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0307-008 (SFD)LICENSED CONTRACTOR DECLARATION t;hherebvtaffirm under penalty of perjury that I am licensed under provisions of 6;ap09 (commencing with Section 7000) of Division 3 of. the Business and Professionals Code, and my License is in full force and effect. v 4 . Li 'ense # Lic. Class ' Exp. Date 80602.2 13 031.3112: Date �t'`�` Signature Of OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the following reason: 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&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. () 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: Cartier SIA TE COMPENSATI Policy No. 1670405 (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, I shall forthwith comply with those provisions:.`~-w•--.�..,,• , Applicant— Warning: Failure to secure Workers' Compensation ove age is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000; in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the 'conditions and restrictions set forth on his application. 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnity & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for,inspection purposes. Signature (Owner/Agent),,-'°_ -� Date -.BUILDING}PERMIT- PERMIT# 0307-ON ' DATE is ry VALUATION'.LOT `$-' TRACT��, JOB SITE- ADDRESS � 7 SC1VAT�LELM APN � - •ii31 OWNER CONTRACTOR /DESIGNER w DyNy 1yE OARMA ./ENGINEER YC. .562 GI,EX 0AU Bx i b, 45.010 DESERT i1".1EW U' CA 91340 LA QUJNTA CA 922.53 (76S)12410-.5400 031M 4410 USE OF PERMIT SF0.4335 SQ.rr. USII39NCF, RVIII..'frill' CONS"WL PERMIT DOP.S RA'TE 'NOT INCLUDE BLOCK WALLS, ROOI , 31'x., OP. FIRE Plt SEPARATE PERMIT &1INSPECTION BY PUBLIC --WORKS DEPT. REQUIREEn, TRACT COTnI31 UC'P10O1<i = �,333,Od1 SIP PORCHIPATIO 461.09 SF GARAWCARPORT 9,30.40 SF TMWATED COST 011' COM1i .U.MON 2.58,'769,80 CONSTRUCT FEE 101.000.418-000 8.1,196,00 rLAAiCHiTt E�1rF1. 101-000-439-316 $1,"6.04 PEE DEPO3I;" 101-000-439.31.8 -$1,000,00 ECHAXICAI, ".X 101 000-421-000, $163.0tt . ELECTRICAL M1 101,xQ00.420.000 '$259,3 PI,t1A9I IND FEE 101-000-419-000 $301.25 STRONG MOTION FEE RESID 101.1000-241.000 Cf1ZA1?[1bf3I+'F -101-000-x.23.0-00 X13.00. DEVE'LCIFER IMPACT 1'EE ART IN PUBLIC PLPCM • RESIX 27tl-(I0.0-445-000 $146.92 ' SLB -TOTAL C0NMMYC1100 AND PLAN CM CK $gs���.•12 . IMS PRE -PAID FFXA -$1,000.00 FEES F?17E. Now 2,2003'.'. "IFINYE�` ANCE [RECEIPT DAuT�yEf ? �y BY J DATE FIN D INSPECT INSPECTION RECORD I— OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR to 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 p 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 6 Drywall - Int. Lath ! �' Final Final BLOCKWALL APPROVALS POOLS -SPAS Steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final I Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines 4-tHeater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K for Finish Plaster Sewer Lateral Pool Cover Seaver Connection Encapsulation Gas Piping Gas Test Appliances Final Final p S— Utility Notice (Gas) ELECTRICAL APPROVAL� 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: CERTIFICATE .OF COMPLIANCE , • i ' �s� ., Desert Sands Unified School District .47950 Dune � Palms Road ¢ BERMUDA DUNES r La -Qu i nta• CA 92253 _ rn RANCHO MIRAGE t_J , Date 9/11/03 c INDIAN WELLS �. 760 771-851 5 PALM DESERT No. 24945 ( �, ���{� LAOUINTA �1 '. Owner Danny& Sue`Garcia APN # 762-250-001 , Address 562 Glen Oaks-Blvd.. Jurisdiction La Quinta� I City San Zip 91340 , . Permit # F. Tract # '28034, Study Area a ; Type Single,Family Residence No. of Units, Lot # : No.' Street S.F.' Lot.# Mo'. Street S.F. Unit'll '28034 .57995 South .Valley Lane - 4335 Unit 6 Unit 2 -� y Unit 7- . Unit3 Unit.8. Unit 4` . ... Unit 9 Unit 5 j Unit 10 ;. Comments At the present time, the'Desert Sands Unified School District does not collect fees on-garages/carports, covered patiostwalkways,•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: :This certifies that school facility fees imposed pursuant to in the amount of $2.14 X',.4,335 S.F. or, $9,276.90 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/First American Bank/Terry Ross Check No. 178630 } Name on the check Telephone 861-7372 Funding Residential By Dr. Doris. Wilson'. ; Superintendent V Fee collected /exempted by -Espe Lara ' , Payment Recd $0.00; $9,276.90 Over/Under .: Signature » NOTICE: Pursuant to Govemment,Code Section 66020(d)(1); this will serve to notify you that the 90-day approval period in.which you may protest thewfees or 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 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 03/29/2004 22:26 6195163388 CONCORDE PAGE 01 CONC0RD•1✓iCONSU�LTING G -ROUP, INC. 4 ENGINEE ERING & CONSTR'UC'I'ION MANAGEMENT - 3505 CAMINO DEI; RIO'SOU'I'H, #.350 + SAN DIEGO, CA 92408 " PH: (619)'516-3377 FAX: (6 19) 5.16-3.388' MEMORANDUM/FAX COVER SHEET ,f TO: r•ROM: GARY KRIIP11 COMPANY: DATE; �• CITY OF LA QUINTA 03/30/04 FAX NUM ER! TOTAL NO. Or PA -;FS INCLOWNG COVER: 760/77'7-7011 1 PHONE N MBER: SGNUr R'S REFERENCE NUMAFR: YOUR REFERRNCF., NUMBER: RE: GARCIA RESIDENCE ` 57995 S VALLEY LANE " y X URGE 7.' X FOR REVIEW X PLEASE COMMENT X PLE,ISE REPLY D PLEASE RECYCLE notes/C(onuncnts . GARY: THIS N TE IS TO CONFIRM THAT FOLLOWING THE COMPLETION OF ANCHOR'BOLT HOLD OWNS, TI -IE FRAMING FOR THE REFF_FFNCED PROJECT IS IN. GENERAL CONFORMANCE WITH CONSTRUCTION DOCUMENTS ANT) DESIGN INTENT. " PLEASE CALL IF YOU HAVE ANY QUESTIONS . KRIPAN ARAYANAN 04►� tl:• <'icrf 1 c f JON TANDY .-�_.. 78-194 Elenbrook Ct. Palm Desert, CA 92211 �> Office (760) 772-7192 ' SPEC I AL INSPECTIONFak (760) 772-7193 Pager (760) 776-3338 REGISTEREMNSPECTOR'S WEEKLY REPORT ION r ❑ REINFORCED CONCRETE TRUCT. STEEL ASSEMBLY ❑ POST TENSIONED CONCRETE ASPHALT 'REINFORCED MASONRY ❑ FIRE PROOFING ❑ r,PiGD 1❑/OTHER q�-0MED JOB LOCATION u -N 0e t1e C� LA- tOo `��^ I` e®�} REPORT SEQUENCE NO. TYPE OF TWdC7ilRE �� IDESCRIPTION PERMITNO. DATES g. , DAY OF WEEK MATERIAL A'16 /� ` ILL ARCHITjCj T� ��.{J�����'p�- ` I SpPIEI T -.) I, HRS. CHARGED 0 -7 o�O S M A0• ENGINFjrR `coe�� ASSISTANTS HAS.CHARGED -"D TEINSPECTION CONTRACTOR-�{I��- —c�s5 --�,-fL/- C:ONTRACSUBTOR._...... UJA%-�- �` S • (p � � 7c � � LS � � N� L.. _ RIC st •S �ol�(0 3 LS wecee_ u l --(v (off �-Os e 1 e -h2. -J A +Jv ALAAAA eA x t COPY SENT TO CLIENT ❑ CONTIN ON NEXT PAGE ❑ PAGE OF CERTIFICATION OF COMPLIANCE dHEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MV KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE NOTED. I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED PLANS. SPECIFICATIONS. AND APPLICABLE SECTIONS OF THE GOVERNING BUILDING LAWS. DIGN TURE OF REGIST� S P ECJO� DATES OF REPORT REGISTER NUMBER ` REGISTERED INSPECTOR'S WEEKLY REPORT I JON TANDY 78-194 Elenbrook Ct. Palm Desert, CA 92211 Office (760) 772-7192 Fax (760) 772-7193 Pager (760) 776-3338 TYPE OF INSPECTION PERFORMED5 O REINFORCED CONCRETE O STRUCT. STEEL ASSEMBLY ❑ POST TENSIONED CONCRETE O ASPHALT ❑ REINFORCED_ MASONRY O FIRE PROOFING ❑ 4; O SER - V� JOB LOCATION`5(I ,._ ` �eq "` L-A �V C ` REPORT SEQUENCE NO. TYPE S E R15 � , X �� PERMIT NO. DITELDc10 DAY OF WEEK MATERIAL DESCRIPTION /A �� of �� A ITE INSPEOR_ HRS. CHARGED ENGINEE/r " ASSISTANTS HRS. CHARGED INSPECTION DATE GENERAL�C SUB CONTRACTOR (•tom ��. CONTRACTOR � O I i� S'c w � e. X455 �c,�c► t .� c� C-��C..s' �u� X— COPY SENT TO CLIENT O CON NUED N NE -XT PAGE O PAGE y OF CERTIFICATION OF COMPLIANCE I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MY KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE NOTED. I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED PLANS. SPECIFICATIONS. AND APPLICABLE SECTIONS OF THE GOVERNING BUILDING LAWS. SIG ATURE OF REGISTERED IN CT 0-3 DATE OF .RE RT REGISTER NUMBER no MMMEM-EMMIMI MINE 'M Imm ..Mom mmmmmlml�m :MiRm EMEMMIMI, m MRM EMEMMIMI * - 0