Loading...
9810-121 (SFD)"LICENSED CONTRACTOR DECLARATION' ". 1 hereby 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 #T Lic. Class Exp. Date ,1167`%0 8131/99 /D/ate,y 7 FfSignature of Contactor e`J 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 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. S,;'.fA'r _ rb"N 1 1154 da.^.7Y3 (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 th� worfkers' compensation provisions of Section 3700 of the Labor Code, I shall fortWith comply with those•proyisions.__� VDate: % % + pplicant- Warnl7 : FaiiJ re o secure Workers' Compensation coverage�is,unlawful and shall aubject an employer to criminal penalties and civil fi/s7Up 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 permitissued 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. " Date Signature (Owner/Agent) / ,..�✓ BUILDING PERMIT PERMIT# 981042.1 DATE VALUATION� �� .'1.90 LOT46 TRACT 27728 JOB SITE ADDRESS 79-525 TOM FAZIO LANE.NOKM APN 761-527-017 OWNER - CONTRACTOR / DESIGNER / ENGINEER TR. NOW. COMST'RUC"f IONK 801 S ACACIA AVE 14-894 LENNON PLACE, S'T'E. C-1 Nt.Ti,C.E.Tc`iCrt CA 92534 PA.!>n4 DIRSER CA 92260 (760)34[-7942 C L# 2541 1 i USE OF PERMIT SNUB FAMILY WtsL.t_c NO q 8FD - ffiRMIT i 09S NOT 1Q`,1t,1.UM BLOCK WAIL OR POfi�� JAN 1-3 1999 -' C;3ST014 CCeTvY'8T`►si:CTTON 6,442.00 SF i ORC:IVPA7'TO 221.00 SAF i _qC ;,, ;.... '' ; •= 4 =c ; C1AlCACi3?!( AlYit )ld'1' t#� ,.t}(! il` i, .., � a ' a s I? s_e it�++f. :;+NI';,.H UC, i`sOi 415.x1.110.9 0 OON.I'1'ttt3'G)'t'iO1,IFEE 101,000-419-f700 Q$41"l.g0 Pi,AN C1.1T;('..K M' 10!1-000-439-318 S t, 7:37, 85 F .DriP0t,1 1" if,1-000-1139-318+ -S? M100 i4>ritNIA14C Ai. ME 110t -000-42J-000 , $213.50 EIL PY,711UC:AL VIM J01-000.42..0M.1li(i 052.8.3 P1 tf drtl a v00 T:. 101. -0M -419 -/Kut $129.00 ., twntle;2�srrOr�'1: :.. ttr�s�ra 101-000-241-000$52.s2 u1tt1%aj;tdU i, i 101 -000 -42.3 -WO Slt�.t6t> N7 A.`1'1°kLh;'itJ t .a`t:1 2wS-000-443-342. $f+,OCtt►.1}t, P10—F- -SPP1,AM 'I til-w)4u1-345 JI.R,T Ito PU61,1C 1`].,A,C11 - kC,81T` 701.000-255-00 f d.,0di3;U3 hIJ?{-'RYT'A.L CCaRISTTL] TC T'1'C? i AND )( PLY•AA1 c��+�1HECj�K, $111,911.(21 p ((}� `` ' LESS PRE-41AM PLCiA! '-st vip.00 RECEIPT DATE ! DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs S_o z �- u T e Underground Ducts � Forms & Footings Ducts Slab Grade e�f P Return Air Steel Combustion Air Roof Deck — Exhaust Fans O.K to Wrap F.A.U. Framing Compressor Insulation fi'- Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath . Gf 10,/9- C— Drywall - Int. Lath Q 0 c o , ' 4 40, C Final Final' POOLS - SPAS . BLOCKWALL APPROVALS steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground PI . Test Final I Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines •2- fL Heater Final Water Piping ri Final Plumbing Top Out og�Plumbing Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test Appliances Final COMMENTS: F1f �� �T "' G ti S'(n O )" t y Final 7, Utility Notice (Gas) -& ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fixtures Main Service Sub Panels ¢ Exterior Receptacles G.F.I. Smoke Detectors i Temp. Use of Power Final Utility Notice (Perm) V (� 4 P.O. BOX 1504 Building ]� tit►78-495 CALLE TAMPICO Address 6 � LA QUINTA, CALIFORNIA 92253 Mailing'`^ Address �� ' itJ6i, 1„��t'71it�1 + I Qt Zip Tel 1�1� t o t� Is ti 22op 1.1.60 Contractor City Izip & Classif. I Lic. # Designer y' , E C1y1 Vf C.0, V 1 & IState A 0� I Lia. # DECLARATION N Chapter 9 (cc OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5, Business 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 thealleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). I: 1, 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. If, 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 of sale.) I1 I, 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 pursuanf.to the Contractor's License Law.) 17 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 (7 Copy is filed with the city. O Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed it the permit is for one hundred dollars ($100) valuation 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. Dale_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 thispermitshall 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 aliplican Mailing Address— ,City. State, Zip_ 9 APPLICATION ONLY BUILDING: TYPE'CONST. OCC. GRP. A.P. Number 7; *2— � Legal Description /1 Project Description `PIS �01-�-.�5 [_ 6� AC-tt. e SDI PA 9283/ Sq. Ft. /�q*01{ NO. No. Dw. Size ((/ "( �j Stories Units New ❑ Add ❑ Alter ❑ 1 Repair ❑ Demolition ❑ Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL REMARKS ZONE: 0 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 A FINAL DATEINSPEC� FA Issued by: Date Validated by: OCr t Validation: r� YOF LA"" Im WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION ' t ' Desert Sands Unified School District 47-950 Dune Palms Road Notice: La Quinta, CA 92253 r Document Cannot Be Duplicated 760-771-8515 CERTIFICATE OF COMPLIANCE Date 1/8/99 APN # 761-522-017 No. 18217 Jurisdiction La Quinta Owner NameGordon Bagne Permit # No. 79-525 Street Tom Fazio North Log # City La Quinta Zip 92253 Study Area Tract # Lot # Square Footage 6,442 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 6,442 or $ 12,433.06 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 _r Fees Paid By CC/1st Bank/Tr Noye Construction - Mr. Tunstead Telephone'_341-7,942 Name on the check By Dr. Doris Wilson Superintendent Fee collected /exempted by Juanita Green Payment Received $12,433.06 Check No. 48970 Signature C�.GGZLG�C� INOTICE: 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 Dislrict('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 Dear Builder: T4'it 4 4 Q" PUBLIC WORKS CLEARANCE LETTER FOR CUSTOM HOME LOTS Prior to issuance of a building permit, you will be required to obtain clearance from the Public Works Department for one, or more, of the following: 1. Verification that rough grading is complete, and the pad elevation certifications prepared by a licensed surveyor, or engineer, are on file in the Public Works Department. 2. Verification that infrastructure improvements and other required tract improvements are complete, or sufficiently advanced to warrant building permit issuance. 3. Prepare an engineered grading plan that provides for on -lot storm water retention, and have it checked and approved by the Public Works Department. • Tract 26524 (Estancias) • Tract 26769 (Mountain View Estates) 4. Prepare an engineered grading plan that provides for building pad grading in accordance with the existing soils report and tract grading plan, and have it checked and approved by the Public Works Department. • Tract 28034 (South Valley Estates) FOR INTERNAL USE BY PUBLIC WORKS DEPARTMENT TRACT: LOT: PUBLIC WORKS A THORIZATION DATE F:IPWDEPTDOCS%FORMSWW CLEARANCE LETTER.ss Y'