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9806-147 (SFD)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. CI'ass Exp. Date Date3 Signature of Contractor`��y OWNER -BUILDER DECLARA ION 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). ( ) 1, 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 Date 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 p rformance of the work for which this permit is issued. VQ I have and will maintain workers' compensation insurance, as required by ection 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. slruvrlr VVIN (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, ( shall not employ any person in?\any manner soras�to become subject to the workers' compensation laws of California, and agree that if I shou0become subject to the workers' compensation provisps of Section 3700 of the Labor``;, Code; I s II f hwith comply with thr`oseiprovisiog��`� Date: (Ik Applicant \1, �:.9 w 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,yoid 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. Signature (Owner/Agent) Date BUILDING PERMIT PERMIT# DATE VALUATION LOT 9 �47 TRACT - S90,75%.80 1 LALK 18 E S JOB IT IJOB SITE APN 773-24"W W OWNER CONTRACTOR / DESIGNER / ENGINEER DAl 11.i ROSS M.11,LLR, PACIFIC" TRADES CONITIRUCT4.ON 17:19 S'1'REXIONNT 1719 S't t. VIONT S OCEANSIDE CA. 92054 S 0f.y"�?,h NSIDE CA 92054 Ci%iH}C�9 t 9L* 1955 USE OF PERMIT SM iNt;:lAi.+01s' 131.l.CK WALLS 0R Pool.. I'PS.A��''1' c i iI`f:,rlllfeSl�N 1,<14£.0tf a.; 3rlle4-I/��1:1'T�r 1G.cit) ti4� 0ARAJOtJf::11fft00R 521.t111 SF 6 Vr, WOOD FRiNCE 20100 Ill F',ST1A1A7rF1) CAST OF CONISTRUMNION 90,7 30 �tr1.�i�iR .i .E�.��i sV 4J.fYttYI.F,! 1,€ 1 -Nil -41"M S59010 �rLAN 11l+ECK NO3c1A;NiCAL fEI3 101-1)«421.-000 S53.50 , 1a EC"t"RICAf 41X 1.01-000.420.000 5131 0 Pt.uNiyllrr.�ly�C3�t1 EX, t01-/0�()0 41r9-6000 $1@27.3u0 � p ty STRO *,� i3ti.r DWOFfiTi S2r.7,0 F t1�0011-(S�7W-4�2t3�-000 � 4'�%'.i'. G�25 4fiJ�� 43F 34x2 S1,998.6E'? PRECI31sPLAN � 10t-(3(31441-345 $25.00 r.LI,DmyoZSIT I -'!"DIAL• {:4'gvvr'kuC'rJo Awn Pt -AN CHECKn7z.48 ,; LESS ME1''.1 ID 'VE ES 42.r 0 Ott Ilk 0 �\.IIDKAJAIRMd F 3L$OI.f: NQW X3,27A8 RECEIPT ATE BY DATE FINALED INSPECTOR N, 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 4 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 /d / 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 APPROVAL 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: Building AAA-- Owner AA— c Owner Address ('1 c( 4 4 " P.O. BOX 1504 78-495 CALLE TAMPICO ILA QUINTA, CALIFORNIA 92253 City Zip Tel. ut. ,.\ �.,�, D 7't �r�) Abu '_'_� A c,r,c. -IZga4),iS 1 Address I Zip State Cla sV- if. �� 2. I< � v � I City B / ` -s Lic. # t Arcn., tngr., Designer Address City IZip I State I Lic. # r1% LICENSED CONTRACTOR'S DECLARATION I hereby affirm thatV.am licensed under provisions of Chapter 9 (commencing with Section 7000) of Divls_ ion 3 o� u rness and Prof ssi Cfde, and my license is in full force and effect. �...,�,,,,I SIGNATURE \ DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractors 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 rile 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 that. he 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). I- 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, 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 (hat he did not build or improve for the purpose of sale.) 1'I 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.) t7 1 am exempt under Sec. B. & P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION I hereby affirm that I 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 r7 Copy is filed with the city. O Certified copy is hereby furnished. f., CERTIFICATE OF EXEMPTION FROM WO R KERS' COMPENSATION INSURANCE (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., 9, after making this Certificate of Exemption you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY., 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 ame 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 state 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 Address 'k City, State, Zip � rr � t BUILDING: TYPE'COSIV T. OCC. GRP. -3"LeA.P. Number -?-73- Legal gal Description ` V1 Project Description (y ' w S p q?o( -11? APPLICATION ONLY Sq. Ft. yNo. No. Dw. Size 3Z Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated PERMIT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOT REMARKS AMOUNT M W h ZONE: IN BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line —Side -Street Setback from Center Line Side, -Setback from Property Line R"' yr FINAL DATE r�� INSPECTOR Issued by: v?. t � • <^y A• \ Date �t`� y Permit Validated by: Validation: WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION Desert Sands Unified School District 47-950 Dune Palms Road Notice: La Quinta, CA 92253 Document Cannot Be Duplicated 760-771-8515 Date 8/7/98 No. 17468 CERTIFICATE OF COMPLIANCE APN # ' 773-244-009 Jurisdiction La Quinta Owner NameDavid Ross Miller No, 52-475 Street Avenida Juarez City La Quinta zip 92253 Tract # Type of Development Comments F_ Lot # Single Family Residence Permit # Log # Study Area Square Footage 1448 No. of Units 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 1.93 X 1,448 or $ 2,794.64 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/David Miller Telephone��9 7-0069,. Name on the check • „� 1r�, . By Dr. Doris Wilson Superintendent w r Al OF � f Fee collected /exempted by Ellen Patino Payment Received %794,64 . R Check No. 055828 r Signature. NOTICE: Pursuant of Assembly 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 tolled them on the District('s)(s') behalf, whichever is earlier. a, 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