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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
595320 B
Date Signature of Contractor
OWNER -BUILDER DECLARATION
30/02
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 exet under Section , B&P.C.�fou�r this reason i
Date 3/�. fm 'L, Signature of Owner _.,4� i�+ '• 11 �'
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.
(.A I have and will maintain workers' compensation insurance, as required by
SV'ction 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 , -T TE FUNDPolicy No. 22il-19322-01
(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 Sec Ion 3700 of the Labor
Code, I skl If forthwith comply with thosVISIDn
Date: -'' f, , Applicant s 1�
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
rany 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 i spection pa poses.
Signature (Owner/Agent)• ` J Date0�--
BUILDING PERMIT PERMIT#
DATE ' VALUATION LOT ' TRACT
JOB SITE 4 '-
APN
ADDRESS
OWNER
CONTRACTOR/DESIGNER/EN (NEER
?"60 (1111yU5
;t -C,5 4 IA0019 �iifY�S, LN,
CA 92253
�3
b. l'OUSAA7D PALMAS CA 92276
COWUN. 4600
USE OF PERMIT
RESIL)FWTIAL c UMT VWRraOM ADON (141 S.F. (N;:WD1't` Q COVERED
PATIO, '(cif► S. R)
CUSTOM CONSTRUCTION 141.00 Ski
PORCH/ lATIO 66,00 Sty
WfWAIRD C0.ST OF C0MMUCUO1'3
111861170
PIAN CHYME IEE 101 _000.439.318
CONSTRUCTION ION irf K 101 _000-4 184)(1110 11' 1
0
MF,Ct,i.A,NWI L FEE 101-000-421-000 319.6
n
ZLEC:T!!' CA1,FEE 101-000-420.000 W.00
S'4`i s0NO MOT 109 FEZ, 101-000-241-000 91.0
I3R9D1140 FEE 101-000-423-11003 $20.6
D
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�+ .�gt,p�y A ry��3; 75 � I) qct RS �p fM � N ppb
4.�'.XA"7R! i'�eY�a63t? Vd+ � �'6
17h�.✓a�n"T`�S
=93,44 9 44
aA. .� .1n�i,i.Y.1J�.Y,� .N �a,V
SJ26
r!MAR
2002
2
i COTYOFL.AQWWrA
:R //
Bl@ 4e�r
Dq7� NALED
'� /
INSPECTOR
G
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
— fj'L
Underground Ducts
Forms & Footings
Ducts
Slab Grade
(
Return Air
Steel
Combustion Air
Roof Deck
f /L
Exhaust Fans
O. K. to Wrap
F.A.U.
Framing
— — x''
Compressor
Insulation — U
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath0
Z
Drywall - Int. Lath
C
Final
Final �- - -oZ
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
Water Piping
Heater Final
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
AZ4 14
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
Final
Utility Notice (Perm) `
COMMENTS:
Notice:
Document Cannot Be Duplicated
Date 3/26/02
No. 23078
Owner NameScott Bryan
No, 79-760
city La Quinta
Tract #
>uesert Nanas unmea know vistrict
47-950 Dune Palms Road
La Quinta, CA 92253
760-771-8515
CERTIFICATE OF COMPLIANCE
Street Citrus
Lot #
Type of Development Residential Addition
Comments
Bedroom Addition
APN # 769-710-018
Jurisdiction La Ouinta
Zip 92253
Permit # 0201-199
Log #
Study Area
Square Footage 141
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 141 or $ 0.00 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 Exempt - Scott Bryan Telephone
Name on the check
By Dr. Doris Wilson
Superintendent ,
Fee collected /exempted by Paula ulZ Exempt
Check No.
Signature
NOTICE: Pursuant to Assembly Bill 3081 (CHAP 549, ST436. 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
seri
sort
magement
January 24, 2002
Scott & Carmella Bryan
3811 E. La Palma
Anaheim, CA 92807
RE: Citrus Course Homeowners Association
79-760 Citrus Street
Dear Mr. & Mrs. Bryan:
This letter is to confirm, in accordance with the Architectural Guidelines; the Architectural
Committee has approved your architectural request to add a bedroom wing onto your home as
submitted on November 20, 2001.
When all work on the project has been completed, please notify this office in writing so that the
improvement can be inspected and signed off by the Architectural Committee and your deposit
can be returned to you.
Please contact me if you have any questions about your architectural variance application.
Si cerely,
Th r hite .tur Il eview Com ittee
Citrus Course Homeowners A sociation .
By: Fran Mullahy, Association Manager
Professional Community Management / Desert Resort Management
Post Office Box 4772 • Palm Desert, CA 92261-4772
73-550 Alessandro, Suite 5 • Palm Desert, California • (760) 346-1161 • FAX (760) 346-9918