0303-007 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affiell'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 forceand.effect.
License # ;fir • Lic. Class Exp. 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 licensfi�dp
contractors to construct the project (Sec. 7044, Business & Professi.o'fiials
Code).
() I am exempt under Section , B&P.C. for' .. reason
Date ��i'r 0 _Signature of Owner Ar l :✓
4l-:':_��
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 Policy No.
(This section need not be completed if the permit valuation is for $100.00 or less)
( )/!-,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 Wshould become
subject to the workers' compensatiovrov sions of Sectidn4700 of the Labo
Code, I shall forthwith comply with t oseovisions.
Date: da '!tcA-'1`2 Applicant '�'y�
Warning: Failure to secure Workers' Compensa ion coverage is ,I lawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, it
addition to the.cost of compensation, damages as provided for in Section 3701
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safet,
for a permit subject to ' the conditions and restrictions set forth on hi
application.
1. Each person upon whose behalf this application is made & each person a
whose request and.for whose benefit'work is performed under,or pursuant b
any permit issued as a result of this applicaton agrees to, & shall, indemnif,
& hold harmless the City of La Quinta, its officers, agents grid employees
2. Any pefmit issued as a result of this application becomes "null'and void
work is not commenced within 180 days from date of issuance of sucl
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 i;
correct. I agreeo=comply with all City3and State lawVfelating to the building
construction, and hereby authorize representatives�gf this City to enter upol
the above-mentioned property f. r inspection purposes 7
f
Signature (Owner/Agent) Date` '
PERMIT '
BUILDING PERMIT
03 .7
DATE VALUATION LOT TRACT.
9111, 7'_V2 A 0 1 1 Y 13LK 228 U -T,
JOB SITE
APN
ADDRESS -Q4°� t' DA Mm—co
"174-125-009
OWNER
CONTRACTOR / DESIGNER / EN 1NEER
ROPM1+�10 S
R0PE2. MOP.RV91 OWYM 33'C7ZMER
74-800 SHERYLAVE 0:11-1
PALM MESE''R`l: P -'A ,,2260
MAIMFt RA r . C!`Y 92260
Y
(9.49)376-2099 CBT.*
USE OF PERMIT (,
b�7.iY1.:1L�`r �a1��4r.r J• dJ V'D �f.aMLDYE:�'
IM S. V. SFA PERMIT I)OF'.S NO3' IMCLUD'? 0LOOCX_ WALI, POOL M
TRAM CONSTRUCTION TION PIF
f
PORCHPA-TIO 21, Ja'i 3F
t A41 C1 R�R't 447.00 8F
F(MA .. COS'1" OF C:ONSMUCITON
; 1..` 2,7'W.,40
�y� )�p`y*P �
l" 'E R�.VdT -3 .✓rfs4:iSUMMARY
COAISTRUCT ION ITE1 103.000.418.000
PI.AN CHECK FEE 101-000-•437-319
FEU DEPOSIT 1€31.000.439.310 42S0100
M-HANfit.'AL 101 -000 -421 -WO $50.00
EIrEMICAL FU 101-000,420.000 $124.26
PLUMB l 40 FEE 101.-000.419-000 3148.00
=0140140TION ME - RESID 10:1-000.241.000 $11,23
ORADYNO ice.' E 101-0013-42." _000 $1:5.00
DEVELOPER IPAPACT FEE
l�Ii Glsa'I~ PL A4w 101-000-441-343 $10D.00
c,M-Tt'�W�f31,, CgR`�#'dd:%�T, 01Z AMN PLAN C;fl7�„,t.'°�
$4,1.2ri}.I'I
:x.1533 PRE -PAM MS
425111W
TOTALMMMT T VVY;8 3ff1I.If,; N 01%,
)Eat
APR 2 8 2003 '
.
CITY OF LA QUINTA
FINANCE DEPT.
RECEIPT
DATE p�_
rBY
DATE FINALED
INSPE O%®�
}.er
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 DeckL
J11i
Exhaust Fans
O.K. to Wrap
i F.A.U.
Framing
_
Compressor
Insulation
Fireplace P.L.
_
_� ��
Vents
j Grills
Fireplace T.O.
I Fans & Controls
Party Wali Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
_ _
Final
Final I ����3
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
Gas Test
Electric Final
Waste Lines
_
%`_03
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
S��G� .
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:
_ a
CERTIFICATE OF COMPLIANCE J FIFZ
Desert Sands Unified School District z4� 0
47950 Dune Palms•Road
¢ BERMUDA DUNES
Date 4/28/03 La Quinta, CA 92253 U� C
RANCHO MIRAGE
INDIAN WELLS
No. (760) 771-8515 P , y
LAQUINTA
• • I0-�INDIO
Owner Roper Morris APN # 774-125-009
Address. 74-800 Sheryl Ave #11-1 Jurisdiction La Quinta
City Palm Desert Zip 92260 Permit # 0303-007
Tract # BLK228 U-22 Study Area
Type Single Family Residence No. of Units 1
Lot # ,No. Street S.F. Lot #, No. Street S.F.
Unit 1 11 53696 Avenida Velasco 1909 Unit 6
Unit 2 Unit 7
Unit 3 Unit 8
Unit 4 Unit 9
Unit 5. Unit 10
Comments Both Cert #24369 and 24370 are used for CC #115327
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 (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 1,909 S.F. or $4,085.26 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/South Bay Bank - Roper Morris Check No. 115327
Name on the check Telephone 949/378-2099 .
r Funding :Residential
By Dr. Doris Wilson
Superintendent '
Fee collected /exempted by Sharon McGilvrey $4,085.26 0.00
Payment. Recd Over/Under
Signature
NOTICE: Pursuant to Government Code Section 66020(d)( , his will serve to notify you that the 90 -day approval period in which you may protest the fees or
other payment identified above will begin to run from the date on which the building or installation permit for this project is issued, or from the date on which
those amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier. .
NOTICE: This Document NOT VALID if Duplicated
Embossed Original - Building Department/Applicant Copy -Applicant/Receipt Copy - Accounting
FROM :ERIKA MORRIS FAX NO.-: Sep. 30 2003 08:10AM P1,
8 OF•L,A QUINTA
Vol SAFETY DEPARTMENT
777-7012
C ON •RE`QUI ST LINE
�e 77'4153-'`
S
0 or RUB II;IIT�R
Con C10r----7M3-007
Permit Number—
POST
umberPOST ON JOIE IN CONSPICUOUS �PL�ApgCE
INSPECTOR MU����ACES
1O�t��� � . . 1' DUES'lgLyf I vC�±
BLOCK WALK, POOL OR DRIVEWAY
APPROACH
- TYPE OF INSPECTION DATE IPSP.
TEMPORARY POWER _
SETBACKS G'
U/G PLUMBING / WASTES
U/G ELECTRICAL/ GROUNDING
FOOTINGS /STFEL Poo�._
CONCRETE SLAB.,.
DO NOT POUR CONCRETE UNTIL ABOVE SIGNED _
OF NAIL I PRE
OKAY TO WRAP . _^ —
FRAMING COMBINATION
ROUGH ELECTRIC
- ROUGH PLUMBING
COVER NO WORK UNTIL ABOVE CIONED
INTERIOR GYP. I3D. (DRYWALL
EXTERIOR LATH
GAS TEST:
SEPTIC ABANDONMENT
SEWER CONNECTION
SEPTIC / GREASE INTERCEPTOR
MASONRY INSPECTION$
FOOTINGS / STEEL
BOND BEAM
POOL / SPA / WATER FEATURE INSPECTIONS
PRE•GUNITE / SETBACKS I—
TEMP. USE OF PERMANENT POWER
ELECTRICAL
PLUMBING'.—
MECHANICAL
LUMt11NG'MECHANICAL"
PUBLIC WORKS DEPARTMENT
COMMUNITY DEVELOPMENT DEPT.
FiNAI JOB COMPLETED
Certificate of OccupancyoTi
V,
T� Ir+maotnaD
INC
i
V.
oF 9 Building & Safety Department
This Certificate is issued pursuant to the requirements of Section 109 of the California Building
t
R
, 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
`a
construction and/or use.
r
,
BUILDING ADDRESS: 51=696 AVENIDA VELASCO
Use classification: SINGLE FAMILY DWELLING Building Permit No.: 0303-007
' i
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RC
v
Owner of Building: ROPER MORRIS Address: 74-800 SHERYL AVE. #11-1
i
. E
City, ST, ZIP: PALM DESERT, CA 92660
i
tt
_ By: KIRK KIRKLAND
'
Date: SEPTEMBER 23, 2003
E
5
- Building Official _
x
IF
11
r
POST IN A CONSPICUOUS PLACE