0101-207 (SFD)�fiirm'
LICENSED CONTRACTOR DECLARATION
I hereby 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
,�� t.
Date '/� �f;r� Signature of Contractor—
OWNER-BUILDER
ontractor 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 --37.00 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.
EXEMPT
(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 tt t lf'I should become
subject to the workers' compensation provisions•of Section"3700 of the Labor
Code; I hill fort with comply with those `p ovi°gions 17
Date: �%�` u �• Applicant ) Y
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 SafetyZ i
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 t
work is not commenced within 180 days from date of issuance of such 1
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,upoh
the above-mentioned property for, nsperction purposes.
Signafure•�(Owner/Agent)'- YtJ i�,. Date
BUILDING PERMIT PERMIT#
DATE ! VALUATION LOT _ _ .. �i�BDi� • ice% TRACT
'. 1,:V X 22 i,� 2914.7^1
JOB SITE �._.._-_._._. ---a-
APN
ADDRESS
OWNER -
CONTRACTOR/DESIGNER/EN INEER
1S"uC. ATPA1tTMSHfi3iC,iiAC;nNe2"!'�UM1,01T19
15.161 20VII-IMMUB
1'C BOX 366
LAS QiIF3�P'l'A CA 92233
1.. QUINTA Cid. 922n3
(160)564.4832 0314 3237
USE OF PERMIT
31•'�;►•T��it.Alll'i' L�t):f.� �'C3Y' i�dCl:,6fI�M kf1�GIC �'Ak�r.J�'�.yCD3.}�P.A OI�,�►.PPPtQ.dtC"ti
1)R1YKU4':f3.Y-.0`'t>FUt'.P1:9',ANCENWTH ALF., P9151f' AL STATE F,AWKIINCLUDENG
THE, M15AIIJOERF! D SP CIVS ACT ✓ F 1973 (W U.S.C, §%1531,14T
PORCH>Q''A` IO 991.0 Sly
O.' RA.GIUCt4ARPORT t 14,543.20
ErVIUM ,la's[' OF CORM. MCIT(ON
413, i i99120
PERAM M. GARY
CONSTRUCTION FEE' 101.000-416.300 S1, -ng 50
PLAN CHECK FEE $1,407.1
FIE93VE0311' 411OCt0.40
MrXIIIIA141M PRE, fD 1.01143 X12 x M°��Q $$56.00
ELEC T 1ICA"L FEE 101.0004.20.000 $2.10.40
PY.'JI BIWO ,ice 101.006-419-000 $243.1%
MONO A OTIt.)IN r(ft -1#FSW 101-000-)M4000 241
MADYNO M 101-000-423-000 $20.00
0XIVEL31'M1MPAC'1" ti"F: 81, ,48
ART 04 PUBLIC P!Ou'C':ES - Id:i3sSIE 701-000-255.000
!n1
1't' MS DUE NOWLAPR
P
2 4 2001
CITY F LA QUINTA
RE EIPT FI PR Y F "'t f / BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Slab Grade
Steel
Roof Deck_
.K.
Oto Wrap ��J�l���/.
Framing
Insulation
5/a ( ,
G� o�A1
_
���—�
�/d b _ ! _
_ j�!
/
Ducts
Return Air
Combustion Air
Exhaust Fans
F.A.U.
Compressor
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
_
Final
BLOCKWALL APPROVALS
Final
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Final
Approval to Cover
-Equipment Location
:.Underground Electric
Underground Plbg. Test
Gas Piping
PLUMBING APPROVAL
Gas Test
Electric Final
Waste Lines
_
�Q_
Heater Final
Plumbing Final
Water Piping
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
����/p�
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
/
r
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduft
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) �%
Coachella Valley Un'— I School District
P.O. Box 847, The& inal, CA 92274
(760) 399-5117, Ext. 235
Project Name:
Owner's Name
Project Addres
Project Descril
APN:
This Box For District Use On[
DEVELOPER FEES PAID
AREA:
AMOUNT: RCFT V.
CK M. CASH:
INITIALS: DATE: '
CERTIFICATE OF COMPLIANCE
(California Education Code 1.7620)
Tract��" Lot #'s• G0111
Type of Development:Residential XX ommercial Industrial
To pare Fee of -Building Area: 4973
Certification of Applicant/Owners: The person signing certifies that the above information is correct and makes this statement
tinder penalty of perjury and fdrther represents that he/she is authorized to sign on b half o owner/developer.
Dated: �" lJ Signature:
*,►,►,r*,►,r*,►west,rr,twwwr,tr,►www,►rsr+r,►wr,tsi• r w�,►' •�t wft**r,e,rt,r,r,rr,►+►rw•
SCHOOL DISTRICT'S REQUIREMENTS FOR THE ABO-ft4ROJECT HAVE BEEN OR WELL BE SATISFIED IN
ACCORDANCE WITH ONE OF THE FOLLOWING: (CIRCLE ONE)
Education Code Gov. Code Project Agreement Existing Not Subject to Fee
17620 65995 Approval Prior to 1/1/87 Requirement
Note:
Number of Sq.Ft. 4973
Amount per Sq.Ft. $ 3.34
Amount Collected $ i fi,f(14 R9
Building Permit Application Completed: Yes/No
By: Foch "Tut" Pensis Assistant Superintendent Administrative Services
Administrator in Charge
Certificate issued by: Marcel a Valdez Signature:
Facilities Clerk
Section 66020 of the Government Code asserted by Assembly•BU13081, effective January 1, 1997, requires that this District provide (If —& written notice to
the project appellant. at the time of payment of school fes, mitigation payment or other exactions ("Fees"), of the 90 -day period to protest the imposition of
these Fees and (2) the amount of the fees. Therefore, in accordance with section 66020 of the Government code and other applicable law, this Notice shall
serve to advise you that the 90 -day protest period In regard to such Fees or the validity thereof, comments with the payment of the fes or performance of
any other requirements as described in section 66020 of the Government code. Additionally, the amount of the fees Imposed Is as herein set forth, whether
payable at this time or in whole or in part prior to Issuance of a Certificate of Occupancy. As In the latter, the 90 days starts on the date hereof. This
Certificate of Compliance is valid for thirty (30) days from the date of Issuance. Extension wUl be granted only for good cause, as determined by the School
District, and up to three (3) such extensions may be granted At such time as this Certificate expires, if a building permit has not been Issued for the project
that is the subject of this Certificate, the owner will be reimbursed all fes that were paid to obtain this Certificate of Compliance
Rev. 09/27/99
V
Certificate of Occupancy
City of LaQuinta
Building and SafetyDepartment �MoF ti
This Certificate issued pursuant to the requirements of Section 109 of the Uniform Building Code,
certifying that, at the time of issuance, this structure was in compliance with the various ordinances
of the City regulating building construction or use. For the following:
BUILDING ADDRESS: 81-085 SHINN.EC®CK HILLS
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0101-207
i
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL
Owner of Building: WEISKOPF PARTNERS Address: 55-161 SOUTHERN HILLS
City: LA QUINTA„ CA., 92253
By: BILL GORDON
Date: 3/7/02
Building Official
POST IN A CONSPICUOUS PLACE