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0011-231 (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 '45/3112C DateSi nature of Contractor a</ 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). . w ( ) 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 EXEMPT Policy No. , (This section need not be completed if the permit valuation is for $100.00 or less). J.(?I 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 3 70 0 of the Labor Code, I shall forthwith comply with those prowslons. • f "Date: 11 � S P'a- Applicant-- if pplicant f / . Warning: Failure to secure Workers' Compensation coverages 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) lt�,c' % l r ! t Date BUILDING PERMIT PERMIT# DATE ' VALUATION LOT 001,1431 TRACT V /© 0 $3,444 iC± JOB SITE V '"` ADDRESS 894)70'F.RW MC. IX MUMS JAPN OWNER CONTRACTOR/DESIGNER/ENGINEER C1114toL WWORT alis.#a, F31M t33+`3O CO. IA. QY7I'bt'rki CA 92253 LA. QL3I.1J'1`A CA 9225:3 ('Yfioj. CA) .771 g (:Milo Mo USE OF PERMIT RMSIDEIMAL AT, D ON 34 S. Y. 'RCA 91 yA1DD1T11110 UN D EW MISTtN0 PATI C1 C:LIVXR RATIO C,IJ'a'U i011 XSl'iVA' MW OF 00-MMUC'!'IION 3.444.00 PI 1 &I' 1 NIK SLT19/iN.lt►RY I'iAAW CHOCK FEE 10) -000-439-:31 S C NST UC,rim nm 101,,040 -418 -OW $63.00- MECIT.+ANIC. AL ME 101•(Alt!!-421®000 $13.00 1✓L:f+.,C'f'321C:�t ���� . 1Cl't••�i3i3•�12C3-0� �s©.oc �yf r I..H11133 PREPAID .,MS �Nv 50,00 2 8 2D ,01m,...x=ERIA •MI? DR "Now $148,95 NOV RECEIPT 6DA1T BY DATE FINALED INSPECTOR /j/0 INSPECTION (RECORD OPERATION DATE INSPECTOR OPERATION DATE I INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs (�i _ Underground Ducts Forms & Footings h21 Ducts Slab Grade _ Return Air Steel Combustion Air Roof Deck Exhaust Fans 0. K. to Wrap 2 ,on 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 az Final Final POOLS -SPAS BLOCKWALL APPROVALS steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final I I Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines Neater 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 COMMENTS: Final Uti14 Notice (Gas) . ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring 4-40 Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) Desert Sands Unified School District 47-950 Dune Palms Road Notice: $ La Quinta, CA 92253 _ Document Cannot Be Duplicated 760-771-8515 _ CERTIFICATE OF COMPLIANCE - Date 11/28/00 APN # 649-090-012 Y No. 21244 ' JurisdictionQuinta" . . La , owner NameCarol Wright Permit # 001.1-231• No. 80-070 Street Palm Circle Drive Log # city La Quinta Zip• . 92253 StudyArea Tract# , Lot#, Square•Footage 84 Type of.Development Residential Addition w No. of Units 1 _ Comments Addition is anenclosure to existing patio cover: 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 feel, detached accessory structures or replacement mobilehomes. It has been determined the above-named owner is exempt from paying school fees at thistime 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 it the amount of • 0.00'' X 84 or $ 0.00 'the property listed above and thailbuilding permits and/or Certificates of Occupancy for this square footage in this proposed project mayhriov% be issued Fees.paid By N/A - Donna Cox F Telephone 760=360-7715 Name on the check By Dr. Doris Wilson Superintendent r f t Fee collected /exempted by Annette Barlow Exempt' $0.00 4 Check No. N/A Signature f TICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90-0ay approval period in which you may protest the fees or other payment identrfied ovewill,begmto run from the date on which the building or installation permit for this project is sssued or on which they are paid to the Districl(s) a to another public entity authorized to lect 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 wash ers. Embossed Original- Building Dept./Applicant,,. Copy - ApplicantlReceipt Copy -Accounting ' po 1/ Ill , DIME STUDY L1v1Nc t'tM ' WT. - Wilt- • ` � .c Lir. •'' •,• - - - - - ter, tfiu=�r�•�:�� "•: � 1� 1 . .. rte:• _ P.ED T?AA M-15MRAA P-3 V p, ko 0 17 • f• a 34 Q x t 5 e .' . *:.'t`;r _ i. •':. •,�.e 1'� .' -� a ,.� •.: �•s;-•:�. - �F 0 C ITY- 0 F LA Q -U I N Ta ; . BUfLDIJTY DEPT.' APP 0 ED ' • t 4J, i + i FOR 'CONSTRUCTIONit �• _ Air BY b00'd OblO-1S9-6SS '13L IN 30VIlOA 00:£1 (031)00.11- ,L00 P i t . S { - ..