9712-074 (AR)LICENSED CONTRACTOR DECLARATION
fl hereby affirm under penalty of perjury that I am licensed under provisions of
F— ��=I Chapter 9 (commencing 'with Section 7000) of Division 3 of the Business and
04 W Professionals Code, and my License is in full force and effect.
O ch License # Lic. Class Exp. Date
Lu `n
wyiiticis�7 "ci 3a:3 i99
�
oZ � Uate Signature of Contractor
O�
r- U C:) OWNER -BUILDER DECLARATION
W W I hereby affirm under penalty of perjury that I am exempt from -the Contractor's
~ d License Law for the following reason:
Z_ ( ) 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
( ) 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
N Date A , I M Signature of Owners
Orn k
d Q WORKER'S COMPENSATION DECLARATION
j 2 Z I hereby affirm under penalty of perjury one of the following declarations:
n O () 1 have and will maintain a certificate of consent to self insure for workers'
Kw compensation, as provided for by Section 3700 of the Labor Code, for the
D Q performance of, the work for which this permit is issued.
n Q C) ( ) I have and.will maintain workers' compensation insurance, as required by
U Q Section 3700 of the Labor Code, for the performance of the work for which this
L 1— permit is issued. My workers' compensation insurance carrier & policy no. are:
,►• Z Carrier Policy No.
ao 5 0=111.1"I ' ON 014 FILE
(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. F
./Date: ' �. [: , `l % Applicant ,n L• / , • [, .
Warning: Failure to secure Workters' 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.
�ignature (Owner/Agent] ' L�f�• i x` v' Date A ' �f
BUILDING PERMIT PERMIT.# (UNTRUE#
9712-�074.
DATE �yV UATION Q%t23�• LOT TRACT `'] e
66 V
JOB SITE
ADDRESS �y- S��t1.1��Y 1.1V1 .. £ ►�i�E�l�i}3iCD APN 631-35Z-04
,l
OWNER CONTRACTOR/DESIGNER/ENGINEER
;IC}PN1 A & AN;NC C:HRI i'' HR( ''Vrff R%Cr. CUVMt CClN'i`RA(I MR.
4 50 f1VTiiNIDA !:�;l;iti ANDD �!>350 AVENJDA.,Fi.�i1<.li.3 fUk
A QUINTA C".& _92253 LAA I!N UN. C:A, 92253
(760 64-351.1 CHL4 1115
USE OF PERMIT "M 'D l�ii'D Ptir':� ."v.i}�! i
112 SY- ROOM.AfXXT (ON
7.235,20 3'.F.
ZINTMAXI-PID COST Of CION-8=1110110NN
P(.Ari' COEM 101-f3UU>4 v -21M
M.CC;'f WICAC, ;:°r"R $18,52
"13 5
r35"a0
TOTAL ft, Cp � ATENVUENOW S182194.
RE DATE BY I DATE FINALED INSPEQTDR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs Q
Underground Ducts
Forms & Footings
Slab Grade
Ducts
Return Air
Steel
Combustion Air
Roof Deck
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 Firewal'
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALI APP O ALS
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 Conduct
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exteiior Receptacles
Smoke Detectors
Temp. Use of Power
t
Final
unary Notice (Perm)
COMMENTS:
yr Lhi %Aviu1 1 K
SURA IST
CONTRACTOR -11&. Clark �)✓. ADDRESS 5`I 350 AV(i vAi,4k ! �ewerQ
OWNER 0e_witf- JOB ADDRESS ''1`I-_-�Cc Ade. Fer�lctdo
This form shall be posted on the gob with the Building Inspection Card at all times in a conspicuousIp ace.
It is the responsibility of the General Contractor or the Owner/Builder to monitor the sub -contractors that
are on this list are the same persons performing the work. Any changes to this list must be approved the
City of La Quinta Department of Building & Safety p=.to work being performed by a changed sub-
contractor. Failure to comply will result in a stoppage of work and/or the voidance of building permit.
TRADE
SUB -CONTRACTOR'S
NAME
TYPE OF
LICENSE
STATE
CONTRACTOR'S
LICENSE. ..
NUMBER
WORKER'S
COMP. NAME/
NUMBER ON FILE .
CITY
BUSINESS
LICENSE
NUMBER/
EXP. DATE
GRADE!
EXCAVATE
A/C -12
PIPELINES
C-34
CONCRETE/
FOUNDATIONS:,
CA}GS t,v.as f�uc���
C-8
611v4y
I-31^G0-1"ltiSI5
S{a Ft Fw� � 9
9�
4985
Iz-lS'`i8
ASPHALT
A
FRAMING.
B
STEEL/
STRUCTURAL
C-51
MASONRY
C-29
PLUMBING
C-36
LATHING
C-26
DRYWALL
�'ig
C 9
113108
10-31_9
CrtoldcK Eagle-
NW -1411,11-100 9.6-98
4014
1 -13 -`lo
PLASTERING
C-36
HVAC
C-20
ELECTRICAL
(General)
�
C-10
0057-4iA A.
ROOFING
Rvv" T;�G S1�y
C-39.636384
�tAc v.td
1410
SHEET METAL
C-43
FLOORING
C-15
GLASS/
GLAZING
C-17
INSULATION
FLOV '
C -238113`i
-90-9
3151 1 pkM.
35'13711 1-1-99
1031
12-11=,10
SEWAGE DISP...
C-42
PAINTING/
DECORATING
C-33
TILE
Dep CohS�vuG{ioYt
C-54
SHS e3o7
Sta3e Fw�N
3118
CABINETS/
INSTALLATION
C-6
FENCING
C-13
LANDSCAPING
C-27
POOLS
C-53
i
OTHER
I s
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u
' POR-OTome- c Ott
� G" er�t6�D L%co
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rPIZ
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pep
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Communtty Azzoctati.on
P. 0. Box 162
La Quinta Ca 92253
Telephone: 760/564-2177 FAX: 760/5644882
ti
June 22, 1998
Planning Department
CITY OF LA QUINTA
P. 0. Box 1504
La Quinta CA 92253
RE: Remodel
49-280.Avenida Fernando
Gentlemen:
The Architectural Committee of La Quinta Golf Estates has reviewed the plans
for remodel at above referenced address.
We find these plans meet all criteria as set forth in the governing documents
of our Association and do, therefore, affix our stamp of approval.
If you have any questions, please contact the office.
Yours truly,
MORGAN U. WARD, JR.
Co-chairman
Architectural Committee
MUW/at
Notice:
Document Cannot Be Duplicated
Date 8/4/98
No. 17450
Desert Sands Unified School District
47-950 Dune Palms Road
La Quinta, CA 92253
760-771-8515
CERTIFICATE OF COMPLIANCE
Owner NameJohn A. & Anne Christ Hewitt
APN # 631-352-004
Jurisdiction La Quinta
Permit #
No. 49-280 Street Avenida Fernando Log #
City La Quinta Zip 92253 Study Area
Tract # Lot # Square Footage 112
Type of Development Residential Addition No. of Units 1
Comments
112 sq. It. addition.
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 Feet or Less
EXEMPT
This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount, of
0.00 X 112 or $ 0.00 the property listed above and tha-Lbuild g' f �,
permits and/or Certificates of Occupancy for this square footage in this proposed project rfiay nowtbe issued �y
Fees Paid B N/A - Jack Clark .
Y it .
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Juanita Green Exempt
Check No. N/A
Signature
$0.00
NOTICE: Pursuant of Asseybly Sill 3081 (CHAP 549, STATS. 19%) this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified
above will begin to run fro the date 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
collect 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