The URL can be used to link to this page

0101-083 (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. Class Exp. Date F' �i1 ASB d,7 d; `d.e iai -r, W3 Date Signature of Contractor , . 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 r 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. • Si"A'l A FUND Wa9-01 U%NT 0004483 (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 Section 3700 of the Labor Code, I shall fo)thwith comply with th�o_s proviisions. Dater s a.- , Applicants Warn g 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 restricti application. 1. Each person upon whose behalf this application is whose request and for whose benefit work is perforITIE C or pursuant to any permit issued as a result of this applicaton agree & hall, indemnify & hold harmless the City of La Quinta, its officers, is nd Rye�.8 2. Any permit issued as a result of this application b comes null and void if work is not commenced within 180 days from dat of is uance of such ' permit, or cessation of work for 180 days will subjecLe,above'infomfMANN rmit to card QDI I certify that I have read this application and state that t DEI correct. I agree to comply with all City, and State laws relating to a ul construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspection purposes. �r Signature (Owner/Agent).--.,,,.4,' Yw Date BUILDING PERMIT PERMIT# DATE VALUATION LOT 0101 -cm TRACT y y y �rry G 8 nT,'9d'e 7L9 A.ACSY T..l ��.l.�tl.l.UF JOB SITE APN ADDRESS OWNER CONTRACTOR / DESIGNER / ENGINEER )VIOUNTA"W C O V",E DEV°sL�. W"' t WC W1111AM RUSSELL LL ROMS 51.370 c�.�".G3MABE$3.M'CT, A 56900 JAIS�IKaNC%k$ff - 71..A. ;"ZURSTIA. C h 92253 'xkt3u'.R3k`•` L CA, 92274 '760 )399-1200 08V 1954 ( USE OF PERMIT 3F0-(iUlA3` &X,81a4=FF)-PZRMVT 1007':3 NOT INCLUOLP f3iAlC5CWA, ..Lo'POf.)IJr#RJVP.'WAYA i'IRA,,OCH, '1'RACI COT'3M1. MON 1,492.06 OF PORtC,WRA.'TIO 90.00 SY .RADWARPORT (SP) 14,074.80 & rt. W000. FENCE, 200.011F XpJfKC11M.0 Cory 010, CVNF11 117fd0V 92, AO dHMl M31� SUftARb CONSTRUCTION, t ION, Mr, 101-000-4 ) 8.000 960%00 ;LAN efMCtr. 1W E01•-000-439-318 $308.52 KMZAVIC&L VAE 101 -0!01 -47,1.000 $51.52 a f. E..t'*c;'i"RICAL FEE 101-000-420-000 �iact.9R VITA > tlBINO I'NE 1101-000-419-000 31 t ti."iS ST'RONQ MaINION FZF • MOM 101.000-241-000 �a.sit (JR&DING FT' 1103.000 423.000 $ AIO OW 1.DPfM.1wiP:AC M111 $1,907.00 1�tt,GCi�3.4�<:�'ikl�t y 101. 11311-441.335 S1001010 itF,f��WY',T+6;:?S3T '; •I ` 'tdSY-CfQQ-�33��31'Ei •$�5f),ab "� J t R-rMAT, C; WAIRddiK'y.2itH.AND PLAW �.' EMCK 19 PRE -PAD M 1.113 42,50M 2001 NTA T RECEIPTw DATE �"�. BY �� DATE INALE INSPECTOR )F1' y( (� 11 :r� V* INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings _ O _ Ducts Slab Grade Return Air Steel Combustion Air Roof Deck _ - 30—a7 C S—t Exhaust Fans O.K. to Wrap =3o --L 5'7 F.A.U. Framing c..2=1 �D 1 s� Compressor Insulation _ c9 S T Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath �j -/ S7 Drywall - Int. Lath Final Final POOLS - SPAS BLOCKWALL APPROVALS 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 3'O St Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection�� -A ( S7 Encapsulation Gas Piping 8 •iL3 - _01 Gas Test Appliances Final COMMENTS: 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.L. Smoke Detectors Temp. Use of Power n' �( a V -1 s7 Final Utility Notice (Perm) ,i•f —C7? S% �I d�-o83 Building /� 36 Address P.O. BOX 1504 78-495 CALLE TAMPICO Air. 7V A 2 r - Z LA QUINTA, CALIFORNIA 92253 vwrrci,A16JVA,-r01A-) 1. �uV� �h'/�Ci��l i'!JI I/V Mailing Address 's 7Cs AU. C !v1 vOil"<, City Zip Tel. ' P I !-7'Lf —/-7 14-90 Address 1 r .�! f () d '.'_TP'YAC 5 6' City Zip Tel. �' 4 -17/ G State Lic. City & Classif. Lic. # Arch., Engr., Designer c'ivrr �At Address Tel. of/ WJ City R State �1i.` 73 Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby atfirm that I. am licensed under provisions of Chapter 9 (commencing with Section 7000) o1=Drvisibn 3,of`the Business and Profions Code, and my license is in full force and 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 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 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). l: 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 that he did not build or improve for the purpose of sale.) 1'1 1, 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 contractors) licensed pursuant to the Contractor's License Law.) 1-1 1 am exempt under Sec. B. & P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION Ihereby 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 n Copy is filed with the city. O Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars (5100) 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 TOAPPLICANT: If, atter 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. 9 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 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 a0plicant Date Mailing Address City, State, Zip k-Jrti::s....Mrlj.;y.;a.-::� H.v.-+i'_f..�•.:+�,,-�.a J^:.-::i-t.:�t,+'.,,�r APPLICATa ONLY �- v r LDING: TYPE'CONST. OCC. GRP Number % -7 y— 2 1 '� -»2- 4 'L I Description L-<aT a eL�V_- LG Z Project Description Sq. Ft. No. No. Dw. Size Stories Units New,9 Add ❑ Alter ❑ Repair ❑ Demolition ❑ Infrastructure TOTAL REMARKS ZONE: 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 FINAL DA INSPECTOR , Issued by: O D to t1 Permit '' nnNN AID �r Validatet�4' \ AI ` V;�df,tVnkj0 �v WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION �- Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. Plan-Chk. Bal. Const. Electrical y+"" Plumbing Ir P S.M.I. i✓ Grading Driveway Enc. ` Infrastructure TOTAL REMARKS ZONE: 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 FINAL DA INSPECTOR , Issued by: O D to t1 Permit '' nnNN AID �r Validatet�4' \ AI ` V;�df,tVnkj0 �v WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION Notice: Document Cannot Be Duplicated Desert Sands Unified School District 47-950 Dune Palms Road La Quinta, CA 92253 760-771-8515 CERTIFICATE OF COMPLIANCE Date 3/28/01 No. 21812 Jurisdiction owner NameMountain Cove Development Inc. No. 54-330 street Avenida Juarez City La Quinta zip 92253 APN # 774-233-004 La Quinta Permit # 0101-083 Log # Study Area Tract # BLK262 Lot # 21 Square Footage 1492 Type of Development Single Family Residence No. of Units 1 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 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 2.05 X 1,492 or $ 3,058.60the property listed above and that building permits and/or Certificates of Occupancy for this square footage in this proposed project may ncw:be"issued Fees Paid By CC Canyon National Bank - Larry Shields Telephc='' 760-r3`.9 1 00ee P Name on the check By Dr. Doris Wilson ,r ... Superintendent ' Fee collected /exempted by Annette Barlow Signature Payment Received $3;058.60 Check No. 05708 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 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 RC DISTRICT - PLANNING REVIEW FORM This form is to be used by CDD staff for review of single family dwellings in the RC (Cove Residential) District, in order to determine the applicability of compatibility issues or need to require the filing of Master Design Guidelines by the applicant. It shall be transmitted to the Building and Safety Department as your correction list. Please attach additional explanations as necessary. APPLICANT Mt. Cove Development SITE ADDRESS 54-330 Avenida Juarez APN 774 _ 233 _ 26Q BINNO.: J' 262 CASE NO.: 2000-387 LEGAL: LOT Z j BLOCK UNIT S.C.@V.L.Q. CHECKED BY: Stan Sawa DATE: 25 �'O Inform the assigned Building plan checker upon your assignment to this case. The CDD Executive Secretary maintains a log book to track applications and assign case numbers. REQUIRED ITEM Y N COMMENT/CORRECTION Compatibility Review Case logged''and number assigned Verify legal and APN information AaPI�J }; 1'cLAS hjP, Consistent with MDG on file (as.applicable MDG filing required (5 filings since 9/3/98) Consistency with street/surrounding area: Colors Materials Architecture u Other Requirements:(- 5- '►O U4,e, ^a- w� U1 Aff ►)VfA o $ WVA6-}e,D®5!6 &,wide/ KPS I I b ►1 ; I I. 11 Certificate of Occupancy City of La Quinta Building and Safety Department This Certificate issued pursuant 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 regulating building construction or use. For the following: BUILDING ADDRESS: Use Classification: Occupancy Group: SFD 54-330 AVENIDA JUAREZ R-3 Type of Construction: VN Bldg. Permit No.: 0101-083 Land Use Zone: RC Owner of Building: MOUNTAIN COVE DEVELOPMENT Address: 51-370 AVENIDA BERMUDAS Building Official City: LA QUINTA, CA' 92253 By: STEVE TRAXEL Date: 08-28-01 POST IN A CONSPICUOUS PLACE