0306-186 (SFD)y:
LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
CF Ater 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
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
pafe A, . r' F Signature of Ownerz-. 1,9 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.
(This section need not be completed if the permit valuation is for $100.00 or less).
(k)' 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 forthwith comply with those provisions.
Date: r!' 7 •+ z Applicant J=
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. 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) 4. � d — Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT TRACT
uxl twao 23 DIX"d
n.�f
JOB SITE_ S
APN
ADDRESS ;:E,�t Z��CIA.N'�F�.��r.�.a��,ANAVARRO
774•0M-002
OWNER
CONTRACTOR / DESIGNER / EN INFER
M0TJk ):.&.iW 001T..DB7'.`."MC
RO, 1; M "'S573
PAL11% D..-T.RT CA 92261
USE OFIT
a���P,E//R••MlLL y dY y -UN104
11t20 ,:. P. IM PEIR 1,11" DMS• 440T INCLUDE 13LOCK Wt.�11,, '1'i.Yi: ISPAs
AlU1 •T. P?, K PLANS OY aAMIE TYPt
-SACT CirNSTRIiCTION 1,320.00 Sig
.F3=_)RCF1/PA110 1 _27. ot) 11311
0AMMli:AR!•'irRT 540,00 3It'
TIMER. ; 3IT.MUR S3T.t MIARY
C ONOT1` (!CITION 11qZx 1111. -000-43 6�41(1ar U81.50
PLAN 6,.f'1V.X FEE 101-000-4:! -21R $56!37
:t F i:: PtJ;,i`.( 1!`.• 1.Ot tCt-4dt�'� 4 a is 1 I�i1,tiU
.
101-00t)-42.1-000
iGP►?,WE 1.121J."o
PLAIIN1 1RVIME 1fJry-gUfi Ory ih�lil �i30,50
3'['WDWO MOTION FEW.. -MID 10) -000-244 d -000 1
C.RA )YIN0'f:` R 1(1.0010•-471••000 $13.001
Dr!7V'i?':'V,1 R R €MP.ACT FEE V20 03, Ute
PREC°1'SE PLAN 1C11 l)Ot�-aa a=:34� :S1rQ.t1U
J.MI S tajE„1"JAIT.A nIX1..3
4250,0
a
TOTAY,
AUG 14 2003
CITY OF LA QUINTA /
FINANCE DEPT.
RECEIPT DATE
3. f )
BY
DAT FINALED
-o
INSP
INSPECTION RECORD
10 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
Q
F.A.U.
Framing
-
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
ton_
Drywall - Int. Lath
Final
Final
�f-� �
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
Waste Lines
APPROVALS
_ /,�
- O �G�`
Gas Test
Electric Final
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
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.I.
Smoke Detectors
Temp. Use of Power - 7 -0
Final
Utility Notice (Perm) �/
CERTIFICATE OF COMPLIANCE
Desert Sands Unified School District 4
47950 Dune Palms Road
Q `,� q BERMUDA DUNES r ,
La Qumta, CA 92253 - RANCHO MIRAGE d
'-Date 8/13/03 � - � INDIAN WELLS �.
No. 24819 (760) 771-8515 to, PALM DESERT y
LANDINTA
Owner Mountain Cove Dev. Inc. APN # 774-065-002
Address P. O. Box 3578 Jurisdiction La Quihta
City Palm Desert Zip 92261 Permit # 0306-'86
Tract # BLK204 Study Area
Type Single Family Residence - No. of Units 1
Lot # No. Street S.F. Lot # No. 'Street S.F.
Unit 1 23 53040 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 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:
4
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 1,820 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 C/C Canyon National Bank, Larry Shields Check No. 1535E
Name on the check Telephone 771-1370.
Funding .Residential
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Patricia Barbuzza Payment Recd $a00
$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 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 s 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
t
LOSE C,
Certificate of Occupan -cy
0
4 gab&
s
, OF Building & Safety Department
This Certificate is issued pursuant to the requirements of Section 109 of the California Building
Code, certifying that, at the time of issuance this structure was in compliance with the
provisions of the Building Code and the various ordinances of the City regulating building
construction an'd1or use.
BUILDING ADDRESS: 53-040 AVENIDA NAVARRO
Use classification: SINGLE FAMILY DWELLING Building Permit No.: 0306-186
yq
Occupancy Group: R3 Type of Construction: VN Land Use Zone: IRC
Owner of Building: MOUNTAIN COVE DEVELOPMENT Address: P.O. BOX 3578
City, ST, ZIP: LA QUINTA, CA 92253
By: KIRK KIRKLAND
Date: JUNE 1, 2004
Building Official
POST IN A CONSPICUOUS PLACE