0312-017 (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
59091 *3 13 ~ � l Ei1 1120
ba
'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).
( ) 1, 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
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:
CarrierS'1A Er FUNDPolicy No. Ir.3553'
(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) shall fortwith comply with those provlsi
Date:fj Applicant—
Warning:
pplicant
r w. !
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 propfertrty, or inspection purposes.
Signature (Owner/Age / . '7'"r-, i /� Date " /� �
PERMIT r;�-�-�"PERMIT#
.`�ULLDING
DATE 1VALUATION' LOT R�A�
7 TRACT
03A.6/20C: .I I *40417511,18G... 65 74890
JOB SITE
ADDRESS ��- 7E�)1`3 X1,1 C? :8'3."kP,�1TT
_015
OWNER
CONTRACTOR / DESIGNER / EN INFER
lCfidfk3RLY LWLM ML 1•fEJ1`TM
B. t.. MWIMM
76588 Tit,GO)VA.I.M.9
76588 i3 G01aA LANE
P1Q1MD=Wr CAr, 92211
PAT—V,. DF Q;KJ* CA 92219
(76(Y)d00-5491 C'13VJ 04099'
USE OF PERMIT
SWOU FAWGY' :DWX1LWG
4815 SN SVDIPIERMI ' DOES NOT .MCi..i,DE BLOCK WA.1A sfP001,SP4 0I1.
DRMT.WAYAPPR6ACH, 2001 C -M
CUUT M CONSTRUCTION 4,8)suo S;+
i'0RCH!PJ%T10 $29.00 3F
GARAGEIC/ RP01V 933,0iy 80F
iATAITIM COYI, M CC;i�'�"�°i�fiJ�" ON
404,7MA0
fig• 7 e (y�rq� �y� p�y1�'S
i F.i.�.1 ill" A'! E SIXTUB ;r. R J
CCiN;1'1'"RUC`PION 'IY E13 101-000-418,-000 $1,707 00
PLA, N -N CHECK. PEP, 101 -000-4-39-318 $ II'm 29
FEE DEPOSIT 01 -000-439- 18 -$1,000.00
1ddPtr.%t142a.tc. 1� 1 :1? 101-000-421-000
ELECTRICAL .FEi 101-000-4420.000 $239.87
P1..UMBINQ VEP 10,1-000 X419-006 5223.13
STRONTMOTION FE - RESID 101-000-241-000 g40,1411'
01UP DIHQ FEE 101-000-423-000 `�I �.t►o
PIWELOPER IMPJACS' FTIM VASA
,etc 114 PUBLIC PLACZS e KES11 270-000.44.5-000
rM7B-TOTAL C ONSUMCMIDW .AND PLIW CHE CK
$6,663.77
V PR*G PA1D 11MM
Q
-$1,000,00
MAR 17 2004
CITY OF LA QUINTA
FINANCE DEPT.
RECEIPT
DATE") I t, /
BY
DATE FINALED
INSPECTO
C,
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
/
Ducts
Slab Grade
_ y
Return Air
Steel
_/ A/ —
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
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
Al
Final
Final
_ 3•—
POOLS - SPAS
BLOCKWALL
APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. 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
COMMENTS:
le
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 Notice (Perm)
/e i
IR -10;7`1
4
u�l'jtrGv
P0 BOX 1504
0 N acl�tQ O 5' f-< 78-495 CALLE TAMPICO
Address --' L (,Z (ll&J CL.LA OUINTA, CALIFORNIA 92253
/ /31
Mailin
Address76j 9,0
Z2
Contractor
A� 1 <9 /5.-P 0-'y /a
Ic-e—
' 11 Zoo
776 T
j�4 ZIpg2 2 -
State
State Lic. 8
& Classif.
Arch., Engr.,
Designer 4 / `//
a_�5 //
Lic #
//226 Il' I
T
City /1)�4 /uts �nJZip �- .( IState or I
E�' �ICG�n �—�1' Lic. #
LICENSED TOR'S DECLARATION
1 hereby affirm that I am licens er Pro sions of Chapter 9 (commencing with Section
7000) of Division of the Bus' s d Profa ions Code, and my license is in full force and
effect. 7
G i
SIGNATUREDATE
O ER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 703 1.5,
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 (8500).
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.)
I'I 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
doesnot apply to an owner of property who builds'or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
f! I 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
Cl 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 ($100) valuation
or less.)
I certify that in the performance of the work for which this permit is issued, 1 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
WHITE = BUILDING DEPARTMENT
APPLICATION ONLY
BUILDING. TYPE CONST. GCC. GRP.
A.P. Number 7 72- ` '7 d ~ ® If fB / p
Legal Description % 65-)t' 2 Lr
Project Description 5��� le aM` ' �'r� �'G`° G"
Sq. Ft._ ' - No. / No. Dw.
Size Stories Units
New 0--- Add ❑ Alter ❑ Repair ❑ Demolition ❑
t
Estimated Valuation
PERMIT AMOUNT
Plan Chk. Dep. /
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading /+I
Driveway Enc.
Infrastructure
U l y ern. /1 Ifs
TOTAL �`_ d
REMARKS v
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street SetbacF from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
YELLOW = APPLICANT PINK = F14ANCE
' CERTIFICATE OF COMPLIANCEc
Desert Sands Unified School District C�� .
47950 Dune Pallas Road ¢ BERMUDA DUNES r
La QUlnta CA 92253 Cn RANCHO MIRAGE !�
Date 3/16/04 , INDIAN WELLS
DESE
(76:0) 771-8515 �,� P LA QUINTA �y
No. 25686PALM
y71
0
Owner Kimberly Lee/Bill Hunter APN # 772-07)-015
Address 76588 Begonia Lane Jurisdiction La Quinta -
City Palm Desert Zip 92211 Permit # 0312-0.17
Tract _# 24890 Study Area
Type Single Family Residence No. of Units 1
Lot # No. Street S.F. Lot # No. Street S.F.
Unit 1 65 50760 " Nectareo St 4819 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/w9lkways, residential additions under
500 square feet, detached accessory structures (spaces that do not contain facilities for Irving, 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 4,819 S.F. or $10,312.66 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/Bank of America - Bill Hunter Check No. 408811762
Name on the checkTelephone 760/200=5491
Funding Residential; .
By Dr. Doris Wilson
Superintendent "
Fee collected /exempted by $ n McGhrey . > Payment Recd o.00
$10,312.66
Over/Under'
Signature C
NOTICE: Pursuant to Government Code Section 66020(d)(1), this will se to notify you that the 90 -day approval period in which you may protest the fees or
other payment identified above will begin to run from the date on which the building or installation permit for this project is iss.ied, or from the date on which
those amounts are paid to the District(s) or to another public entity authorized to collect them on the Districtrs) behalf, whichever is earlier.
NOTICE: This Document NOT VALID if Duplicated
Embossed Original - Building Department/Applicant Copy.- Applicant/Receipt Copy- Accounting
K, G, �'.�'".�e��!'t.;:t"J4'i�:�('•�i:i,l��?5ftf����'
ti sr
�4F'Y"iW .l 'y C �'(�`t•"'•��'i" t�.W. \} r��� Ai 1
Gi;}-vCrl S'i
rlgt1,3�••,wt
�'ic�+'3 •_! �.'.�rzit. 't�tt�wrt�
i
el:uL
sitF.'=1 tiri t',f3UD*.
nvititi_1
°.'+�i:+• l"iS''e.aci ; fqc: (w
e0trx ��'t:.tt�.'•
�
�ii�$LC •'l�fiti
t
..._........_._....,........._.._....._.............�_.._ ..._........_.�_.........
'O"m .3 3h .at,+i
-
�3 ifau:��h ytim,�, ;;srrtc a 7
pis
A.P.
......_...___,.._.._......._...._......_.........._..._.
..__.,...... .... _
i
l�t1l#
'i iit�l,D
St t' U
N :'Ir�f
wn':8!3Sii!i'tt?w
*xHlGD `rlt cert) br3t,4,t ctns'• 3IUCtfi} t,lS .J.'R7) f":BLfl;;
a4dern !.-!a:'1E,Zti ti}':i AJ (,VIIt;v N—,a 'D;In "i, ? InIyvv , .*",rit ;I n v l n! ^. S nMr C,� !:,A r^ h (; � r• W +
.$r'iG' f - - 'tI F:t� , Qn !-;�tS1 u'wt3Cst, t-. !�t/i1� �0.'Y3:liti L.7'1:YCtdJ .} � tltGr_',9 G?Ctc.
., ta•3G�'IT>'+rVJDl;n1 '•t119tsof ., aftli! in'11itC f -eq tF'tC•��'t(j>t";+s:y •': IG:(1'�t,4'A v'."1tr....�t:,;Cr ct;f It rill bwK°m,..-4:) l:*3d Lt6;! ti LjmJ')
svc-drIw ;.it:y?Ai' ow, tit -101 Mr -q 't^� ;:�a1tS11 $t�,'i °F;t�4C� !� AP. 2 tj. X r•i .3u to i(tH'arns rrli EU
b,:)Vec; )d }qoq van) l:.vlotq L%sf o' -ic ?#til ni etlGstcC t ti u.,n, tti1 Stet yartaqu:io to 1U1#"riC $tttt *tj i
F3-)h9mA lo
LI -0 LY'VE
t:.ilit�lsir,•,,►( r.t►ticFti:� .
lf':,�t:�11Ti7f:•C:Ct� ,
(J(pe k l fi tr:t;�.isi :la'•.'itli{ :2 Y1,1
�o : �` ,:ait 1�4lrnq yF,r' t,+u': rl��n ,• t^i rJ�nyn Ia�ro:rw'�� >;r,'4-�� �":tT irr,l Ucr; ;4FivFA of ��1A2 t!i�J rt�1 i t}{t:ti1','t>Q� n;,��� ;���J :n�m�.a�i aJ ln�:u.. u� •�'.:?tT�:�;
+`a:i,i'N n� ::>ra fri rnttu2 ;�+ .Gau• at Et tJ3t'!+a �ti'•t :+YA ►itn;_:;i nai�i'�nt r;, rnlglt:td rt!! tfa`C!LY Rti `?3hq F,ril rr;G}! t 71 t7` r^gsd t#i'rJ rNC+lN �rh:i:st,►lt''C,EYuij js:,;;V
I`1f!i�.9 � lb:!1ffDll�t"! 'i1r:^Rl� ia' i' -t s �• r ' �
i . �ti,,'s(� ;.v'kl �1Q +^9:v sBC.if:• 1 Ot tf35lAL)c1,4:' Y+i• its v�it,,UQ 1 _':t`DntA Qi'� ? � ;-Ft�1A=�, rtSt 0, h'il+:t �w:ti G!itNC1!!F!; :1�:'+tt
y;c�a�tr?#Q OIsAV 'r'.e xci�thUCIittY :r;�i !'.�!�t
�,Ett;�iUCf?�.1- yq•�� 1�tt9:Y.9�ilitc�J;I:;�A • ,�+jo� fttrac?C��glttris;i;t;an�:1 wt.�b(i;;E - it,Et`.�iy{? �3?dCtJ'.%:ti3