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0310-296 (SFD)LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chaoter 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 41=9742 101s I Ii. Pate -031 Signature of Contractor, l_36__��_, 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 Siqnature-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 providba-for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. (AA)� I have and will maintain workers' compensation insurance, as required by Secfion 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 ,'3�T.�1'! L FUND Policy No. 174056.03 (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 t�ose ° rovisions. 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 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 pursuantto— anypermit issued as a result of this applicaton agrees to, & shall, indemnity- & hold harmless the City of La Quinta, its officers, agents and employee"s.+ 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 propert..far�I spection purposes. Signature (Owner/Agent) _-��-^���--� Date �ri "�'i�-► BUILDING PER PERMIT# (.Y3iB}-29 DATE VALUATION LOT. TRACT 12 :BLK 292 JOB SITE ADDRESS 7-710 CALL SCJ ���uA. APN 7 74-252-012 OWNER CONTRACTOR / DESIGNER / ENGINEER E, 0, DA MSf?N 13I,.WIDSON 53-815 AWALIJr3.MAIM.0 53.87;3 A.V9?,M. .tAMAi')n,0 LA QZ7M, A CA 92253 SQA Qtt1NFTA C.A. 922533 CY60Y171 3362? C�.U# 5954 USE OF PERMIT Sim "J1FJ*n'11YDWLLWGr 1546 Sly. SF15 PPAPA1T. DOES NOT 3LYE LOCK WAL 1,, POOiAPA .11L DRlt/ f:WAY .OPROAC"E1 T!tA.CT CC,*N9TRUCTI0i4 9F PORC1•, TATIO, 15.:.00 Sx? 0ARA.f1FJV-.PJ10RT 521.00 Sia VSd`.IPJ!U*nM COWOF CO.1+7!<"fRU( OH 36.194.30. (*ON1TRUCTIONFKF .10.1-000-418"000 2tc1b,9t) PLAN CHFIC ( FEE 1014)00-439-318 ;$5"30.10 Fa DR -POSIT 4250.08 M1Cr1 "ICAL ►Eta $59.oa E.W.T1t.1CrAL FLE 701.000420.000 $113,03 PLUM 1i.1?il•"FFEZ 141-000419-000 $118.00 STRaN0 MOTION F'9E - RUID 101 y000-241.000 $9,62 a RAD I N Q Fr1f:1>~a1-o"'Y0I423-00© $15.00 DEVELOPER IMPACT FUE PRECISE PLAN 101-000-441-345 �ir9i1.� M. -TOTAL C0'ti9:-RUC1..10MANffT:,LAN' CHECK USS PRE-11AYD "M -$230.00 7. f W0T.L ;SEM' :XYYEN D`UE N'0W DEC 01 29[3 x'3,:1.1 S.7?s RECEIPT DA1TE,// J( BY DAT FINALED/// INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs - -s(% Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck Exhaust Fans O.K to Wrap Q F.A.U. Framing _ — Q Compressor Insulation _ Vents Fireplace P.L. Grills Fireplace T.O. Fans 8 Controls Party Wall Insulation Condensate Lines Party Wali Firewall Exterior Lath fJ�' Drvwall - Int. Lath APPROVALS BLOCKWALL APPROVALS Set Backs Footings Bond Beam Final Steel Electric Bond Main Drain Approval to Cover Equipment Location Underground Electric Underground Piba. Test POOLS - SPAS Final Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines p 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 p v Gas Test Appliances Final COMMENTS: Final Utility Notice (Gas) fJ�' ELECTRICAL APPROVALS Temp. Power Pole - O f Underground Conduit Rough Wiring Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power _ �v Final Utility Notice (Perm) 37 7 7-a 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 1,546 S.F. or. $3,308.44 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 - Erick Davidson Check No. 087832 Name on the check Telephone 760/771-3362 Funding Residential By Dr. Doris Wilson Superintendent Fee collected /exempt9d by har n McGi .. Payment Recd $3.308.44 Over/Under Signature NOTICE: Pursuant to Government Code Section 020(d)(1), this will se 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 CERTIFICATE OF COMPLIANCE Desert Sands Unified School District o��o 47950 Dune Palms Road z BERMUDA DUNESCn r �� Date 12/1/03 La Quinta, CA 92253 � RANCHO No. ' 25221 (760) 771-8515 �� PALM DESERT V y LAINTA � �QINDNDIO O Owner Erick Davidson APN # 774-252-012 Address 53-875 Avenida Madero Jurisdiction La Quinta City La Quinta Zip 92253 Permit # 0310-296 Tract # BLK 292 Study Area Type Single Family Residence No. of Units 1 f Lot # No. Street S.F. Lot # . No. Street S.F. Unit 1 12 77710 Calle Temecula 1'546 Unit 6 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 1,546 S.F. or. $3,308.44 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 - Erick Davidson Check No. 087832 Name on the check Telephone 760/771-3362 Funding Residential By Dr. Doris Wilson Superintendent Fee collected /exempt9d by har n McGi .. Payment Recd $3.308.44 Over/Under Signature NOTICE: Pursuant to Government Code Section 020(d)(1), this will se 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 CITY OF LA QUINTA SUB-CONTRACTOR LIST"6UILDERr-9eX(Q-,'-- 3/Y1,03'JOB ADDRESS PERMIT NUMBER U-M: SMO Thisform shall be posted on the job with the Building _OWNER Inspection Card'at all times in•a conspicuous place. Only persons appearing on t is list or their employees are authorized to work on this job. Any, changes to this list must be approved by the Building Division prior to commencement of work. ' Failure to comply will result in a stoppage of work and/or the voidance of building permit. For each applicable trade, all information requested below must be completed by applicant. "On File" is not an acceptable response. Trade. Classification .:.:: /...... Contrac;or .... ....:......... ..:...:.::.::.:...........: ::: ...... ......State..Contractor. s.lacense::, ;:: ' Worke�s:.Com ......_...P ensation lrsurance ? ... _. Crt :: ss. Ucense V Company Name Classification License Number Exp. Date Carrier Name Policy Number Date (e.g. A, B, C-8) 9 (xxxxxx) 1 xx/xx/xx) (e. . State Fund, CalCom ) 9 P Format Varies) (xx/xx/xx) (xxxx) (xx/xx/xx) l G D_ AU l osd • V0 ? �fi 7 1031163 �1 �18s6-o3 /� , 0 5 5 g.4-c4 CONCRETE.IC' 81 ': ':' 1 (1 .- ,\_ll� h FRAMINGlG:51:'<:.;.>s:ss: W / STRUGT;:::STEEL°IC;:51):; MASbNRY :(C,r291 PLUMBING:JC=361;<;`;>: tv :>°. S(�lJ� ��912��4 i , LO "���3��- s"l'dY S7 � 00 131 oY :F�XOTR Mad RO:.: F.:N:::1.::: ;3;,);.>:.:;::::.;:;::;::: 9�!%� "C' 39 &A 0123 �•��� S?ir?er �1/n�✓l �ftY� 7 �% 0 s�/-/8•G13 :'' E .T' ETAL; C 48 `` :: < sH E :.: .::..:;:.::�;.::.:;.::►::.: :: e C^ Z�t� C s 7 Yy 3 `1. g~/-a Y s�,-za '(v�ro '7- pa- / o Sit .i 13I Jo C( 4. D-AU l O c:Z N ' l'l� �%7 % iJ ti(T/ 7 / �. (0-3/-6.3-4- 0� GLAZING.IC`:=1`71'<`:>>'>>::>< LO01- INSULATIO.NIC-'`;<>:<>>`I / : ![ (� / r PA.INTINGs:(fs331 >:; :>.....?:> / t CERAMfCTILE(C.=..541.<?« ( l I r (1 .................................................. . 1 i LANDSC 'PI!.4 '27i z; : / I !! l l < r l Certificate of Occupan'cy 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. BUILDING ADDRESS: 77-710 CALLE TEMECULA Use classification: SFD Building Permit No 0310-296 Occupancy Group: R3 ' Type of Construction: VN Land Use Zone: RC Owner of Building: ERICK DAVIDSONAddress 53-875 AVENIDA MADERO City, ST, ZIP LA QUINTA CA 92253 By: KIRK KIRKLAND Date5-17-04 Building Off i al POST IN A CONSPICUOUS PLACE