0306-183 (SFD)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
N W Professionals Code, and my License is in full force and effect.
O =) ch License # Lic. Class Exp. Date
r-_ Q
' W
r1_
oZ r- Date Signature of Contractor
CD 0
UOWNER-BUILDER DECLARATION
W Wd r- I hereby affirm under penalty of perjury that I am exempt from the Contractor's
U) 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).
1, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
c'') () I am exempt under Section , B&P.C. for this reason
LO
N Date '-'/ : t .• Signature of Owner
p Mme. ..� ...�
Q WORKER'S COMPENSATION DECLARATION
o Cc I hereby affirm under penalty of perjury one of the following declarations:
Lo H p () 1 have and will maintain a certificate of consent to self -insure for workers'
X W �= , compensation, as provided for by Section 3700 of the Labor Code, for the
O � Q performance of the work for which this permit is issued.
C0 Q U ( ) I have and will maintain workers' compensation insurance, as required by
p Q Section 3700 of the Labor Code, for the performance of the work for which this
liLO
v Z permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
Ob5
r- C)
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,
1shall 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.
Applicant—, Gs.,�
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 inspeciion'purposes.
4 Signature (Owner/Agent)'? .• � ���*��� P Date
BUILDING PERMIT PERMIT Jt
05w) -M3
DATE VALUATION LOT
L TRACT
$% " i%e: d i2.6 1 L111. x:04
JOB SITE�y
APN
ADDRESS r' J-�:'i VAUX C>� ITITAWRi!A
74-Off,001
OWNER
CONTRACTOR / DESIGNER / EN INEER
?,'D, BQX 3576
2='A('.3zh. z'ESERT CA 92'26?
USE OF PERMIT
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OR 1A111Mi1,ltAPFROACH
TRACT CONSTRUCTION 1,$46.60 Sr
Pow"HNIATIO, 1.519.00 3F
CIAR..gGDCAt'KV.T $2LOP 3I:
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WIXC.HA141C.41.FER$39.00
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K<il IMMO PEZ 10k CfW-+419-000 $11�.+.)G
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ate
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$`�'3,'?)3.'1€1
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AUG 13 .21003
RECEI
FIN DEPT.Y
1
DATE FINALED
INSPECTOR
yA� INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs _
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
St
Combustion Air
_
Roof Deck s.,
Exhaust Fans
F.A.U.
Framing ? •; G
Compressor
Insulation . ':max. - G
Vents
Fireplace P.L.
Grills
Fireplace T.O. ' '
Fans & Controls
Party Wall Insulation ^r.:3`
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final I— O ov
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 - Q
Heater Final
_
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
OX for Finish Plaster
Sewer Lateral
Sewer Connection G
Pool Cover
Encapsulation
Gas Piping
Gas Test Gil- G
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole — - of
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) "' O _.
COMMENTS: T
G-If%9h �1 r i�,
J"
-
Date 8/6/03
No. 24795
CERTIFICATE OF COMPLIANCE
Desert Sands Unified School District
47950 Dune Palms Road
La Quinta, CA 92253
(760) 771-8515
4�J�FtFZsc�o
Q BERMUDA DUNES
RANCHO MIRAGE b'
INDIAN WELLS
PALM DESERT
LAQUINTA
Q INDIO y�
O
Owner
Mountain Cove Dev. Inc
APN #
774-065-001
Address
P O Box 3578
Jurisdiction
La Quinta
City
Palm Desert Zip 92260
Permit #
0306-183
Tract #
BLK 204
Study Area
Type
Single Family Residence
No. of Units
1
Lot # No. Street S.F.
Lot # No.
Street S.F.
Unit 1 24
77965 Calle Chihuahua 1546
Unit 6
Unit 2
Unit 7
Unit 3
Unit 8
Unit 4
Unit 9
Unit 5
Unit 10
Comments
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 (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile
homes. It has been determined that the above-named owner is exempt from paying school fees at this time due to the following reason:
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to
Education Code Section 17620 and Government Code 65995 Et Seq.
in the amount of $2.14 X 1,546 S.F. or $3,308.44 have been paid for the property listed above and that
building permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued.
Fees Paid By CC/Canyon National Bank - Larry Shields Check No. 15274
Name on the check Telephone
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Sharon McGilvrey
Signature C
>.,� At�
Funding Residential
Payment Recd
$3,308.44 Over/Under
NOTICE: Pursuant to Government Code Section 66020(d)(1), 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 issued, or from the date on which
those amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier.
NOTICE: This Document NOT VALID if Duplicated
Embossed Original - Building Department/Applicant Copy - ApplicantlReceipt Copy - Accounting
10/28/2009 TLTE 18:04 FAX
10002
Q O
P• INSULATION
*' L7 • FIREPLACES
chmld ■ GARAGE DOORS
Building Products _ wSTRUCTURED WIRING
A M;tscn Co
• WEATHER-STRIPPING
74741 JONI DR STE. #A
PALM DESERT CA. 92260 +
Mountain Cove Dev Proposal #GHI477 September 29, 2003
P. 0. Box 3578 Plan# Ensenada
Palm Desert, Ca 92261 77-965 Calle Chihuahua
Phone # 760-771-1670 La Quinta, CA 92253
Attention: Larry Fax # 760-564-9591
Paragon Schmid Budding Products is Milling to fumish to you all material and labor required br the appligUon of
sulati n: Draft stop, fire block, fire stop (UBC 708.2.1 et seq., formerly 2516(f), or locally adopted
equivalent), or fire rated caulking are not included within Contractor's scope of work, unless specifically listed
ibelow.
1 -Insulation
RR-4�unaced batt insulation in ceiling areas using one layer R-30 with R-19.
R-13 unfaced batt insulation in exterior wall. -�
R- 8 unfaced batt insolation in the gables for code of La Quinta.
Afs Foil stapled to gables to complete radiant barrier.
Caulk & Seal to meet air infiltration requirements per Title 24 of the State of California.
Does not include foam around plumbing pipes at sill.
$1,900.00
TERMS OF PAYMENT: Payment in full due as stated on invoice regardless of any payment arrangements you have with
third parities.
ACCEPTANCE: Contractor may change and/or withdraw this agreement if Contractor does not receive your signed
acceptance within 10 business days after the date listed above.
PRICING: Any additional work performed is subject to Contractor's then current pricing (unless Contractor othenNise
agrees in writing) and to these terms and conditions. The prices above shall remain firm for 90 days after the date YOU
sign this agreement. If performance of this agreement extends beyond those 90 days, YOU agree to pay Contractor's
then current pricing for the Work performed after those 90 days.
Paragon Schmid Building Products, a Masco company. Customer:
State Contractor's License No. 221517 COMPANY NAME:
BY. BY:
TITLE: TITLE:
DATE: DATE.
Form P/s-tol
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