9607-056 (AR)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury'that I ani 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'
-627t6:5
,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).
( ) 1, 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.
•1 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 asue�d My �norkers' compensation insurance.carrienV�.'golicy noAre:
Carrier _ Policy No:
(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.fhe
workers' compensation laws of Califomia,•and agree that if I should become
subject to the workers' compensation provisions of Section 3700 of -the Labor
Code„I shall fo hw-th comply with those provisions. % +
Date: Applicant /%:r �%. ✓ �'.�.��
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 issuedas 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% gent) %�`- -'Date I _8
' BUILDING PERMIT .PERMIT# °°NTR°`�
'}{�f}'jsF3�ivr 3 7 2 5
DATE VALUATION LOTI TRACT
7O2-:tl 6 $14,tA_'�.20 '
JOB SITE
ADDRESS 48.701 SNNTA URSULA •
APN -
,
OWNER
CONTRACTOR / DESIGNER / ENGINEER
:d,?i.14t1'a.1tABARSARA Rf't P
DF3A`!°1 C.C3;Pt�i'ttil 'Y"tfr�Pl
.48101 SANTty UltSULA 9e
74315 FAIR `Virtil'-OWN' :6
LA ()"N.''A, CA 92253.
PALM DJEF+EWC CA 9V61
($
C'_%1IA 4324
USE OF PERMIT
k1DD 481 V) AN.0441Y 41Y '1'0 EMS` ING F3MROOM
• -., ' 98t�.�ii :3�~
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..,
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141645.20
PI ANCffwCf< �k 4U1. Ut?f1-� 39-3'1tS 51()5>3fi
ila 't�tiv,i: t►C i1.� 101.060-421-000
0—r- "f k(C, A t, F03 i 11t-ilttU-illfl-C)fi(? O'7,.1.SF3
P UN21,10 O Vff - , 1'414.)004,19-000 a0.Q0
zrltA7*`'O;t'i 1431-�`t?�J!1•tiLGn9.0f! .
S'i'0 N JWMIt'at 17.1 as-.RES10 1.01-000441-00
Slit -11i01 MON AND PUV! i CRECIF:
LESS S F 113 -s -PA. 4D FEES
SO.00
'&M.34
t'.€, PERM iVil1 i' FIRES DUE1�14D 4'
•.
2.2:.1996: . - .
JUL . _
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
I INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
`
Forms & Footings
Ducts
Slab Grade
T
Return Air
Steel
t
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
(e
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
G
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVA, S
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
44ZHeater
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.-
OMMENTS:Final
Desert Sands Unified School District
Notice: 82-879 Highway 111
Indio, CA 92201
Document Cannot Be Duplicated 619-775-3500
CERTIFICATE OF COMPLIANCE
.0;
Date 7/22/96 APN # 646-130-014
No. 14670 Jurisdiction La Quinta
Owner Name James & Barbara Reed
No. 48701 Street Santa Ursula
.City La Quinta zip 92253
Permit #
Log #
Study Area 122
Tract # Lot # Square Footage 188
Type of Development Residential Addition No. of Units 1
Comments
adding to existing bath and bedrooms
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. FT. OR LESS
EXEMPT
This certifies that school facility fees imposed pursuant to Government Code 53080
in the amount of 0.00 x 188 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 B �v
Y N/A y Telephonej_ 340 `1874
Name on the check
By Dr. Carol McGrew
Administrator in Charge
Fee collected /exempted by Pauline Pearson Exempt _''56. 00
Check No. N/A
Signature 2aa Q d A. o V Las& A
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