0004-177 (AR)M
LICENSED ,CONTRACTOR DECLARATION s
I hereby)pffirm 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 effefct76/
License # Lic. Class JjExp. Date
Date "� �r ✓ Signature of Contractor�t
..�
4
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury thattI 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
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.
( have and will maintain workers' compensation insurance, as required by
Section 13700 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 STATE FUND Policy No. 239.99 U14IT 0020047
(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 andagree,that if I should become
subject to tl�e workers' compensation provisioris(ofySection 3700 of the Labor
Code, I shajl forthwith comply with those(proyisions.�'
Date: q ,
icant
0 Applicant k �tJQ". ' f
I, -/ iE
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 `nd"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�epreseniatives of this City toenter pon
the above-mentioned property'for Inspection` purposes.
Signature (Owner/Agent) !�
PERMIT
)( ) BUILDING PERMIT1101
DATE VALUATION .X LOT "0W4477 TRACT
$12,114.30
JOB SITE
ADDRESS .'It COR01?"OS MCLE
APN
646 -21t3 -i318
OWNER
CONTRACTOR / DESIGNER / EN (NEER
AAl i'UNTO MO2vae.S M'
J.A DOI" Cliff. uc-MON F• ,
78065 CORONADOCIR
743•I5BUTIMNWOODDIRIVE
LA QUINTA CA 82253
PALMDESERT CA 92260;
k160)340.4628 CBL4 *2484' z ,
f ,
USE OF PERMIT
1.41?S1DY_?N l22'bf..t2• Dr1.10N
V1
117 SY. SRUK:FAST NOOK ADDITION AND LAUNDRY ROOM,. . t..FMODFL ��8 �'e �•
CUSTOM CONSTRUCTION 1I7,00 Sts
VALUATION 3,000.00 LS
TSTIMAWD COST Cal+' CONST.I RCT ON
1.2,1.14,30
PMAUr liVE SUA4MARY
PLAN CHECK. FEE 1031-000-439.3113 $93,60
CONSTRUCTION FLEE 101-000-418-000 $144.00
ELECTRICAL FC, E 101.000.420-000 SI9110
STRONG MOTION FIEF . RESIO 101-000-241-000 $1.21
PLUMBR40 FEE 101.000.419.000 $21:00
13R.A.PfHO FFA' 101-000-423-000 $70.00
SUB -TOTAL CONSM1 11=014 AND PLAR CIMCI;:
$2911.01
IXS3 PRE -PAID FTXS
$13100
'COTAL MMIT FM D'17E NOW
$298191
J
RECEIPT
DATE
/6Y ..
DATE FINALED
INSPECT
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
_
— —pv
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
0. K. to Wrap
Framing
F.A.U.
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
_ _ _
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
— ( —Q7 S
Drywall - Int. Lath
S%
Final'
BLOCKWALL APPROVALS
Final
POOLS - SPAS
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
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
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)
COMMENTS:
Desert Sands Unified School District
47-950 Dune Palms Road
Notice: La Quinta, CA 92253
Document Cannot Be Duplicated 760-771-8515
CERTIFICATE OF COMPLIANCE
Date 4/19/00 APN # 646-210-018
No. 20321 Jurisdiction La Quinta
Owner NameAntonio Monis Jr.
No. 78-065 Street Coronado Center
City La Quinta zip 92253
Permit #
Log #
Study Area
Tract # Lot # Square Footage 117
Type of Development Single Family Residence No. of Units 1
Comments
nook addition and Laundry room remodel
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:
Residential Addition 500 Sq Feet or Less
EXEMPT
This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount'of `
0.00 X 117 or $ 0.00 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 Exempt Telephone
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Olivia. Aguirre Exempt $0.00
Check No. N/A
Signature
NOTICE: Pursuant at assembly BID 3081 (CHAP 549, STATS. 1988) this will sena to notify you that the 9"ay 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 essued or on which they ars paid to the District(s) or to another public entity authorized to
collect them on the Disbict('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
MAR — 3 0— 0 0 T H U 15:15 T R I A D
a
ISLANDS HOMEOWNERS, ASSOCIATION # ONE
La Quinta, California
March 21, 2000 0 3 RECD
(760)564-2177 FAX (760)564-4882
Mr. Joe Dolan
Dolan General Contractors
Mr. Dolan, Corona dos' v
We find the plans for the home of Mr. Monis, 78065 fkdm Circle, La Quinta, California, to be
in keeping with the association guidelines. The board therefore has given its approval for the
x9pow aswign,
7_ .
R _ 0 1
becky k. kochell 760 564..2177
fOK 760 564.46E2
triad 2
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fbr )iw wafl
vo. 6ao� 1459 51..455 deser► db d-.. k, gtr�rp� �. 92253
ISLANDS HOMEOWNERS' ASSOCIATION # ONE
La Quinta, California
March 21, 2000
Mr. Joe Dolan
Dolan General Contractors
Mr. Dolan,
We find the plans for the home of Mr. Monis, 78065 Cedros Circle, La Quinta, California, to be
in keeping with the association guidelines. The board therefore has given its approval for the
proposed construction.
REGISTERED INSPECTOR'S WEEKLY REPORT
JON TANDY
37630 Medjool Ave.
Palm Desert, CA 92211
Office (760) 772-7192
Fax (760) 772-7193
Pager (760) 776-3338
TYPE OF
INSPECTION
PERFORMED
O REINFORCED CONCRETE ❑ STRUCT. STEEL ASSEMBLY
❑ POST TENSIONED CONCRETE ❑ ASPHALT
❑ REINFORCED MASONRY ❑ FIRE PROOFING
❑
❑ OTHER
JOB LOC
_—L�IAy
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Lu
REPORT SEGUENCE NO.
TVP UCTURE*"'- �
`otaks jZes.�.�
PERMIT NO.
D
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DAV OF WEEK
MATERIAL DESCRIPTION
ARCHITECTS` h
W C
IN TO
HRS. CHARGED
ENGINEER
ASSISTANTS
HRS. CHARGED
INSPECTION
DATE
GENERALd
CONTRACTOR
^ ` SUB
r-{ T'� CONTRACTOR
0 ��
1 1 I ra-IA-p�
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COPY SENT TO CLIENT ❑
CONTINUED ON NEXT PAGE O
PAGE OF
CERTIFICATION OF COMPLIANCE
BV CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MY
'_-[-]=OF THE ABOVE REPORTED WORK UNLESS OTHERWISE
=`A/ORK TO COMPLY WITH THE APPROVED
`-"^-ARLE=SECTIONS OF THE
NATUROF REGISTERED IN6E TOR
c�-i
,,,'Jr_ -C a � � �'
D E OF WORT
REGISTER NUMBER