9802-008 (AR)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
k-CrAapter 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 Signature of Contractor
OWNER -BUILDER DECLARATION Y
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
c6ntractors to construct the project (Sec. 7044, Business & Professionals
Code).
I am exempt under Section B&P.C. for this reason
ate " -. �� K. Signature of Owner f J r
,
;a • 'r 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. r
I have and will maintain workers' compensation insurance, as required b '
.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. ' ,
iii :1 �•!'l �1i'�'4i.l C. l"/ i f .A ,4'1 �;'
(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
woakers' compensation laws of California, and agree that if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
..C`ode, 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
co?rect. 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
fe above-mentioned property for inspection purposes.
ignature (Owner/Agent) f ` i' ' f� - Date -
`. f ,"-Y
BUILDING PERMIT PERMT# °°NTR°`#
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DATE.. VALUATION$2,64�Y �( LOT :14, If).. TRACT
JOB SITE '
ADDRESS 48-7 i 1 ..15AN VICENTE, E,
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OWNER
CONTRACTOR/DESIGNER/ENGINEER
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RECEIPT
DATE
BY / `�
DATE FINALEDINSPECTOR
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
0. 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
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
r
Final
Utility Notice (Perm)
COMMENTS:
Notice:
Document Cannot Be Duplicated
Date 2/3/98
No. 16608
Owner Name Charles R. Knox
Desert Sands Unified School District
82-879 Highway 111
Indio, CA 92201-
619-775-3500
-CERTIFICATE OF COMPLIANCE
APN # 646-140-009
Jurisdiction La Quints
Permit #
No. 48711 Street San Vicente Log #
City La Quinta Zip 92253 Study Area
Tract # Lot # Square Footage 34
Type of Development New Residential Addition No. of Units 1
Comments
I
ivmg room ,
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:
Add. of Sq. Ft. to New Construction
EXEMPTION NOT APPLICABLE,
This certifies that school facility fees imposed pursuant to Government Code 53080,, lin the amount of `
1.84 X 34 or $ 62.56 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/Wells Fargo Bank/Charles R. Knox Telephone '
Name on the check ' 7,— �C
By Dr. Doris Wilson z f,
r�Cz
Superintendent
Fee collected /exempted by Pauline Pearson Payment Receive d�0,61 56 •-:'
Check No. 7377001765
Signature
4, P,
IOTICE: 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 dale 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