9904-034 (AR)LICENSED CONTRACTOR DECLARATION
I he",by affirm under penalty of perjury that I am licensed under provisions of
Cf ap er 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
743867 N
Signature of Contractor
OWNER -BUILDER DECEyiARATION
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 m. 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 Policy No.
FUND 1500131911W,3
(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 thole
Date: Applicant � • -
Warning: Failure to secure WV a s' Compensation co rage is unlawful and
shall subject an employer to- � final 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 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 ford spection purposes
r
Signature (Owner/Agent) /' -- ' Date
BUILDING PERMIT PERMIT#
DATE 416/94 VALUATION 505,258.30 LOT 162 TRACT LX -15
JOB SITE ADDRESS 78^705 AV.VNLA A 71 ORMS
APN 769-144-0()5
OWNER
CONTRACTOR / DESIGNER / ENGINEER
p i
AVORIM DEVla O.PMENT, TNC:
NVORLD DEA ELOPMEN` INC
Ptd BOX 13287
POBOX ,13287
PALA/i DRSEWir CA 92255
PALM DESEK17 CA. 92255
(760)771-5571 C BL#! 5028
USE OF PERMIT
1CF:11:1i:P1'1'1AL ADD i°1C.1i'4
SAUPPf s4MENNAL TO PEWIT 90812.068, ADDING 291 S_r. 0.041V"1i v`C
A.idEATOHCAJIS13l.tNVEK+CO.hlw,CRU T:10N,
A .1
APR 0 61999
*war ADD( i 1� T 281. 0 5}
�I
z
0—LA QUIINT
�
i
T11 e� n� a` a �r'� d�
' X%T11Wo.E��a��i{i'i:+..r1 T 0V ACML 4 S��A.�e.��rn S�.OIN
A11.1,20011,0n
PERKIT !tiER 53.iIV8MAR
PLkN Ctd'3f_ , l+:L"•ks 3U1�UUU-431.3!23 � t.i.f.
€';f)tf8t'i`RUM!0N17FE, 1.00(WllR4)00 Q1?I,ila)
NMECDANI X'A1 fer33 101-000-421-01M, $211.
.1rlttt TW VEE 101.000-420.000 $24,84
?f:llfbfR.lttiiCt$33.0
>r IFRA. M� CTURP r1M,' 22540443-342 t.
ART IN 3?s#13LiC:1?I;, ACES - [z68M 701-i°r011-:255-C(( 0 $38.15
C� Ifs-1c.t7 Af,. t"(IAES"i"1t 1.tC`9`ifapf Af�i.r 111, AN CHIl',L'K
$744,49
LESS PXF-PAM MIS
$+0.(I'.)
"3'MAL £'N..ifd'1Uff F UES DUENOW
S744.4981
RECEIPT
DATE
BY Ir''V
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
16
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 j -
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final y I
POOLS - SPAS
BLOCKWALL APPROVALS
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 4—
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
COMMENTS:
Final
Utility Notice (Gas) er
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) er
r
d_?
Notice: .
Document Cannot Be Duplicated
Desert Sands Unified School District
47-950 Dune Palms Road
La Quinta, CA 92253
760-771-8515
CERTIFICATE OF COMPLIANCE
Date 4/6/99' APN # 769-144-005
No. -18553 Jurisdiction La Quinta
Owner NameWorld Development Permit #
No.78705 Street Avenida La Torres 'Log #
City La Quinta zip 92253 Study Area
Tract # Lot # Square Footage 281
Type of Development New Residential Addition 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, residentialadditions 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
4
This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of, X r.
1.93 X 281 or $ 542.33 the property listed above and that building Q
permits and/or Certificates of Occupancy for this square footage in .this proposed project may now be issued ,
Fees Paid By ccNalley Independent Bank/Scott Stokes Telephone
Name on the check
By . Dr. Doris Wilson
Superintendent
Fee collected /exempted by Adriana Gauto Payment Received $542.33
Check No. 192483
Signature
NOTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1996) this 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 sssued or on which they are paid to the District(s) or to another public entity authorized to
collect them on the District('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
H