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9606-056 (SFD)LICENSED CONTRACTOR DECLARATION 'N 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 r, ` •as � r lADat Signature of Contractort7 - ' 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). ( ) I am exempt u, der Section B&P.C. for this reason 6Date 4 114 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 Policy No. (This section need not be completed if the permit valuation is for $100.00 or less). (t/)f 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 shouldbecome subject to the workers' compensation provisions of Section 3700 of the Labor Code, Iall foth comply with those provisions/ „r-• . Applicant rs�4!1.^r.v�r,�,s,�+ar l�" •"�.r.� • Js !• - Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director;of Building and Safety for a permit subject to the conditions. and restrictions set forth .'.on his application. 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall,`indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null -and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation: I certify that I have read this application and state that the above information is correct. 1•ag4e to comply with all City, and State laws relating'to the building 'construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspection purposes. Sg ature (Owner/Agent) Dated/r•�»._ B. ■I�D'�w w�w�I� - PERMIT# : CONTROL# -� i -,I U /G rY 1L 11 - - ,, ,� - 3577 DATE.' % 6 VALUATIONX97 60 LOT,i7,1 TRACZ ADDRESS 1«�« li ft �t } .��t MARC?,JOB SITE APN 773-043-0 0 OWNER CONTRACTOR / DESIGNER / ENGINEER VTC.1r. , ww.rr'R .. IN4''K DE,VFi,OPNIL'NlT 11684 WNWRE, BOULEVARD#624 ` SIMI)* * CIT CA. 9tNOA k�D.$M9i3t`s226. Ci3LV lYd s+S 1sid443i3x�12cl�IG' USE OF PERMIT `tAd l..ls "rlJlti.L :u VI i;T.iNC 2M E.'('AHQt.ri` 1 CANYON Siris -22161 30,13AIW Fn7X PLEK UT DO -ES -Nat 114Cl UDE BLOCK W,nl , OR POOL, t� r..t<At�'.i • � c:+�e�'1 Kl,ll: i'tUty <,`a.tfiA�� Sig PORC-10P ATIO 68.W 13F + Al2A€YWCARt't' RX 539,0039 f= I NXFkA) COSI" OF CONSTRUCTION :131..797.0 PEMMIT FEE 8UNIMARV CCJNSrl,RUC'.rfON' nh 101-000418-000 .i?%JVN C t*"- ..V,Ef 101-0.004V-318. 11—t J) M11$11rr . MI C1 XNI`C.A%.FEE edit -(3(31-421.-•000 $60,00 'i�i,F�"1'f21t:AJ •��. , - 1(11 00•.0-�1�0•U00 $13:E.Fid. 1'LtiJhU3tI i 1 ��13t�0i}0 $166.00 il'7CtJWi� MCl`e.iOR FE--8SID (01-000-241-0% 0. $1,118 GRA1,).fNr FRE t.f}LYOOt)•423y0(10 ��0.1Jt3 DIT.RASIMUC!'U[tt:'Fal 22;5-00-443••342- PfMCME POW l.fii-AUO-=�41���4s: S2S.Q© ►iiUr I N P UD L`1G' PLACES 70"1,- 31f-255-000 $i�✓;dv S. UB -TOTAL CCONS3,'RtX7ftGN AND PLAN CHECK v,8,•13.89 ASS 'P -PAUD ,HOES' -$250.00 JY,MI .S• h DUE NOW =A4Yi9 ®� 1996 rJUL' B >� RECEIPT DATE 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 Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath Final Final POOLS - SPAS BLOCKWALL APPROVALS steel Set Backs Electric Bond Footings Main Drain Bond Beam GY✓ (� Approval to Cover ,vt! Equipment Location 42 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 J� Appliances Final - COMMENTS: v a 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 d Final Utility Notice (Perm) 1 P.O. BOX 1504 APPLICATION ONLY Building 4/ C h -�' 7&105 CALLE ESTADO Address / J ® !�U �Jc✓n/ZC Z LA QUINTA, CALIFORNIA 92253 Owner V t G is te, l C 6 Mailing Address City Zip Tel. Contractor i Address 6 ? y e Ilit, rza t2(, city— .</ u d ityS/ud Id ��� Z0! 60 State Lic. p° & Classif. 13 Arch., Engr., Designer��� me NT r"(JJio LAY Tel.. ?/,Y" ��iG�S 221 BUILDING: TYPE CONST.- ® OCC. GRP. A.P. Number Legal Description -713P - 03- No c i i Project Description Clty Lic. # Sq Ft Address l ® E' TH h g v i_rL -4fRrJ.Y T4 -;?3_ S® 9 City Stae Pivhm ,-X zq )di 6 a Lic•#C 38'A7 6 LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. SIGNATURE DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, or thathe is exempt therefrom, and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). 17 1, 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, Buisness and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he did not build or improve for the purpose of sale.) 1.1 I, as owner of the property, am exclusively contracting with licensed contractors to con- struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) 17 1 am exempt under Sec. B. & P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION I hereby affiim thatel have a certificate of consent to self -insure, or a certificate of Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No. Company 0 Copy is filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATIONINSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) valuation or less.) I certify that in the performance of thg 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. Date Owner NOTICE TO APPLICANT: If, atter making this Certificate of Exemption you should Ibecome subject to the Workers' Compensation provisions of the Labor Code, you mu' i iorthwiR comply with such provisions or this permit shall be deemed revoked. I CONSTRUCTION LENDING AGENCY 1 U I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code.) ��. Lender's Name Lender's Address �— — This is a building permit when properly filled out, signed and validated, and is subject to expiration if work thereunder is suspended for 180 days. I certify that I have read this application and stale that the above information is correct. I= agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives -of this city to enter the above-. mentioned property for inspection purposes. Signature of applicant —Date— Mailing ateMailing Address City,'State, Zip BUILDING DIVISION Size New Add ❑ No. Stories No. Dw. Units Alter ❑ Repair ❑ Demolition ❑ , �ZONEQ BY: Minimum Setback Distances: 11 1'' Front Setback from Center Line 11 111 Rear Setback from Rear Prop. Line i Side Street Setback from Center Line e..o Side Setback from Property Line I FINACDATEy INSPECTOR Issued by: Date Permit Validated by: Validation: i Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. 4�11 Plan Chk. Bal. Const. ,Mech. Electrical Plumbing S.M.I. t Grading Driveway Enc. Infrastructure ' TOTAL REMARKS �ZONEQ BY: Minimum Setback Distances: 11 1'' Front Setback from Center Line 11 111 Rear Setback from Rear Prop. Line i Side Street Setback from Center Line e..o Side Setback from Property Line I FINACDATEy INSPECTOR Issued by: Date Permit Validated by: Validation: i CONSTRUCTION ESTIMATE NO, ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO, FT. 0 $ UNITS SLAB GRADE 2ND FL, SO. FT. BONDING YARD SPKLR SYSTEM POR. SO. FT. Ca' MOBILEHOME SVC. BAR SINK GAR. SO. FT. ld POWER OUTLET ROOF DRAINS CAR P. SO.FT. GAS (ROUGH) DRAINAGE PIPING WALL SO. FT. ¢y OTHER APP.IEGUIP. DRINKING FOUNTAIN SO. FT. to TEMP. POLE URINAL ESTIMATED CONSTRUCTION VALUATION $ GROUT WATER PIPING NOTE: Not to be used as property tax valuation FINAL INSP. FLOOR DRAIN MECHANICAL FEES WATER SYSTEM WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASH ER(AUTO)(DISH) APPLIANCE DRYER FINAL INSP. GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRYTRAY AIR HANDLING UNIT CFM KITCHEN SINK ABSORPTION SYSTEM. B.T.U. 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 SO. FT. G c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID @ 1 I c SEWAGE DISPOSAL GAR. FIREWALL SO.FT.GAR @ 3/ec HOUSE SEWER LATHING GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE CONST. FEE ELECT. FEE SMI FEE PLUMB. FEE STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. 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 (FINAL) OTHER APP.IEGUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. $ plus x$ =$ LUMBER GR. FINAL INSP. FRAMING FINAL INSP. ROOFING REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S StGNATURESIINITIALS GARDEN WALL FINAL 71 Notice: Document Cannot Be Duplicated Desert Sands Unified School District 82-879 Highway 111 Indio, CA 92201 619-775-3500 CERTIFICATE OF COMPLIANCE Date 6/28/96 APN # 773-043-010/011 No.' 14648 Jurisdiction La Quinta Owner Name Vicki Porter Permit # No. 51450 Street Avenida Juarez Log # City La Quinta zip 92253 Study Area 114 Tract # Lot # Type of Development Single Family Residence Comments Square Footage 2216 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: EXEMPTION NOT APPLICABLE This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of 1.84 x 2,216 or $ 4,077.44 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 Palm Desert National Bank/CHI Trust » Telephone,} 568-6014 ,. Name on the check *�`, ' - _ 23 IN By Dolores A. Ballesteros Superintendent r Fee collected /exempted by Pauline Pearson Payment Received $4,077.44 Check No. 72790 ' Signature n g �t��.XL/ 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 1 +mc�t�v �y�jysj.piYiP* i`xdSa� i:""�'•�?�FP�> ..r, h � .. _.,`"'IFcMt9P+�4'traA'%!�"'�!s,�*'7'?NF1%G"r.`",y�,!r*;"`�:;�9"*.rtT77'�!}4-�!:�t,�a7%�i►'�,,77p-gA:w:.r.✓r,r� COACHELLA VALLEY WATER DISTRICT CASH RECEIPT DETAIL Received From: 1,f41e > Service Address .�u-- CP_ XIMeter(s) AService(s) ❑ Backflow(s) ❑ House Lateral(s) ❑ Detector Check(s) ❑ Meter Surcharge xSanitation Capacity Charge ❑ W.S.B.F.C. ❑ Temporary Construction Meter ❑ Turn on Charge ❑ Uncollected Account - Name ❑ Inspection Fee - Tract - Fee - ❑ Plan Check Fees Water / Sewer - Tract - ❑ Bond Payment - A.D. - Bond ❑ Customer Deposit ❑ Other Remarks: N8 .6j29 G.A. Code $ Sa-G� TOTAL $��.25�•/7C, ❑Copy to: Cash / Water Service Check �r�`��4'• �° r Money S r Cashier Order w�y� 4.' �' CVWD-438(11189) r Ceffificale .01 Occ'upa'ncy Cify of .Ca Quinia Building . and Sa-fely'Peparimeni This Certificate issued pusuant to the requirements of Section 109 of the Uniform Building Code, certifying that, at the time of issuance, this structure was in compliance with the various ordinances of the City regu/ating'bui/ding construction or use. For the following: BUILDING ADDRESS: 51-450 Avenida Juarez Use Classification: Single Family Dwelling Bldg. Permit No.: 9606-056 Occupancy Group: R-3 Type of Construction: VN Land Use Zone: SR r Owner of Building: Vickie Porter Address: City: By: Daniel P. Crawford Jr. Date: October 24. 1996 Building Official POST IN A CONSPICUOUS PLACE