9703-056 (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
4977 707 S 9/30097
:1
Date 6"' Q r 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&RC. 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.
( I have and will maintain workers' compensation insurance, as required by
Se• tion 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:
Carver Policy No.
S'1'A'1T,FIAN1) 2Z) 911t:rri"1't!p'1t,�t;t
(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
ode, I shall forthwith comply with those provisions.
Date: Applicant 44 , e
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 aV Safety
for a permit subject to the conditions and restrictions set forth on his
application. j ,
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, indemnity
& 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 cer ity that I have read this application and state that the above information is
co7ect. 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
Zten above-mentioned property for inspectiionnppurposes.nature (Owner/Agent) _o�9- - "'• Date c' -V7
BUILDING PERMIT PERMIT# -•"".`'•'CONTROL#
..7..'5104
9711113-0%
DATE/ SM VALUATION 'S 106, 189.80 LOT I NO TRACT 4 �, 6k
JOB SITE
ADDRESS 78-840 NfSiuciN CIRCLE
APN
6044334111
OWNER
CONTRACTOR / DESIGNER / ENGINEER
i�1f)ININA n11,1NCE
DAA IEL DUE'NAS CONS�Rt IC•r€ON CO
7989012.YAN WAN'
P.O. € OX 374
11UNIUDA OUN€;S CA 32201
LA ("KIL11 f1'A CA N257A
11760)564-0821 rll€.# 47119
USE OF PERMIT
tiF�l.t
.WA) -1."04 txl'1: !N(_'L.l1.i 1i -;l iw.(jCK WALL AS if:ii�,il N Ofl S#1w,.T 1(95
,
V
t7 ii%'1' i NS`€'Ttilti_"T[(.+N 1,7KGO Sig
i�(_,RCIItillKFIC} 71W
(,4ARA(JHY(.;A1C1"(:+HT 51} ,011 SFS
(lt•cu"6 W A€.F, 01IT/LFI 7ry:175,rN►
NN'1'ENII,t'1 U1) (I)ST Of t:ON'SIi2tJt;1'9t: N
106,: 39.80
r.:1 i 3u'!'F<F ir.'t'3t_thl f i !i 101-OM-418-O(K) N1
t'3 t1id 0 111-4-11<_ Irl"j? 10140)-«)M 118
A't:'15 A1€i.l.�t�i)I�j' •a�.51i f,t}
hittA 3IANN'At.k l:ls [�,l t►tni 1121-i�ui1 ,,w�i
FF;E 10114011-47041100 $1 RAY4
tai 1 11\110INIf t1 M t0F.11Nl-•10030 11'%4 ;
11' W04 NV/'T itJ 1174 121:31.) 101-000-241-000 31tJ.�s3
+1)tADINtlt-)s!c ; ltil.-lkit}- 23titHl 120fiv
161144A.:I RI if 71 IRE t -Ti ;
�1t2't' 1t4 131ltlt 1C" F>t fly y:r _ R} (f; 71)1 •fK]{1:?SE (1()f) VNIIio
/
S€IR-'TY1A11 C'(1`.; i"R.1.►(_?1QN /INI) PIAN ('11€SCK
$3,3(1Ft as
LESS ITE -€`.A1€7 FT MS
$210100
4't1'1'e!#,.i'1;+,lkM1�ii'C 1+'f��3�:,'f (►ilk, i�(�d"V
3i:1.C►,'�.lF�
MP's ®1991
[RECEIJ
��
DATE
F
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs s i
Underground Ducts
Forms & Footings
Ducts
Slab Grade IReturn
Air
Steel fu
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap 17 1 4.
F.A.U.
FramingCompressor
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 - o —
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 I I
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
S r Lateral
Pool Cover
r_0 onnection
Encapsulation
s Piping
Gas Test
Appliances
Final
MMENAT�S:
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
Final
Utility Not— (Perm) �/
Building
79—SVD
Address
07ri0.A1,A1A
MaiiTingg
Address
New ❑ Add ❑
City
//1,,1� "vok_
Izi
t„ontractor
J )C,�
Address
City
State Lic. i
& Classif.
4
P.O. BOX 1504
78-105 CALLE ESTADO
te, LA QUINTA, CALIFORNIA 92253
%t1i4AI WR 4(
vkq�
City 7
( 7 1J7 Lic. #
Designer
Address Tel.
CityI Zip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereb affirm -that I am licens,�d=nn�de,r pylons of Chapter 9 (commencing with Section
7000) of on 3 o the Busingss If rofessions Code; and my license is in full force and
effect. ` \ CL/
SIGNATURE -' DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7.".5,,usfnass and Professions Code: Any city or county which requires a
permit to construct, after, 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).
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 improvesthereon 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.)
I 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 confractor(s) licensed pursuant to the Contractor's License Law.)
11 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
171 Copy is filed with the city. ❑ 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 (S100) valuation
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.
Date Owner
NOTICE TO APPLICANT. If, 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 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
BUILDING DIVISION
'77D3-456
APPLICATION ONLY
BUILDING: TYPE CONST. _V OCC. GRP. 13
A.P. Number 60q — 2_33— O «_
Legal Description LOT- 120 7p,!�-Gr Z 3 z,6 R
Project Description
r
Sq. Ft.
Size
No. No. Dw.
Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
//1,,1� "vok_
�• / S' �F G�
/1 u
/!J I
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
2so•ao
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
i
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 DATE INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
a
_ !y
CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES
1ST FL. SO. FT. a $
2ND FL. SO. FT. to
POR. SO. FT. C
GAR. SO. FT. @
CAR P. SO. FT. FL
WALL SO. FT. @
SO. FT. @
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC,
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
t ,
NOTE: Not to be used as property tax valuation
SLAB GRADE
FLOOR DRAIN
BONDING
MECHANICAL FEES
STORAGE TANK
WATER SOFTENER
SEWER OR SEPTIC TANK
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
FOUND. REINF.
APPLIANCE DRYER
METER LOOP
GARBAGE DISPOSAL
OTHER APP./EOUIP.
FURNACE UNIT WALL FLOOR SUSPENDED
GAS (FINAL)
LAUNDRY TRAY
AIR HANDLING UNIT CFM
GROUT
KITCHEN SINK
SERVICE
ABSORPTION SYSTEM. B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
WATER SYSTEM
COMPRESSOR HP
POLE, TEMIPERM
LAVATORY
LUMBER GR.
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
FINAL INSP.
BOILER B.T.U.
SO. FT. @ c
BATH TUB
SO. FT. @ c
WATER HEATER
VENTILATION
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID @ 11A c
SEWAGE DISPOSAL
FIRE ZONE ROOFING
SO.FT.GAR @) ?/ac
HOUSE SEWER
FIREPLACE
SPARK ARRESTOR
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
AL
SMI FEE
PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC,
FENCE FINAL
GARDEN WALL FINAL
NSPECTOR'S SIGNATURES/INITIALS
�' .r ,.1' .1. „ .tis
r
Notice:
Document Cannot Be Duplicated
Desert Sands Unified School District
82-879 Highway 111
Indio, CA 92201
619-775-3500
CERTIFICATE OF COMPLIANCE
Date 5/8/97 APN # 604-233-01 l-4
No. 15500 Jurisdiction La Quinta
Owner Name Donna M. Lince Permit #
No. 78-840 Street Nolan Cir.
City La Quinta zip 92253
Log #
Study Area 233
Tract # 23268 Lot # 180 Square Footage 1716
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
1.84 X 1,716 or $ 3,157.44 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 Donna Lince Telephone 772-3921
Name on the check
By Dr. Carol McGrew
Administrator in Charge F .
Fee collected /exempted by - Pauline. Pearson Payment Received $3;1`57.44
Signature (,��A
Check No. cash
VOTICE: 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
:oiled 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
Certificate of Occupancy
City of La Quinta
Building and Safety Department
This Certificate issued pursuant to the requirements of Section 109 of the Uniform BuildingCode,
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: 78-840 NOLAN CIRCLE
Use Classification:. SFD Bldg. Permit No.:- 9706-056
Occupancy Group: R 1 Type of Construction: VN Land Use Zone: RL
Owner of Building: DONNA M. LINCE
Building Official
Address: 79-890 RYAN WAY
City: BERMUDA DUNES, CA 92201
By: STEVE TRAXEL "
Dater 4-30-98
POST IN A CONSPICUOUS PLACE