0208-239 (SFD)I
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
74:311 -9
ate Signature of Contractor
ALAZ
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 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
performance of the work for which this permit is issued.
;(e) 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:
Cartier 0`uhTE,FUN Policy No. ISU"W
(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 p;Pvlslons of Section 3700 of the Labor
CodeI sh. II fo. hwith comply with }hosg:provlsio s
Date. i'�"{,i�e.w. Applicant f�i»s
Warning: Failure to secure Workers' Compensatio 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 onY his
application:
1. Each person upon whose behalf this application -is made & each per son at
whose request and for whose benefit work is performed under or pursubnt 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 i
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 of City,_ttand State laws relating to the building
construction, and hereby a�lthonze �epiesentatives of this City to enter upon
the above-mentioned pro erly for inspection purposes. Y
Signature (Owner/Agent) Datel�
BUILDING PERMIT PERMIT#
M8_2319
DATE VALUATION LOT TRACT
50 12 32
JOB SITE
ADDRESS _495 ASA RITOM e ul—A-R Z
APN
OWNER
CONTRACTOR / DESIGNER / EN (NEER
53-485' .,AVL> Mi A SWA1�C�'% , .
4.5 -24,60 PALM V,
LA QTM ZrA CA 9.2253
MIX0 C& 92201
(760)347,-05001 f �., 4998
USE OF PERMIT ,
9KA %` %' 17 AWL ly"M .UNG
370-Pk}''�.Mi'1T NC'),tU') F -S 130 LF 81.fy:CK &W...&LL cS..5lT'V 5' RLOCK
a V`rAIA,ta`ITY SIANry.F RD.
D010 140T IINC! iJIM POO), & SPA 09 OtvliFk,"i A.'i` APd.'R !A€. H-
PORCHOAT14) 1.00,011 SP
0ARACMUCARPORT $X04;10
'
6 T. W1'C,5,L 130.0-0 .L?
5 n, WALL 50.00 F
PW4 CHECK 101000-4391-318 MAO
M,'iLIOSIT 43550.00
WX "NICA 1 512,50
I:'UCTRICPL V0e
LTI �tl1lt i ? :01.000.419.000 SI VA100
W ROWU MOTICM "FU 41-.957) 101,,000-241-t 010
GRAMMPER . 101-00 0-423-000 �13.Qb
=4f'Ir•I.,OPL17: JAVAC.1' .FEE $2"Oo.,00
PREC11139 PLAN 101-000-4-41-345 $100.00
Wl,STRUC 101i R& 1-01-000418-000 �. n
TexM.,PMrYjav
n, c
O OSP
C� rlC
ECEIPTDATE
f i
BY. �-y""
DAT N
INSPE
ra
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
,�?i
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
_J,
Exhaust Fans
O.K. to Wrap
,p
F.A.U.
Framing
Compressor
Insulation
—
Vents
Fireplace P.L.
i
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall -Int. Lath
•p2 ��
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
61 -C2
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Gas Piping
_
Encapsulation
Gas Test
"Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Pourer Pole. �-
Underground Conduit
Rough Wiring
Low Vottage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power--�(j �I ��
Final
Utility Notice (Perm) �G
COMMENTS:
12—
2Temp.
L
�� �� ( '— G 7
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 1,705 S.F. or $3,648.70 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 Check No. 11981
Name on the check Telephone 760/771-1670
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Monica Guillen $3,648.70
Payment Recd Over/Under
Signature '
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 - Applicant/Receipt Copy - Accounting
CERTIFICATE OF COMPLIANCE
�'�Xfu-z
Desert Sands Unified School District
47950 Dune Palms Road
Q BERMUDA DUNES r y
Date
11/22/02
La Quinta, CA 92253
Cn RANCHO MIRAGE
No.
23888
(760) 771-8515
�J INDIAN WELLS ti
V' PALM DESERT .y
t� LA OUINTA
U���INDIO `^
O
Owner
Mountain Cove Development
APN #
774-034-024
Address
53485 Avenida Juarez
Jurisdiction
La Quinta
City
La Quinta Zip 92253
Permit #
Tract #
Study Area
Type
Single Family Residence
No. of Units
1
Lot # No. Street
S.F. Lot # No.
Street S.F.
Unit 1 12
53485 Avenida Juarez
1705 Unit 6
Unit 2
Unit 7
Unit 3
Unit 8
Unit 4
Unit 9
Unit 5
Unit 10
Comments CC #11981 for $3,628.70. CASH $20.00
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 1,705 S.F. or $3,648.70 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 Check No. 11981
Name on the check Telephone 760/771-1670
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Monica Guillen $3,648.70
Payment Recd Over/Under
Signature '
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 - Applicant/Receipt Copy - Accounting