0312-274 (SFD)LICE NSED'CONTRACTOR DECLARATION
I hareby 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 # a. Lic. Class Exp. Date
-746198 i IDC10M.
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:
( ) 1, 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.
(,y') 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 MATE FUND Policy No. 046-0) 0002.T1-02
(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 anyf manner so as to become subject to the
workers' compensation laws of California, and agree that if I should become
subject to.the workers' compensatA provisions 6f Section-370.&of the Labor
Code, I shal.fort�wi h comply with those prons''�-"'�^
Date: Of Applicant
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 Safetyr•
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.
v
I certify that I have read this application and state that the above information is
correct. I agree to comply wit all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter uponY
the above-mentioned property,for inspection.purposes.
Signature (Owner/Agent) Date M �i
PERMIT k
BUILDING PERMIT��_s,� -
DATE VALUATION" t ` jl *�� LOT . 1 TRACT 1pLK 62
';;♦
�JOB
,
SITE
ADDRESS:4.—mAVbr...ed:U)A',,,VF-1,A.ShC0
APN `i'74.^174-01.1.
OWNER
CONTRACTOR /�DESIGNER /ENGINEER
am-91p.7r. D 110pG,
A XW(120 7.RJ.dlJN
79.02.5 VIA SANK Cz "�.A,
78.074 CALM CADIZ,
1A QuINTA. CA. 92253
92253 ,
TA QT;lWTA CA 912253
-4832 MILO, 6,146
1 1
A
USE OF PERMIT Y i,�
SI!�CiT 1vA 1 ''Y,T3lnll�F.j.st
1.936 SF SFT): PLRMIT DOM NOT 11,1CL9J &-PQOL, SPA ORBLOCK
WALLS, A;4I' .I�.l3t?t,TE PiERI1�MA14D 114�r�ECTION 1: RE i.I,IRES 3Y
laUBLIC'WOR�:S DEPT T FOR 1DIi117OTUV"APP IRQA.CH.2001
t
TRACT C014STRUC: IO14 1,936,00 OF
;
gAPtA01VCAR00RT 447.00 SF
ENlr'I'.>iM'€' D COST OF CLWaffR.1,9=0iNT
1131886100
TERM, f 5711 SMIMARY
s
CaNSTI3UC'1'IO N FEE 101.000.418"000 26881$0
ti
PLAN CHECK FRE 101-.000-439-318 $562.08
I P
FER. DEPOSIT 101.000-439-318 -$2g0m
MECHANICAL FLP; 101-000-421-000 $211.00
�'-
ELECTRICA.Is FEE 101.000-420.000 1125.20
i
P-L17Pt{lklING FIFE 101-000-419.000 $1750.00
S'TRONO MOTION PITE - R981D 101.000 241-000 $1.1.34
0Fl 0fl-Xi IfFly, I W -000-42:3-0010 PS.00
13E1lEI.e PER IMPACT F-Eg WOOD
PriECISE PLAN 101-.000-441-345 $IOf1.00
t.
WBTOII . £y€`) `RUC'!i(3N AIM PlAW CMCM
$4,061.17
RRRy PAID i?i .9
4250,00
VANI.'WS
222004
CITY OF LA QUINTA
FINANCE DEPT.
RECEIPT
DATE j
BY %
DATE FINALED
INSPEC R
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
_
-
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
_ d
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
Gas Piping
PLUMBING APPROVALS
Waste Lines
Gas Test
Electric Final
Heater Final
Water Piping
_
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
- C/
Encapsulation
Gas Piping
_
�--.
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole Q �j
Underground Conduit
Rough Wiring
Lt,ln,yoltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
GY.1.
Smoke Detectors
Temp. Use of Power -
Final
Utility Notice (Perm) d�
COMMENTS:
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 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:
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 1,936 S.F. or $4,143.04 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/Palm Desert National Bank - Rick Morris Check No. 087942
Name on the check Telephone 760/564.4832
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected
Signature e
Payment Recd
'$4,143.04
$0.00
Over/Under
NOTICE: Pursuant to Government Code Section 66020(d)(1), this will to notify you that the 9D -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 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, whir is earlier.
NOTICE: This Document NOT VALID if Duplicated'
Embossed Original - Building Department/Applicant Copy - Applicant/Receipt Copy - Accounting
CERTIFICATE OF COMPLIANCE
Desert Sands Unified School District
�o
47950 Dune Palms Road
4scff
Q BERMUDA DUNES r
Date
1/20/04
La Quinta, CA 92253
00 RANCHO MIRAGE b
�+ INDIAN WELLS
No.
25379
(760) 771-8515
`�, PALM �y
.QINDIO
y�
0
Owner
Sunshine Development
APN #
774-174-011
Address
79-025 Via San Clara
Jurisdiction
La Quinta '
City
La Quinta Zip 92253
Permit #
0312-274
Tract #
BLK 62
Study Area
Type
Single Family Residence
No. of Units
1
Lot # No. Street
S.F. Lot # No.:
Street S.F.
Unit 1 16
51960 Avenida�Velasco 1936 Unit 6,
r.
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 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:
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 1,936 S.F. or $4,143.04 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/Palm Desert National Bank - Rick Morris Check No. 087942
Name on the check Telephone 760/564.4832
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected
Signature e
Payment Recd
'$4,143.04
$0.00
Over/Under
NOTICE: Pursuant to Government Code Section 66020(d)(1), this will to notify you that the 9D -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 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, whir is earlier.
NOTICE: This Document NOT VALID if Duplicated'
Embossed Original - Building Department/Applicant Copy - Applicant/Receipt Copy - Accounting
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Certificate of Occupancy
4
Building &Safety Department
This Certificate is issued pursuant to the requirements of Section 109 of the California Building
Code, certifying that, at the time of issuance, this structure was in compliance with the
provisions of the Building Code and the various ordinances of the City regulating building
construction and/or use.
Use classification: SFD
Occupancy Group: R3
BUILDING ADDRESS: 51-960 AVENIDA VELASCO
Type of Construction: VN
Owner of Building: SUNSHINE DEVELOPMENT
Building Official
Building Permit No.: 0312-274
Land Use Zone RC
Address: 79-025 VIA'SM CLARA
City, ST, ZIP -.'LA QUINTA CA 92253
By: KIRK KIRKLAND
Date: 5-25-04 '
POST IN A CONSPICUOUS PLACE