0202-148 (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 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
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. {�(oitci
(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 $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above -mentioned property for inspection purposes.
BUILDING PERMIT
DA VALUATION LOT
OWNER
LAVIGHT J.#Sk 9114k;
78760 33AN.Cx'11 DR
T_ tk QiTtwrA
USE OF PERMIT
tt1i..:1?.�".`�t.f+�i.• �,Lai�+.l"i"it:)3J
PERMIT #
xir - TRACT
APN
CONTRACTOR/DESIGNER/ENGINEER
'14-7 8 t GARY AVE
OC)NE.t3 i:OC:)M ADDITION (17+6 :.F.; ("CONVERT THIRD CAR GARACIE� a
0 0 1 ) F,
BONUS RCIK�m
1 :In$ "P
PLAX i:HEM N1?.1*r 18
MEX I1.ANICAL kI.T 101-000- 21, 0700 $191%
I?,J,FCTRICA1. YEF, 101 o0o.'c"o-Q.0o $21. f
L
AR 2,5 C3f1r
F.
. t,:a���N (°'�A1'f£" , S 1 e3v) 1 f)
NS
RECEIPT I DATE I BY I DATE FINALED I INSPECTOR
Signature (Owner/Agent) Date
INSPECTION RECORD
OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR
BUILDING APPROVALS MECHANICAL APPROVALS
Set Backs 11 Underground Ducts
Forms & Footings Ducts
Slab Grade 179 Return Air
Steel Combustion Air
Roof Deck Exhaust Fans
O.K. to Wrap F.A.U.
Framing - z Compressor
Insulation -Q G - Z Vents
Fireplace P.L. Grills
Fireplace T.O. Fans & Controls
Party Wall Insulation Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
r
Final < '-
Final —2 POOLS - SPAS
BLOCKWALL APPROVALS steel
' Set Backs Electric Bond
Footings Main Drain
Bond Beam Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
i rine: Gas Piping
PLUMBING APPROVALS Gas Test
Electric Final
Waste Lines Heater Final
Water Piping Plumbing Final
Plumbing Top Out Equipment Enclosure
I Shower Pans O.K. for Finish Plaster
Sewer Lateral Pool Cover
Sewer Connection Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
I. Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Zemp. Power Pole
Underground Conduit
Rough Wiring
i.M Voltage Wiring
Fixtures
Main Service _
{ Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
til'ity Nktice (Perm) - Z
i
r
m DesertSands Unified Sclool'�Districtj
47 950,;,Dune Palms,Road ;
°Notice:La'Qumta,CA 92253"
Document Cannot Be Duplicated s R 760-7711,45,15..,s, a
CERTI'ICATE OF COMPLIANCE:,
Date3/22/02 AP 14 # - 604-1,63, 001
No. 23072 , Jori dict on 'La uirita ,
Owner NameDywight Jenkins Permit #,0203-148
No, 78-760: Street Samta Drive~
city .La Quinta - "'Zip { ,92253 ` Study area
v-, Tract # 23269 Lot#i '101 Square Footage 1.76
J.
i. Type of Development Residential Addition 's., No. of Units '1
CommentsReside' ntial,Addrtion Bonus:Room of'176. sq:°ft. 'J
? i' ~ 3-
;At the present .tune, 'the Desert Sands Unified School Distract 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 1s exeinptfrom:paymgschool fees at flus time due to,tlie followir►g reason::
fi ..:
Residential Addition SOO�Sg Feet�or Less
.T. I _ .. � EXEMPT
" This certifies thatschool facility fees imposed pursuant toGovernment Code 53080 u -in amount of
0.00 X . 176 or $ t0:00 r ".+ ,j
r the propertyEhsted above and that building
permits and/or, Certificates of Occupancy for this square footage m flus proposed project may nowkbe'is`sued
`•� '.;Fees .Paid By -
4 Exempt Albert Hernandez' ! r Telephone '
'
CIF
Name on the ch'e'ck
;;'• rvBY,r, . Dr. Doris:Wilson
Superintendent
Fee collected /exempted by .Crystal Scott Exempt;' $0,.00`
j r Cheek No:
t . Signature
,. .I `
.i i
NOTICE: Pursuant to Assembly Bill 3081 (CHAPi-549 STATS. 1996),thlswill serve to notify you that the 90 -day approval penod m which you may protest the fees or other,payment identified '
above will begin to run from the date',on which the building or instillatiompermitfor this project is sssued or,on which they are p'aid'io the District(s)or to another,public entity authorized to s
collect. them, on the Distnct('s)(s,) behalf, whichever is earhe
n••,
Collector: Attacti'a copy of county or city� plan,',check application form>ao d►strict c py fors all waivers:
Embossed Original -Building Dept./Applicant Copy, - Applicarit/Receipt. Copy Accounting
le.'OWP, eft: D ht ef, k
.Hom wig., 9p ^nti4aJeh Ins
Addre!38: 787.60.84n ita- Drive
-
La
0u:['n-.ta-...CA 92253
M
x
W
1/2 Hot
I 6/ts" SL;
Door
217'
House Interior
CITY OF LA QUI NTA
:BULDINGA SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
Entry to Weather Strip
W/H Door !MTE
House
xis t:xistipg
l
Switch
Duct to extend
Electric Outlet
10,
SmokeiDetector
14 6 V. 1&3*rr, 6A" Up
Water o.*
Existing
Existin Hi/Low 9" x 6"
Telephone Jack
Cable TV Outlet
Hbater.1
mb n Air Ve�n
Co vents Combustion
24" CLW
Notes
All lbonstrylptid'n shall comply with
. �,the -1998 Califomig Building,
Light
`-Plumbing, Mechangibal and
37'
-Electrical Codes and all other local
C
co -es and ordinances.
F,
5/8'! Gypsum Board from floor to
roof for .firewall between garage
and new addition.
-a) A
-1/2" Gypsum board for interior
-7
PH N
walls and ceiling."R-13 insulation
in walls. R-38 insulation in ceiling.
=104
Ar
Walls of room and hall area;tb be
textured and painted.
47'
Room area flooring to be carpet.
8.91.
q,
Hall area floorinq'to be tile.
New addition ceiling height to be 8
C
feet.'
Z
Exis ting-Stuc
Wall
Light/Ceiling Fan �&
(i) SD
ff
'Efxmsrnnpi�tt
X0
Le end
Switch
Electric Outlet
SmokeiDetector
14 6 V. 1&3*rr, 6A" Up
Air Supply Register
Telephone Jack
Cable TV Outlet
Ceiling Light and/or fan
_ o'me Owners: Wight & Donna Jenkins
Address: 78760 Sanita Drive
La Quinta CA.92253.
. House Interior
x AODfOYQt� a �$ � •x _ z '
W
S' CCIM f1I E
`�Z.,,,..,.,..... ntryea tp
. x' �. W/HDoor -
Mitlals - .,t.,,,:..,,.,,.. ..a..•.....� Housto ere .£ s
xis ing,
• �8S@'AIQ. �.rw . +�....► ,_ ., , - Duct to'extend . , . , „ .. � ,
-:.. 1/2 Hot -
1Exhibit I .Water Existing Hi/Low 9'`x 6" '
Heater s Air Vents n ►�/ ♦ r���.�� Combustion-
`i�l1N A�YgiMK� 1�'M�wwwrA�riti rrwww�w�. -I 24" CLW >>; ..- .ra •- :u
Notes;,;
• _ I - #._, All construction shall comply with • -
ug6t the 1998.,Califonl uilding,
TTg
o+ ,.y. Door.`^•� ? Plumbing'Mechangicel'and
- CITY O F LA .Q U I N �.) T1' I ac
.EleIXncal Codes and all other Iota codes and ordinances.
BUILDING & SAFETY DEFT. a
518' Gypsum Board from floor to
�® roof for,,firewall between garage
`A P O ® D O SD and new addition.
FOr" — — — — —.1/2" Gypsum board for interior ,!r:
R* CONSTRUCTION PH N walls grid ceiling. R-13 insulation',
in walls. R-38 insulation in ceiling. "
jjr Walls of room and hall area to be
DATE BY *1H0 textured.and painted.
Room areaflooring.to.be carpet.
s Hall area floorinq to be tile.
New`addition ceding height to be
C ; feet.
Y '
xis mg wl
Existing Garage Wag
®LigftUCeiling Fan �
Legend
Closet
= Switch
= Electric Outlet
Garage �— 0 = Smoke Detector
Entry . ® = Air Supply Register
O SD
=Telephone Jack
'
Closet
iA = Cable TV Outlet
® = Ceiling Light and/or fan
�VITAgg_M6)M,_nd5&w
z�=A
X0
�y .5