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9805-098 (AR)LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of H Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. `W w) License # Lic. Class Exp. Date w 316292 - i3 9131 /N rZ W oZ t- Date - i'� Signature of Contractor O� U C) OWNER -BUILDER DECLARATION WUW I hereby affirm under penalty of perjury that I am exempt from the Contractor's I) 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, 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 O N Date Signature of Owner rn Q WORKER'S COMPENSATION DECLARATION, CL It ccI hereby affirm under penalty of perjury one of the following declarations: r .< O () I have and will maintain a certificate of consent to self -insure for workers' X'W _LL _ compensation, as provided for by Section 3700 of the Labor Code, for the 0:_J _ performance of the work for which this permit is issued. m QU ( ) I have and will maintain workers' compensation insurance, as required by p0 Q Section 3700 of the Labor Code, for the performance of the work for which this rn H permit is issued. My workers' compensation insurance carrier & policy no. are: It Z Carrier r Policy No. �,I _ vN t-� 00 �I cbOIll c; wi'C:'tyi� 1• �u lr '.A'1`t J (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 provl ions of Section 3700 of the Labor C�, I shall forthwith comply with those pro isions. � Date:- Applicant Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 N of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his application. 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, tindeninify 79Q. & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days- from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is L-the ect. I agree to comply with all City, and State laws relating to the building truction, and hereby authorize representatives of this City to enter upon bove-mentioned property fore spectio�n purposes. r � .ture (Owner/Anantl .l.-.i'J, Date BUILDING PERMIT PERMIT# , CONTROL# 9It!?.�-9� J1► DATEVALUATION �a �t LOT TRACT7924 /, � - J0f3fSnt /r` APN ADDRESS .gM1�f5A l�IIr�D%�..'+. �I�L��i 0.1-JTr1-�!Q}u OWNER CONTRACTOR /YDESIGNER /ENGINEER j� �y VIER. L. DUNCItIN. C (�j �( ( �( 1.1,^jAtTE i.1 ,1 k.j1'{�! y[t 1-� �e 7„ 4. V%� fJr�. d�. V LM, l),N 8108 [VIM)LE LN SHA.V6+Nhh MISSIDN KS, 66208 REDLANDS CA 92373 USE OF PERMIT f3laFL.i�l�3C 12L Cii31 t?i.idis WWGI-0 t3A.%Ga.M 1`c%ttii.Ol 1.,Ai�S�t; 4 , 22 S.F. Or LIVINOt AREA. C0Sl1'otiviCGKSI RLIM019 i aY.: T lr.�,7 C0N'ST.Z4UC T 1.Qr4 V, SUMMARY ts.C,../eNI > t$: i(il,-1A 1 sa.ltt©r.S C(iWTRJ fr,'7'te;)N R -4i. I1 t)1 _(000.41 R-fn1t0 $ai Rt,fKt i1•ii; tir si'�g�:i1;.��'.i:i3 101.00-421-1000 .bZtj.ity b.t c C`UCIIAL (lits 101-000-426-000 $3(07 f'l,f.}1ifN,iTJe 'I'1s1✓ 101-000-419-000 $^1 50 et(Y (10 PtTf3 - ta_s?`,143 10!-(I()0-'241.0{0 X13! 'f'0�`1.Air, CONS C'!i UCT10N AND PLAN! 1''141;(;1,'. V 3703 03 LESS PRF -'.AID FEES g,U.flfi �gg� TOTAL I'9 RN111IT l+'ET',% 01) x: i4ON11 SUN 15 �'rv, RECE64 DATE BY �/ DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade 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 i Condensate Lines Party Wall Firewall Exterior Lath DT II - Int. Lath 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 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 t _ ' C ) Final Utility Notice (Perm) COMMENTS: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBINGAES S UNITS SLAB GRADE tST F! . SO FT BONDING HEATING (ROUGH) STORAGE TANK FORMS YARD SPg 2ND FL. SO. FT., DUCT WORK ROCK STORAGE FOUND. REINF. MOBILEHOME SVC. BAP SIN POR SO FT Fc OTHER APPJEOWP. REINF. STEEL GAS (FINAL) r POWER. OUTLET ROOF DR GAR SO FT. �q GROUT WATER HEATER ' SERVICE FINAL INSP. DRAINAGCAR P j0. FT �Z WATER SYSTEM WALL SO FT Z -f�� DRINKIN 30 PT ;q FINAL INSP. URINAL ESTIMATED CONSTRUCTION VALUATION S WATER PIPING NOTE: Not to be used as procany :as +a!nanon +. 1 FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM VAN EVAP.000L HOOD f SIGN WASHER(AUTONOI SHI APPLIANCE DRYER FIRE ZONE ROOFING GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED FIREPLACE LAUNDRY TRAY AIR HANDLING UNIT CFM I KITCHEN SINK ABSORPTION SYSTEM B.T.0 TEMP USE PERMIT SVC WATER CLOSET COMPRESSOR HP POLE. TEM/PERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SO FT.:& c BATH TUB 1 M SO. FT. -�& c VVATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID 0 T+.0 c SEWAGE DISPOSAL SO.FT.GAR @ li c HOUSE SEWER FINAL INSPECTION GAS PIPING PERMIT FEE PERMIT FEE FEE DBL TOTAL FEES' MICRO FEE MECH.FEE PL.CK.FEE JPERMIT CONST. FEE ELECT. FEE SMI FEE PLUMB. FEE STRUCTURE PLUMBING ELECTRICAL HEATING A AIR GOND. SOLAR SETBACK GROUND PLUMBING' UNDERGROUND A.C. UNIT COLL AREA SLAB GRADE ROUGH PLUMB- BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAIj OTHER APPJEOWP. REINF. STEEL GAS (FINAL) r TEMP. POLE GROUT WATER HEATER ' SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. f plug xf -f�� LUMBER GR. FINAL INSP. FRAMING FINAL INSP. ROOFING ' " +. 1 REMARK& VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIOWSOUND FINISH GRADING FINAL INSPECTION CERT. OCC.' ' ccur^.c ctu�i INSPECTORS SIGNATUREMNmALS GARDEN WALL FINAL kotice: Document Cannot Be Duplicated Date 6/1/98 No.' 17104 Owner NameLester Duncan Desert Sands Unified School District 82-879 Highway 111 Indio, CA 92201 619-775-3500 CERTIFICATE OF COMPLIANCE No. 48-865 Street Avenida El Nido City La Quinta Tract # Lot # Type of Development Residential Addition Comments Jurisdiction APN # 631-321-009 La Quinta Permit # Log # Zip 92253 Study Area Square Footage 22 Rebuild/remodel, a ing 22 sq. ft. living area. No. of Units 1 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 22 or $ 0.00 the property listed above and that building permits and/or Certificates of Occupancy for this square footage in this proposed project`inay now. be,issued Fees Paid By Steve Crane TelepiioneYf909- Name on the check By Dr. Doris Wilson Superintendent Fee collected /exempted by, Signature Juanita Green Exempt Check No. N/A $0.00 NOTICE: Pursuant of Asi6mbly Bill 3081 (CHAP 549, STATS. 1996) 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 from 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 3 ~•�——\.=• = i•.i E..[a 1 _ / F;tl: r '� .�.•.� r—. r. _ .r— t t— e = _ F' - ►_t `y��4 f o- •,. MI f P 0. Box 162 Iia Mizita Ca 92253 `�Iaphrone:..-760/564-21"1; Pte': 750/afa4--M2 Mav 1 1,198 Kam) LI -I ,, Department\ CITY OF IA QUINTA P. o. Ii,)Y 1504 La Outtt+:r CA Q225, RE: Kr•)•=)nc.t ruct.io- at -.R-805 E, Ni.do Gent 1 (? w,rt The rerohrttrclural t;ommitt!�e of i,%3 Quinta Golf Estates has reviewed the E,I w., for reg+•ow;t ruct ion of,garage and remodel, of, }:.itehen area at said rt sidenc,- The Commt t tc-o finds that these plans meet als the criteria setforth tri CC&Fs .ind have. r17erefor•e, ,� prcvazd tbem as presented. if you r,o v, • •-my questions, please contact the office. Your; ! r.0 i ,, , � J MORGAN Co-•chd t s':n 1rr ARCH i'! Et " 1" 4M I . C;UMMITT'EE r "