0005-124 (AR)'.. v .
`LICENSEb'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 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
(/S I am exempt under Section B&P.C. for this reason
Date r> . 9%_ 2...,. Signature of OwnerC!'A.
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.
(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 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.
%Sjg-h edl(Ow" 66r' /Agent') - 'I -E Date 4-2
�/I� BUILDING PERMIT PERMIT#
DATE VALUATION LOT —124 TRACT
,,3,62.x0
JOB SITE
APN
ADDRESS 7W780 aS'ANIIA D.MVE
604^I 003
OWNER
CONTRACTOR/DESIGNER/EN INEER
AWAONDO L ORKDO
0ViNP'S6BT_71iDMZ
78-780 Sl"ITADRIVE
78-780 SANITA.DRINT3
LA QUINTA CA 92253
LA QLM-4TA CA 92253
(760)345-8116 CBL
USE OF PERMIT
n7MMv°Z SAL ADDITION
NEW BEDROOM ADDITION 294 SQ. F"1'.
/
ADDITION 154.00 3f
Ff.ST71"TED COST OF CON.;rk TC'L`ION
PIM CHECK IEE 101.000-439.318 320,24
MECHANICAL FU 101-000-421 -M $21,50
ELECTFUCAL FEE 101-000.420-000 $21,00
.
PLUMBINO 2,.E 101-000-41-9-000 $26.00
Y t
SUB -TOTAL CON'XrRUCDOAt AbR) PLM CI -IEC
IHSS I'R3i-PALp t'1
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'L'O'TS FERMt M.8 DVE i01
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RECEIPT
DATE
B {/��
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
;r . ZC • 40
Ducts
Slab Grade
Return Air
Steel
S —`Leo a®d:
Combustion Air
Roof Deck
(41 , -t�®
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
1
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
,-L- -00
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
Final
Utility Notice (Perm)
COMMENTS:
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City of�La `Quin:t�aI
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•BuiIding.8[ Safety Division
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P;O Box `t 504<, "' .
::Permit #
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78-495 Calle Tampico ' "
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La Quinta, GA 922-53 f
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Building Permit Application and Tracking Sheet , .
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Project Address:
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Owners Name: . 3
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Desj��
ert Sands U®iited School Distriet '
47-950, Dune Ti lm§ Roady
Notice:
. La�,Quenia, :Ck*91253=
'Document Cannot Be Duplicated" ♦ 7607771 8515
CERTIF'ICATE'OF COMPLIANCE`y }
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Date 5/19/00 ' APN # 604-163-003
No. 20460
Jur>Isdiction •-:La Q.uinta
Owner NameArmondo Lo -redo < Permit #0005-124
No. 78780 Street Sanita Drive ` ' 1Log4
r City La Quinta Zip 92253 Study Area
Tract # Lot # Square li ootage <l54''
r
Type of Development Residential Addition i No. of Units 1
.Comments 154 sq. ft. ne'w bedrodin,addition to tkhouse:
At the present time, the Desert Sands Unified School District„*does., not collect. fee -on garages/carports, covered.
patios/walkways, residential additions under`500:square feet,:detacheddlai"(cessoryatructures or -replacement mobilehomes. It'
has beemdetermined the above-named'owner is exempt from:paying'scfioohfees'at is` a due to the following reason:
r T+
Residential Additll®nf:500, Sq Fiefbir Less
,:
EXEMPT
This certifies that school facility,fees imposed: pursuant to Government Code 53,080 1 in.the:amount of
0.00 X 154 or $ 0.00 the, property listed above and that building
t
permits and/or Certificates of Occupancy for this square*footage!in:this.proposed.projectmay now be issued
Fees Paid By N/A - Armondo:Loredo . - ._ I ~
34T 1epho. = -
Nameowthe'check
By Dr. Doris Wilson
Superintendent_ -
Fee collected /exempted by Mary Ann L. Borja Exempt
Check No. N/A
Signature ”' y
• NOTICE: Pursuant of Assem ' BH13081 (CHAP 549 STATS:'1996) this.wtll serve to notify you that the90-day approval penod in which you may protest the fees or other payment identified
above will begin to run from the date on which the building,or installation permit forttiis project issssuad'orwhi
on ch they ere paid to, the District(g)or to;another public entity authorized 6
collect them on the Distrtot('s)(s') behalf, whichever Is earlier.
Collector: Attach a copy of county or city"plan"check application forme
,'Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt
district copy,: for all�waivers.
Copy - Accounting
.. .. _'xt.:.._
,CITY OF LA,QU I;NTA:.x
-BUILDING.& SAFETY DEPT
APPROVED
FOR CONSTRUCTION
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