PERMIT NUMBER OWNER _t'•' �/kdC LGl lyl BUILDER*L-k 12 This form shall be Posted on the job with the Building Inspection Card at all times in a conspicuous place. Only persons a0`iiearing on this list or their employees are authorized to .work on this job. Any changes to this list must be approved by the Building Division prior to commencement of work.' Failure to comply will result in a stoppage of work and/or the voidance of building permit. For each applicable trade, all information requested below must be completed by applicant. "On File" is not an acceptable response. Trade /Classification ' Contractor: State�Contractofs License' : .< .: Workersom ensation Insurance: . Cit Business License `' Company Name Classification (e.g. A, B. C-8) License Number fxxxxxXI Exp. Date (xx/xx/xx) Carrier Name le.g. State Fund, CalComp) Policy Number (Format Varies) Exp. Date (xx/xx/xx) License Number (xxxx) Exp. Date (xx/xx/xx) EARTHWORK IC -12) r CONCRETE IC -81 ..s.P. /; ll�ICI•'7'i:t'" C1.✓tL✓Z 1.::. L 3b�3� It 34 tY% CSI �AG•�,E'" i�Y'i'L Zj`i[7 1"i3-�- 1�:��3� t� �7ij(JU FRAMING IC -51_-.,- A t �J� Cctil.S UG iovl C10I6 -�•4olGl.T5 03`29j00 m, r-, C01-1.09 INS N 1012-4- '3 j 1111 9`I 2/2g00 066 2 STRUCT.'STEEL (C -51).J, MASONRY (C-29)" PLUMBING (C-36) U. - M n2O CN30� "Lip 7,51a 1 LATH, PLASTER (C•351" b C 1) L3 10 iia CG (f 017. Co. W- 9^ 1',qC) `I 979 DRYWALL(Cr9) L'+QL _35 1 I ) ,OQ QMcyij kriem./J q9- Eqbll 04 10-6^99 1d�'0 HVACIC-201::>:-'�.. - ELECTRICAL IC -101. 4 Sar ;;o l�li'S'G\' /n. n� C `I� _ � 1 ` _Ile �7 / ROOFING IC39) ,Ic-00 e- 6 i a C3) 63103°0' 31 ✓D (9L -3 p G 6 Vic- SHEETMETAL�IC-43L*'; FLOORING (G15) GLAZING (C 171. '" ,.,t., �L� '/, 1- rJi G ^I 37XD1 - DI6 ta.v�.Q[ -. '����-v �_I 03og5 INSULATIONIC21-'if:;^` t, 2c'✓W IItCV• .A'%\ La Cq X37 3g�a3 :{ {!5� ILI. jy101lvi.. WC1 C1J�3���5 01�0(iV) lt%3� ��•'I SEWAGE DISP.•IC-42I': •s,. PAINTING (C 33) ' _ CERAMIC TILE (6-54) * Ccn 6!OU 3218 -�IS �C CABINETS IC 6) FENCING IC 13) LANDSCAPINGV (C -27P;.,':: POOL (C-53) `4