9810-001 (SFD)LICENSED CONTRACTOR DECLARATION
I 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 # y Lic. Class Exp. Date
"D Pate Pate f r -} 1 614x` Signature of Contractor
OWNER -BUILDER DECL RATION
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. 70441. Business 86 Professionals
Code).%J
( ) 1 am exej pt under Section B&P.C! f'or this /i aso"n
Date t �y, Signature of Owner �
,V J
` v W 1 -1ORKER'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.
flTAT% b^L � �di3 131 X15; 5.'1ii
(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
9de, I shall forthwith comply with those pro"visions.is ` ' 9
Dates j Applicant 1 j /)
.,,
1�� �•ct.; i/ • V14
Warning: allure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil Ines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the
above-mentioned property for inspection purposes.
VSignature (Owner/Agent)_ f� Date
V,
,.It d; / :1is
t N
PERMIT#
PERMIT
.,,BUILDING 9 1„ ,,,1
DATE r , f VALUATION LOT TRACT. 28470-2IV 403 36'
JOB SITE
ADDRESS 78-562 TALKING 1< Ity� N
APN 7f 0-93#1••i1.18
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OWNER
CONTRACTOR / DESIGNER / ENGINEER
r-
J01*1 RICH
ANDREW .1"IERIC , C(?RPOf.AMN
-20 Oi:J'I'1MER
44-835 DEEP C.AN`YON RD
ROLLING RILLS CA
PAI�d1 T3ESER'i' (,:A 92201
f�E�)3Ati-?2"8 ri31..# 3031
t r, , �n�-r.
.,rT;„,i.ev a: i•�.�;"r{i .1.tlk a.r.5
USE OF PERMIT.-,��
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61tlL�lali ►'�,LV!It i.. .VWG�.✓,I.��.EV:,y
'1401LARFA
S1rU -1'`�Lsf�ii�' .I�rCJ tJU'! INCI.Ui.9E �LC•!C:[i W e�i.%�; taR fM:.i,GI.
CUSTONO CONSTRUCINON 6.M.00 3F
:EiCiitci;lr2'a1.C10 V0.00 SF
0ARA.00CAt+tPORs` t,1,15.00 SA:
I Ci ST1.P,v!A'; AT YL CO3$IT 0 V L:O1`1S.TRVCT ON
532,1123.30
PERNOT FEE, SUM MARY
C'0Na'1'RLW' I0NFEF. 101-000.41WOW 32,135,51)
f�1.,A�? +"ifij•:l;F� ��.#;• 1� I-1}nQ}-�:��_3? }i g1,�eli ilk
17Eh' Dr-f'1031T .11.250.00
';VA ,N1tA.i tC;AL FEE IdJI�(iQG-f1;1 li�til ai6't. u
1vL1St;:'sR.(C:AL, F}rR 1014X)0-42U-•O1t0 S-145.45
a`L t�, rC1 &LOTION 1 -MI, - ESS) .101 -ow -141 -ow
0i '3044 F i001,-000-423•'tW 2t1.i1ti
iNF4t1#.6t'iRl1C'8 URli, ..FFE 2`5-000-443-�3,U �L+.tNJi1.f10
.ART f_N PUMt�iC,
:9JR—ii;Y1'A.1, (;0N!�} 1'PLTKMON AN!) Pf
LESS PRU'-PAIDs'FES
41,250100
TOTA1, PERMIT FEES 011K NOW
510.625.93
j
RECEIPT I
DAT ^.
BY ff I`r'4 ^%
DATE FINALED
INSPECTOR
I (t�
J
.1k I -1 1 4'
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms 8 Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
- -
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
Drywall - Int. Lath
,
Final
Final
BLOCKWALL AP ROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
' Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Af
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
-d0
Appliances
Final
Final
Utility Notice (Gas)
ELECTRIC—
Temp. Power Polei��
Underground Conduit
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)
APPROVALS
i
y
COMMENTS:
-
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Notice:
Document Cannot Be Duplicated
Desert Sands Unified School District
47-950 Dune Palms Road
La Quinta, CA 92253
760-771-8515
CERTIFICATE OF COMPLIANCE
Date 12/4/98 APN # ' 769-930-018
No. 18069 Jurisdiction La Quinta
Owner NameJohn and Joann Rich • Perinit #
No. 78-562 Street Talking Rock Turn Log #
City La Quinta zip 92253' Study Area
Tract # Lot # Square Footage 6,387
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:
1
EXEMPTION NOT APPLICABLE
, In ihe'amount of
This certifies that school facility fees imposed pursuant to Government Code 53080 � .� �
1.93 X 6,387 or $ 12,326.91 the property listed above and thatibuilding N�
permits and/or Certificates of Occupancy for this square footage in this proposed project may n.Gw be�issued
Fees Paid By CPD National Bank/Andrew Pierce Corporation Telephone,;, 346-3228-
CName on the check ;` •`
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Juanita Green Payment Received $12,326.91
Check No.. 74273
Signature rI_1W114'66__ /d8.�
NOTICE: Pursuant of Alombly 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
will begin to run f m 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
Stein .and .Associates 760'560- 3696' `, ,12/02/98 09:32' •01/01 NO'-822
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Poet-N'° Fax Note • 7871 �etB 1 e ►,
.i' . To ft F U i tom.
i CoMept
PE IA&6aa
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Phone• Phone s,
Fax a
December 1, 1998 -
r z 1Mii R"t am mail t
Y • ,
• Mr. Greg Butler
Building and Safely f fi
• CITi OF 1A QUINTA ', ;
78.493 Calle Tampico
La Quinta, CA 92253
Re: Lot 36, Traci 284742..' '.
78-S62 TaUdng Rock Turn
Dear Greg, i
= Thin Tette . - . . � •• - . .. • F, .
r will serve as approval of the above referenced residence to obtain a permit from
the City of La:Quinta. The above residence is pending final 'approval from the Tr®ditiori
Architartural Review Committee 'subject . to a final ,revidry of revisions to, Coriatrucdon
Documents. .
T ..
If you have any questions or need additional Idormadon, please do not 6sltate to call:
Thank you:
Sincerely, t A 1
Christina J, Doren
Architectural Review Coordinator
Aid_
- pc. Darrin Coffin, Andrew Pierce Corporation
Gordon Stein, Stein and Associates'
o - , , Vrj i-.- S � til:
,
Inv,
j°'�T
•cam ,OF
Dear Builder:
Prior to issuance of a building permit', you 'Will be required to obtain Public Works
Department approval for one of the following:
1. Verification of pad elevation by a licensed surveyor or engineer.
2. Engineered grading plan for project requiring on -lot retention.
Tract #26524 (Estancias) -
Tract #26769 (Mountain View Estates) , a
3: Verification that the building pad has been graded and compacted'in accordance
with the soils reports, and tract grading plan.
Tract #28034 (South Valley Estates) '
Public Works Authorization
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