9812-859 (AR)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
FF- i1 Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
04 W Professionals Code, and my License is in full force and effect.
O n M License # Lic. Class Exp. Date
W i 64x26 B ASIS A 680MG
oZ t,- pDate' _// I Signature of Contractor
CD 0 -
J U C:) OWNER -BUILDER DECLARATION
W Lux r- I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
Z ( ) 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).
co () I am exempt under Section , B&P.C. for this reason
LO
N Date Signature of Owner
ON
0)CL z WORKER'S COMPENSATION DECLARATION
C) Cc I hereby affirm under penalty of perjury one of the following declarations:
LO O ( ) I have and will maintain a certificate of consent to self -insure for workers'
X W compensation, as provided for by Section 3700 of the Labor Code, for the
O J Q performance of the work for which this permit is issued.
C0 Q U (R) I have and will maintain workers' compensation insurance, as required by
O CJ Q Seciion 3700 of the Labor Code, for the performance of the work for which this
F- permit is issued. My workers' compensation insurance carrier & policy no. are:
� Z Cartier Policy No.
r,- CY ZENITH 2WIRAMAN
J(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 those provisions.
vDate/ r 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 Safety
for a permit subject to the conditions and restrictions set forth o4' his
application.
1. Each person upon whose behalf this application is made & each person at 3
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 for inspection purposes.
/Signature (Owner/Agent) `bate
BUILDING PERMIT PERMIT#
DATE VALUATIONLOT TRACT
S14: 1m ;, S6.85510
JOB SITE '
APN
ADDRESS 79-835
OWNER
CONTRACTOR / DESIGNER / ENGINEER
MA.RG.�RIM F S[NICf'OPI
''.'Al,l i�.''Z'!NI CC?tiSTRII ''Y'aCIN
79833 TANGELO
41905 BOARDWALK 1113
LA t UINI.A CA 92253
'ttv. DP SEW k C'.A. 922(g)
('7601779-9797 C111M 255
USE OF PERMIT
U-SIDEWTIIAL ML)D!'TTUN
CLISTON1 CON 9' WIC T SC'N WOOS].,
S].,
PERMIT FFE, S1./MAIMi Rt
FLAN CHECK. Va, S.5 S.
IS1E-[N�?t?-44�►/Si(1
101-000-421-000 J��.l•J
t:f..,l f:'1RICAL FEE 101-000.420.000 sx .ua
`TRONQ NICI CIC>N M- D • t2k,31I3 101-000.241-000 5.69
-,K!7R tC"� c�N aND ��. fry��� C�
' = LESSS r'RT.-PAID FEB
$19 ?7
SO 00
DEC 0 9 1998 Tt>:•ea►.Ir.PFUUMIT FE -EN OU 0, Itia0W
S18217
..'IT/%.'ITY 0 F U, C-4..
RECEIPT
DATE By
1 +
DATE FIN LED
INSPECTOR
w if
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
- O Cl
Ducts ,
Slab Grade
Return Air
_19--10-7
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
-( _
Compressor
Insulation
_LZ —`127 Zk5,C
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
2.22
Drywall - Int. Lath
zz - Z_
Final
Final
_ '
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 I
I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
71 - ro -
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)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G. F.1.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
Desert Sands Unified School District
47-950 Dune Palms Road
Notice: La Quinta, CA 92253
Document Cannot Be Duplicated 760-771-8515 ,
CERTIFICATE OF COMPLIANCE
Date 12/9/98 APN # 769-560-031
No. 18079 Jurisdiction La Quinta
Owner NameMargaret F. Sinicropi Permit #
No. 79-835 Street Tangelo Log #
City La Quinta zip 92253 Study Area
Tract # Lot # Square Footage 88
Type of Development Residential Addition No. of Units 1
Comments
88 sq. ft. closet addition.
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 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:
Residential Addition 500 Sq Feet or Less
EXEMPT
This certifies that school facility fees imposed pursuant to Government Code 53080 , in the amount of
0.00 X 88 or $ 0.00 the property listed above and that-.build.ing
permits and/or Certificates of Occupancy for this square footage in this proposed project -.may now be issued
Fees Paid By N/A - Valentine Construction .TAlephon 779.-9797
Name on the check +�k
By Dr. Doris Wilson ' .�
Superintendent+
Fee collected /exempted by Juanita Green Exempt $0.00 .
Check No. N/A
Signaturelr4��
NOTICE: Pursuant of Assembloiil 3081 (CHAP 549, STATS. 19961 this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified
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
November 24, 1998
f .
Mr. & Mrs. Anthony Sinicropi
79-835 Tangelo
La Quinta, CA 92253 {
Re: Architectural Request — The Citrus Course
Homeowners Association
Dear Mr. & Mrs. Simcropi,
The Architectural Control Committee for The Citrus Course Homeowners
Association. met again to review your plans for the addition of a laundry room.
After lengthy reconsideration, the committee has approved your plans with the
following conditions: i
,All plans must be submitted to the City of La Quinta
prior to construction.
Verify setbacks & permit requirements with the City
of La Quinta prior to construction.
Structure must be painted to match existing house trim.
Please feel free to call me if there is anything I may assist you with or if you have
any questions.
Sincerely,
r
Melissa Layton,
Community Association Manager for
The Citrus Course Homeowners Association
}
Professional Community Management / Desert Resort Management
Post Office Boz 4772 • Palm Desert, CA 92261-4772
•73-550 Alessandro, Suite 5 Palm�Desert, California • (760) 346-1161 FAX (760) 346-9918