9909-178 (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 „
`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
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:
Carrier 4 !` ^( V Policy No.
(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.
bate`. Applicant—.
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above infoPmation is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) ._` Date
BUILDING PERMIT PERMIT#
DATE VALUATION�>�iie�),. -. �i � ��,.i LOT TRACT
A A
JOB SITE' �;� L°�� E" a�r..�.�r� ��Px,ti2
APN
ADDRESS
OWNER
CONTRACTOR / DESIGNER / ENGINEER
R?Y A I ` TD
1`i19 S'l'l 1.11'14a1IT
171t) S'Pke.Nlf!�
USE OF PERMIT
SIEvOU,
a➢�� � fr'at�Y<�94i! Y (3f ;C?+',� PX+�`.Y' �h�Y_:5.35:�2 �:�..'' Jy�d: �i''s`F1�. ��yw i'�.±±s"S. ,
f4,.1K01'19!.'6"") t'Qi bf
6 «j'f WALL Ifto�Sl i �:
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,fi0`r.(iQl
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PtE08h PLAN B$
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Vf VELVIS OV 1141 N1*6 W,
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
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
_ ,�� rj
F.A.U.
Framing_
Insulation
' l
Compressor
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
C %
�' ✓� r C
Final
Final
POOLS - SPAS
BLOCKWALL
APPROVALS
steel
Set Backs
Footings
_ _ /
Electric Bond
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
[L
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
57
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final o•y
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole (� q
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G. F.I. i
Smoke Detectors
Temp. Use of Power
i
Final �+T�►
Utility Notice (Perm) Xjp
aki' �
T4tyl 4
Q
P.O. BOX 1504 APPLIC ON ONLY
Building / ' t 78-495 CALLE TAMPICO
Address 1 A � � . J L ASC 0 LA QUINTA, CALIFORNIA 92253
Mailing t
Address n tG S � ��
City ZipQ T
Contractor
City
ate Lic. city
&tCla sif. ��' �I L'lc. #
Arch., Engr.,
Designer
Address Tel.
BUILDING: TYPE'CONST. OOCCC.. GRP. �
A.P. Number "? -? 7; v- ( // i ` -s J a-
()0( 1 Legal Description ` O fn Q 111 G
Project Description S ' r. o
City IZip I State I
Lic. #
LICENSED CONTRACTOR'S, DECLARATION
I hereby affirm bat I a Iice(tsed under, provisiong,ofrChapter 9 (cgmmencing with Sec If
70001
of Division 3 f the us'ness and Professions Code, and my ((cense is in full force and
effect. (" h . �k'V' -
'QWNER-BUILDER DECLARATION
I hereby affirm that I am tempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permil 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 thealleged exemption. Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than rive 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 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
of 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'1 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 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
r] Copy is filed with the city. O 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 thg 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., It, 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 it work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information is correct.
r agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives sof this city to enter the above-
mentioned property for inspection purposes.
Signature of a0plicanl Date
Mailing Address
City, State, Zip
WHITE = FINANCE
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear %etback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOP"�
Issued by: Date Permit
Validated by:
AUG 2 7 '1999
Validation: ;� -- �^ •- A
YELLOW = APPLICANT
1 i )
PINK = BUILDING DIVISION I
Sq. Ft. 'fLf (f(r No.
Size 1 Stories
No. Dw.
Units
New ❑ Add O Alter ❑
Repair ❑ Demolition O
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
z - CC
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear %etback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOP"�
Issued by: Date Permit
Validated by:
AUG 2 7 '1999
Validation: ;� -- �^ •- A
YELLOW = APPLICANT
1 i )
PINK = BUILDING DIVISION I
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 11/19/99 APN # 773-173-032
No. 19627 Jurisdiction 'La Quinta
Owner NameDavid Miller Permit #9909-178
No., 51-825 Street Avenida Velasco Log #
City .La Quinta Zip 92253 Study Area
Tract # BLK61U5 Lot # 4 Square Footage 1421 y
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 thelamount of
1.93 • X 1,421 or $ 2,742.53 the property listed above and that building,—
Z
permits and/or Certificates of Occupancy for this square footage in this proposed project may, -now bei"ssued
Fees Paid By cc/Capital Bank of No. County -David Ross Miller Tel 760-967=0069
4
Name on the check , n
By Dr. Doris Wilson
Superintendent
Feecollected /exempted by Juanita Green Payment Received $2,742.53
Check No. 16022
Signature
[NOTICE: Pursuant of sembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90day approval period in which you may protest the fees or other payment identifiove will begin to ru m 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
llect them on the D' 'ct('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 DeptJApplicant Copy - Applicant/Receipt Copy - Accounting
11/15/1999 10:31 7609679394
NO'► -16.1811 11:I0M fRClli^CACTAI B��`�ESiATE
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PACIFICTRADES / PAGE 01
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DAVIp R=S NILIaaR. pp1RR2EA MAR KIS SOLE FWD >5lFU1AA11'!3
the real property in the* city of LA QMYTA, County at Riverside, $tato of mUfCraia,
described az
LOT ♦ Oretre or amn OAWnm A7 VJ11<.R Lh gbIll's'�, T� - Wo • S 116 Slit3Vidt
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state of callto s+ia
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main
peearaoaaslly eppe4ue:d
pe:rsaaally kncio to M@ for graved t:o me 04
the baets of saeislacto y svtdanee) to be
i6* persvn,S) Whose ng(s) is)a;'e subscribsd
to tine vithLa UWtrjjw= 04 sckumisdged to
me that hatete/that► oauemted. the some in
his/Mos/thait aUthsariaeod ear4eitY(iasl , Smd
thae by him/her/tbai AWSture(s) an the
tnetrumant the Pers a), or Um warnmy upon
behalf of rbicA s ts) acted, macuted
the instz=0At . - / -
!I4 TAX s�►1 51r°' SUM AS
C 1 COLLI R
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as
-(TUG area ser official notarial seal)
nnin e Vin W. F .
This form, is to, be used by GDD`staff for review of single family dwellings in .the RC (Cove
Residential) District, in order to determine the applicabitity of corripatibiky issues`'or• need
to require the filing of -Master Design Guidelines,by*the applicant. ,It shall be transmitted to
Building &Safety as your correction list. Please attach additional explanations as, necessary.
APPLICANT' Pacific 'Trades
s
PROJECT
ADDRESS: ' 51-825 Avenida Velasco
APN:. t 773-173.-032. ti.
LEGAL: LOT 4 BLOCK ° 61 UNIT S.C. @'V:L.Q::.
CK'D BY: • �"
BIN N0:'. 2 CASE .NO. 99 .1.19 CHEM -DATE:
Inform -the -assigned-Build ing-plan-checker-:upon'_y-our..assignment to this case. The CDD
Executive Secretary maintains a :log book -to _track -applications=and assign=case numbers:
REQUIRED ITEM _ _ Y-
N •
'
COMMENT/CORRECTION
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Case logged and number assigned
e '
Verify legal and APN,information
-
Consistent with MDG on file` las.applicable)'
MDG filing required (5 + filings since 9/3/98)
6o
Consistericy ....w-street/sur-rounding•area:-
Colors
Materials
'
Architecture '
-
L
OTHER REQUIREMENTS:
GA)_VL
The zoning code, architectural and landscaping manuals, and/or assigned inspector should
be consulted where uncertainties arise. The completed checklist shall be -maintained-in the
Building '& Safety ,address •file. v -
'. PLAN: S-1
ATTIC VENTILATION
1,929 SQ FT7 300 =t` 6.43 -SQ FT REQUIRED
r 8 VENTS / ,14" X 18"VENTS,(1.17 SQ;FT X:1.5 SQ FT) ,
X 1. 1-7 SQ FT X 1.5 SQ FT = 14.04 SQ FT` ;
=SS 50% VENTED AREA - 7.02 SQ FT"
;,TUAL NET TOTAL SHOWN 7.02 SQ FT