9906-213 (SFD)LICENSED CONTRACTOR DECLARATION
,.I .herely affirm 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
X 706110 0513V2,011
r
Wate C 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). , . •
( ) 1, 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.
u`l`Ta'3'Td41ii`'.`".yt.ffti'l�2vf_ff�' ' ' '._�fT;!s•0„i"1�^u:d9;i
(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.
trate: Applicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties andcivil fines up t6$1 00,000, 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 s
e condition• 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.l'have read this- application and state that the above information is
correct. Ilgree to comply with all City, and State laws:relating to the building
consyuction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes
Signature (Owner/Ageht"): /L �'F IIA.A Date ' f t r `°Ir
PERMIT #
BUILDING PERMIT_4
DATE #gJ2f)J.1"VALUATION 5+f;*36,9034.20 LOT TRACT
__JADDRESS JOB SITE 79-03.1 TOM F4AZIO Ll�tN�..��U
APN
OWNER
CONTRACTOR) /7�D�EgSIG•NyE�R /y ENGINEER
(�
4823 LAKE VVA" KtNGTk-)tit BLV
78-17.0 CALL .ES FADO 9200
R" -ND WA WAM
LA Qslt3u'I.A, CA. 92253
(70)777- 1611 C-F!°L 3751.
USE OF PERMIT ,
'ING.iL .9 PA:MILV `l..0 W .
wa`r,�;ti B • m %'ALLSK OR P001,
CUSTOM CIONSITi-fi;t`O'i014 ?,rty.06 SF
T•'%.�EGI:�L'k''A.id�f:3 d42,fit. Sp
• c 2�tCa�{dfiftl�l:il�K..i� l• yfh�.lf1P 'fil' .
�,n�ti��I�r'�N .'I.1) CIMI'M ti��' �,�N•S'T.RU :o 4.
,.� +"''06 903,20 '
�y 'pap yy� +�y.g3ir-g. A
K� �aE?SY`AF9 8 .�1 . �i.•wDiWiG'a!!?tI'aK�-
C"t�lt!':yl'l'4I.t1�;'1'i<Jid 1"FIs '6:E3!-t)L�-4•lt�•£k7t) $'N,4.�iD.Sli
`�,,'f rj'- j'
RIAN r„'afFrX 11"R, 14
FMI DEPOSrr 41.211,50-04
N41CHAWICAL FEE 7VV3°
f7.<f3UDUCAL Ef;K, 5400.09.
; + --••i.
;s?f,I 110k-0r*-419-0?6 $"µ ;ff att1
U.
;;1,1110=? C;107110N Va.. - IRLWD 10.; -000 241
L:j1�#3�)�l:l4l'�: �.r6�-8'i�Et•}••�d.�••�?�' �+``�t1.:N)
ART iN.PUBL,IC PLAC,`JH:S-•K&S.-W itj14-11?-25.5•tW
LESS I?R PAID FE, ES
-$1,250.00
°it'oT kL rEk 4; J)tif,-N
405.57M.��¢.7,.
rECEIPT,
DATE
BY/
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs ,2 -
Underground Ducts
Forms & Footings rte/
Slab Grade
Ducts
Return Air
Steel
Combustion Air
Roof Deck _
O.K to Wrap
Exhaust Fans
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath o c�
Drywall - Int. Lath �—
Final
Final
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 f
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
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring,�
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
�J
G� Lf�—
.sij6
wet oleo 0j _-,51
. 4 tsu�OdNG S S• 4� QUINTA
�E� ° Rrn�
?77`701 EPq +EIVr
•
CO7N REQUEST LI
777 71S3 �E
Contra VIRGIN C®
P*" I�ur , I
POST OAO j®®1� . `-�—
INSPECTOR MUST C®lySpICU
� ADDRESS SIGN ALL APDL. ®A8 IE PCE
79.031 TOMACES
SFD ' P'E'WIT ® ��ZIO L
SNOTI �
�'��I,S OR .P®®L ������ BI,®�It
TYPE °F I grow
FOUNDATION �, SKDATE
ETBAC
ROOF
- _
FOOTING STEEL
GdD SYSTEp�
GROUND PLUMBING ..;.,
PRE-GuN TE
DO NOT P OUR CONCRETE UNTIL ALL ABOVE HAS BEEN
CDfdCAETE SLAB
JOISTS 8, GIRDERS
SIO NEI
— —�
ELECTRICAL GROUND WORK
Z2
Mll 1164:i
D® NOT POUR CONCRETE UNTIL
ROUGH ELECTRIC
2 1.
ALL ABOVE HAS BEEN
SIGNED
ROUGH PLUMBING
� ROUGH GAS &GAS TEST
HEAnNa A/C
ROOF
BE
AP'
- _
O s'FRAMING
g
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGN D
DRYWALL INTERIOR
Z2
EXTERIOR LATH
POOL PRE PLASTER
L FENCE 8 GATE
SEPTIC TANK
_
FINALS
CI FrtT®�ee�
FINAL GAS TEST
HEATING - VC.
HOUSE NUMBERS
JOB COMPLETED
TEMP POWER
,
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO '
TURN ON UTILITIES OR OCCUPY BUILDING
P.O. BOX 1504 APPLICATION ONLY
Building/ 78-495 CALLE TAMPICO
Address ' n2 ( i r�iA l -A t a; n{ 7rLA QUINTA, CALIFORNIA 92253
I f,- L- _✓
Mailing
Address
City
Address
City
zjrate uc.
& Classif.
Arch., Engr
Designer
Address
p
Lic. #
0
M
Citny A I � IZIp,9002 IState I
j� J Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license Is In full force and
effect.
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for -the following
reason: (Sec. 7031.5%siness and Professions Code: Any city or county which requires a
permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to file a signed statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civil penalty of not more than rive hundred dollars (5500).
[; 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, Buisness and
Professions Code: The Contractor's License Law does not apply to an owner of property who
builds or improves thereon and who does such work himself or through his own employees,
provided that such improvements are not intended or offered for sale. 11, however, the building
or improvement is sold within one year of completion, the owner -builder will have the burden
of proving that
he did not build or improve for the purpose or sale.)
I 1 1, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner of property who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
1-1 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
n Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars (5100) valuation
or less.)
I certify that in the performance of thg 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.
Date Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information Is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives -of this city to enter the above-
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
BUILDING: TYPE'CONST. OCC. GRP.
A.P. Number
1
Legal Description
Project Description
� E q'ITIA c I-It�jZ�7�� rrcL� x1 Q2 . A4 QZM
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
PERMIT AMOUNT
Plan Chk. Dep. j [") oo
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
r" j
TOTAL
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: D Permit
Validated by:
Validation: J1JN 2 o 1999
WHITE = FINANCE YELLOW = APPLICANT
iTy Ci �r i Vl+Jlr0I
PINK = BUILDING DIVISION
r
Desert Sands Unified School District - -�
47-950 Dune Palms Road t
Notice:�
La Quinta, CA 92253 �
Document Cannot Be Duplicated 760-771-8515 t'
�1.
CERTIFICATE OF COMPLIANCE
Date 9/29/99 APN # 761-531-005 & 006
No. 19393. Jurisdiction La Quinta
Owner NameVincent & Virgina Coviello Permit #
No. 79031 Street Tom Fazio Lane South Log #
' City La Quinta zip 92253 Study Area
Tract # Lot # Square Footage 7874
Type of Development Single Family Residence 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, 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:
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of
1.93 X 7,874 or $ 15,196.82 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/ 1 st Community Bank / Bill Turpin Const. Telephone 777-7611
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Sylvia Carrasco
Signature
Payment Received $15,196.82
Check No. 088356
40TICE: 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
rbove 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
mllecl 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
RECORDING REOUESTEB By
as 'TT11E■ 11ETA.0Es MAIL tX111 sm An fliust OtrERWISt Sm"M
11!1.011 ILAIL TAX STATISM T11: "
Vincent F. and Virginia S. Cov•illl
Street 4823 Lake Washington Blvd. # 6
AddrMs Kirkland, WA 98033
Gly &
MAII TAX $TATEMENTS TO '
"'"" Vincent F. and Virginia S. Coviello
Adan;
JON TANDY
37630 Medjool Ave.
Palm Desert, CA 92211
Office (760).-772-7192
SPECIAL' • Fax (760) 772-7193
'REGISTERED INSPECTOR'S WEEKLY REPORT Pager (760) 776-3338'
TYPE OF
INSPECTION
PERFORMED
❑ REINFORCED CONCRETE ❑ STRUCT. STEEL ASSEMBLY
❑ POST TENSIONED CONCRETE ❑ ASPHALT
❑ REINFORCED MASONRY ❑ FIRE PROOFING
❑
❑ OTHER
JOB LO"
'►
JA
REPORT
REPORT SEQUENCE NO.
TV CTURE
h
PERMIT NO. -
DATE
DAY OF WEEK
MATERIAL DES
IPTIO!3
ARCHITECT
INSPECTOR
HRS. CHARGED
-
ENGINEER
ASSISTANTS
HRS.CHARG ED
_
INSPECTION
DATE
L SUB
CONT ACTOR_ V �'� CONTACTOR
i
01 It P (A 7
r
ry r
COPY SENT TO CLIENT O
CONT ON NEXT PAGE O
PAGE OF
CERTIFICATION OF COMPLIANCE /4rn
�oT�cv�T.T CT
HAI-HAVE INSPEED TO THE BEST OF MY
IYNATURE OF REGISTERED INS
OTHERWISE
- d a . -� al._ �' � . 17�y tom. � Y �. c � _ ., �`-�r---•--^- "..,- ��-� � r �� -�.� y��.-�
V�f ?K_