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0309-253 (SFD)T LICENSED CONTRACTOR DECLARATION 'x ; I hereby affirm under penalty of perjury that I am licensed under provisions.ofY Ly?° -Chapter 9 (commencing with Section 7000) of Division 3 of the Business and 04 w�" Professionals Code, and my License is in full force and effect. =)"M ,fiLicense # Lic. Class Exp. Date rl-aILD ,h (� w r l oZI� c�o0ro H LUa� U) Z 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: ( ) 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, Business & PrOfeSSionals Code). (pr) I, as owner'of the property, am exclusively contracting with licensed g'obtractors to construct the project (Sec. 7044, Business &Professionals Code). () I am exempt under Section' B&P.C. for this reason Date'"rf' I V Signature of Owner a 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: Carrie Policy No. (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 1 should become subject to the workers' compensation provisions of Section 3700 of the Labor Code,:l shall forthwith comply with. those proVi ions. / (1 Date•'fir /r Applicant . rn�/rs.�.c Ale. :: fti -r; .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 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 this 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` innsppeec�ti%onepurposes. Sig ture (Owner/Agent) JV/_ �" �' 4,-- Date i BUILDINGPERMIT PERMIT# DATE VALUATIONLOT TRACT s - . RP .3t1 ?' 1 E Bad 204JOB SITE ADDRESS ;4S„��I�TB�GIS�i� APN P'�1�•O��J'UQ� OWNER CONTRACTOR/ DESIGNER) EN INEER C'aANYO•N'9-Or Wr. INC. :i WME2 - a,..i. P.O. BOX 3578 i Po goy S%-77 Z yCBLO I ISF OF PFRMIT MOLE FAMLY I7W..UNG 7 60 fF3�0 x.lC yI� Pilt:MT1' I30E.� 2d{J'3'.TEICf;G1L1� i�1'.DCIf. leb',P;3.LY NS,i(�L�fS1ti.i1 r OR DRIVEWAY "11RO.ACH • e TRAC T C014STRUC°PTON SF. 2��3 F'OR:CHIPATIO 1 • pfl, sE _C 1 Q E clut C1 OF LA A I DEPT ,. COST OF COl�it5.a".`E UC110H 109151�.'5�.'�'0 �ry7t�t��;e;r�. t Y;� 7-��•�y �r �:y�gS''[iUM/1►11711) ,i-.�LniSS.JIviaL .�iTER o�Y?•'WY,I�%1�t.9K.& . irCiWSTF.C7rrTiC7t4 .FIEF. 101 �OQO.4I��OF9C1 $674,30 PLAN CHECK PER, 101,,00,0439-318 $560.29 FEE DEPt 3ff 101-000-439-318 4250,00 ME.CE A3fiCAL FTE 101-0002-4.29--000 $:59;00 ELECIRIC.,t�1. FEE . ...101-606-420-000 $123,00 Pi.Uts9BI1dGFZ9 , 101'1=0010-4i9' OO. $190.00 STRO140 MYTION WEE RUM 1171-,000.241.000 GRADTHO FKH, 1 O1.000 -x;23-000 $15 Ga L1EV'nC'm WP.ACT FE); f dfl lGf nI ICISEPL.AN 101-000441-343, 343, 501:3 - AL. CGIRUC:Ti1 OX AND .PL.AW :Cf3ECK. LIES,'}T P.R1r"'��L�I'M :4250.00 '.%OTAL1:;°MUM FIMS l DLP NOW X3,827.77 RECEIPT DATE BY DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Qr ae - Underground Ducts Forms & Footings 14 Ducts Slab Grade Return Air Steel Combustion Air Roof Deck el` Exhaust Fans O.K. to Wrap _ F.A.U. Framing , O v i 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 BLOCKWALL APPROVALS steel POOLS -SPAS Set Backs Electric Bond Footings J . O 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 APPROVALS Temp. Power Pole G ,� Underground Conduit Rough Wiring Low Voltage Wiring Fbdures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) COMMENTS: r7 5 O>C 5 -L/ -Df P J r Cols%vW&r ?jlv is 6o,1 TA}a73n pF /Ze C on.cp, L�2c £ _0 7 $ j 3 � 2 Re'1Acc^w-- �bk 6.42D /%914,1S174vSf/ ... ..»x: > :-`ti.' ,,:?"[, ...r""y+'- {D'-^•".---{^+�r-sr^ .• ;-'" �""''- -''"� ti.w..t" - . ,-4.y`" ti.1�,ti---•�, ,. D3o9-.ZS,�4 P.O. BOX 1504 Building�; 'y p \% �l 78-495 CALLE TAMPICO Address S 1- 4 � G A0- ' i � F� P d LA QUINTA, CALIFORNIA 92253 Owner .Mailing 1 Address 7 6 - City Zip Tel. P. 0 1 , -1- -2: tv i 1 7 9 t,! 4 i A 2Z 33 N' 1041e5011 57- r 5'TE Q L (OS City Zip Tel. 03aSOAJ Cttu k/ 9.7e)(. State Lic. City & Classif. Lic. # Arch., Engr., I Designer -Le fit.► Address�I Tel. I Lo QuI� City Zip State Q c 7 7 S �i Lic. # .�....� LICENSED CONTRACTOR'S DECLARATION I hereby affirm thaf�,am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division'3-oof the Business and Professions Code, and my license is in full force and effect. SIGNATURE DATE OWNER -BUILDER DECLARATION 1 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 rite a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) or Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis for thealleged 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 orimprovement 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 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 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 C7 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 ($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, alter 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 Ihereby 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 applicant Date Mailing Address City, State, Zip APPLICATION ONLY LDING: TYPE'CONST. OCC. GRP, Number 7 -1 04. S p [s, A ,I Description '57, , 194 Ab • tJ6�0 ill - i,J'd Description Sq. Ft. No. No. Dw. - Size ( F?ZC Stories 1 Units New W Add ❑ Alter ❑ Repair ❑ Demolition ❑ s Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.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 DP Issued by Validated Validatior WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION 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 $2.14X 1,820 S.F. or '$3,894.80 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 TC/World Savings Larry Shields- Check No. 5396950755 Name on the check Telephone 760/771-1670 Funding Residentid By Dr. Doris Wilson Superintendent Fee collected /exempt!ron M GilvrTy Payment Recd $O.m $3,894.80 Over/Under Signature NOTICE: Pursuant to Government Code Section 66020(d)(1), this will serve to notify you that the 90 -day approval period it which you may protest the fees ors 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' r 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 4 It. CERTIFICATE OF COMPLIANCE . Desert Sands Unified School District • - 47950 Dune Palms Road �4� UNES r:. Q BERMUDA DUNES Date 12/9/03 q La Qulnta CA 92253 f rn RANCHO MIRAGE b INDIAN WELLS No. 25251 760 771-8515 LM DESE `� PALA QUINTAT y �Im INDIO y�~� ')GI Owner Canyon West Ent.lnc. APN # 774-065-008 Address P.O. Box 3578 Jurisdiction La Quinta City Palm Desert Zip Permit # 0309-253 Tract # BLK204 Study Area Type - Single Family Residence No. of Units 1 Lot # No. Street S.F. Lot # No. Street S.F. Unit 1 16 53180 Avenida Navarro 1820 Unit 6 Unit 2 Unit 7 Unit 3 Unit 8 Unit 4 Unit 9 , Unit 5 Unit 10 Comments At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patiosNvalkways, 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 folbwing 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 $2.14X 1,820 S.F. or '$3,894.80 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 TC/World Savings Larry Shields- Check No. 5396950755 Name on the check Telephone 760/771-1670 Funding Residentid By Dr. Doris Wilson Superintendent Fee collected /exempt!ron M GilvrTy Payment Recd $O.m $3,894.80 Over/Under Signature NOTICE: Pursuant to Government Code Section 66020(d)(1), this will serve to notify you that the 90 -day approval period it which you may protest the fees ors 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' r 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 4 It. z. RC DISTRICT - PLANNING REVIEW FORM �,b This form is to be used by CDD staff for review of single family dwellings in the RC (Cove' . Residential) District per Section 9.50.090 of the ZoningCode. Its ur pose is to de p . p determine:.l) that the proposed housing design does not duplicate the same architecto�ral style of any house within 200 feet of. the applicant, and/or 2) if there is a need for the. applicant to fife for Master Design Guidelines. If the applicant does need to file a Master Design Gu deline, please transmit this information to the Building and Safety Department as part of your correction list. Please attach additional explanations as .necessary. APPLICANT: SITE ADDRESS: 5 ,�5 - /Pp L. k)a,VCA,VVO APN DIES^ - Ob 8' CASE'NO.: LEGAL: LOT % BLOCK 6 UNIT S.C.@.V.L.Q.. CHECK AND APPROVED BY: DATE: Inform the assigned Building plan checker upon your assignment to this case. The CDD Executive Secretary maintains a log book to track applications a.nd assign case numbers. REQUIRED ITEM Y N COMMENT/CORRECTION Verify legal and APN information Consistent with MDG.on file (as -applicable) MDG filing required (5 filings since 9/3/98) e Architectural variety within 200 feet of the surrounding area: - Dov P d e Gov m `ss\On . Architectural design featur Ga e ;o n5 Other •Requirements: ���h CITY OF LA QWNT�4 SUB-001-TRA7CTOR LISW JOB ADDRESS D3' l �O NA��422� PERMIT NUMBER Q 10.? -2 � OWNER . C19NI ON QST EV -r - BUILDER This form shall be posted on the lob with the Building Inspection Card at all times in a conspicuous place. Only persons appearing on this list or their employees are authorized .to work on this job. Any changes to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result in a stoppage of work and/or the voidance of building permit. For each applicable trade- all information d Trade /Classification Contractor requeste State. below must be Contractor's License completed by applicant. "On File" is not an acceptable response. Workers.Com P ensation Insurance City Business License IF Company Name Classification (e.g/A, C-8) License Number (xxxxxx) Exp. Date (xx/xx/xx) Carrier Name (e.g.lState Fund, CalComp) Policy Number ; (Format Varies) Exp. Date (xx/)x/xx) License Number (xxxx) Exp. Date (xx/xx/xx) EARTHWORK (C-12) , a(��ti��/�f? /B�, ���a��i C'� CONCRETE (C-8) FRAMING (C-5) STRUCT. STEEL (C-51) MASONRY (C-29) Lam. O (� e� 1^{e�fvloy C /1 (;• l�(C�i -7 I c5 /Q 3 1 v � �/ C o 2t 2c � f,1� 2 �C 1� ;3 ECr GAN 1,2e •T , / Q� �o� a �C3 � , � ��� I 1 1 3 075 • 9 v.T: 6_-�2 5.p2 0�lr /Z PLUMBING (C-36) tkkI G)VaP C 36 P1 C 516WY:F 1 y 5We FL.--, % a90Q7 'l Dj dl%317 LATH, PLASTER IC -35) Frirr3o.-''�D35LCooel �Nsu�•c� r4A10ROOFING Of 6LL� DRYWALL (C-91 HVAC (C-20) ELECTRICAL (C-40)rArc SQrq r wbll ��.....,.. .;��►b3 7$%6 �N 0 f °�t � 6.26�-C* 11 b� o� b3 c aC A16_3 Sf7® py (C -39)C31 SHEET METAL (C-43) GWKe�.ti � t► C 2� Il 3o e, YYs 3- }�,.•�..,..... TNZ o3271/2fi �o �Y bLS15 3131 c?%t y►'1�z,,,, R PST Io15cs -b4 1� V403 b 3 c of CI29 14 FLOORING (045) 145-7-71CO S 3 by GLAZING (C-17) �c.�.�,•. I'1�rf'bi �/IwtS C, 1 1 'j 61 It 5r 11 INSULATION (C-2) �,�e�,e..Z �+fi•�i�i•...+' C. Z � Lo 3X'S 306 I) 3p e+3 S �®�.- �'-�,.,.r 2 64La6l,43 z- 1'1 b aIL7� y z� cy SEWAGE DISP. (C-42). .0-9C3 PAIN riNG(C-33)' CERAMIC TILE (C-54) AQIlkso TA. 4ow t 1129,75 STalr D'lrwoi 10gIT2oo2 loci• o aa!/�S" foy CABINETS (C-6) FENCING (C-13) �'d 'iw..f�..aj+*► ra x;W 10 CL �.Y 13 5 413'�`s� .Jta � Tw-►Z Off), 3 IT244Ae1- )CllrIca630�-Y T)Q i LANDSCAPING (C-27) POOL (C-53) tLe►�- �� S �. %cl � ��I l►- �Ce S- �5'Y 6 y a3 e I i 1/26/05 •53-180 Avenida Navarro — Single Family Dwelling (0309-253) (AJF Construction: 760-641-5988) PERMIT EXPIRED • 'Most recent inspection on this permit: 5/17/04 (Insulation). • Permit expired on 11/15/04. Declared so on 1/26/06. • New full -fee permit required in order to renew action.