The URL can be used to link to this page

0312-001 (SFD)LICENSED CONTRACTOR DECLARATION I hereby affirm under penaltyy of perjury that I amglii-ensed under provisions of Chapter 9 (commencrng,wii6'86ction 7000) oft ivision 3 of the Business and Professionals Code and my License is in full force'and'effect, License # I1 Lic. Class f Exp Date ®466W ' f+y, l`}!' 1120 Signature of Contractor ��r'` e #y J OWNER -BUILDER DE CLA`ARATION I hereby affirm under penalty of:perjury that I am exempt from the Contractor's License Law for the following reason: 4 ( ) I, as owner of the property, or my employees with wages as their sole compensation, will do the work Band the structure is not intended or offered for sale (Sec. 7044, Business & Professionals Code)." 1 I _ ( ) I, as owner of thee, property, am exclusively contracting,,with licensed contractors to construct the project (Sec. 7044,yBusiness& Professionals Code). 1 O I am exempt under Section B&P.C.�for this reason t Date YSignattire of Owner: WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty�of perjury ones of Zthe following declarations: () I have and will maintain;a certificate of consent to'self-insure, for workers' compensation, as provideaxfor by Section 3700 off the Labor Code, for the performance of the work for which this permit is'issuewb ( ) 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 O.ATE FUND Policy No. 1641054-01 (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, (,,shall forthwith comply vVith`tthose-prcivisionsl' ')' r/ /Date: dk U 1' Applicant ��:2._ �+k�-fY•".•� �~� e' 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 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 permi'v'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. A Signature (Owner/Agent)`` "``-"Date BUILDING PERMIT PERMITk - 9Q/ �y /� DATE q �/ VALUATION yam} �( ( LOT % TRACT 284.70-2 �/ _.. '_• ! '1` / 7 M13�ti T1: V` fM �ei84. f 0-2 - JOB SITE ADDRESS ��.1. .k AAnaildl`I .+�� d i�Y APN OWNER _ _ _ , _ __ - -- _ : _ e' CONTRACTOR / DESIGNER / EN INEER ALPH4+. OA&, CIA WJRV1MQ A A1: FRA O2uWA f 42.829 COOK ST 41104 PALM 15FSE T CA 922,111 PALLIA 7arWRT t_`A 92260 Q 0)5 0 -17 17 CBU' 2357 USE OY�Fry�PERMIT .} 7 ,lIJ.•3 VA E FAILY DW d:n4l atLV d3• SPINPLfi.AtIT DOPE 1-10TINCLUDE, BLOCK IYALUP>~10.USPA. OR .APP" ACH .� DRIVF,tV'. ;',r.OW4P''4.ACE 'MTH 3iktat; f�"�'DEM &STATE LAWS, i'NCI.ErDD46 TIV •ENDANOZE RY11) &'PZCIFS ACT OF 1973 (16 U,S.C, § 1531, F -T VUSTOM C 014 8 RUCT10N 3imoa sy PORCHIPATAO 969.00 S 0P A0iaA( "0RT 1,207.00 SP P 1 T FZX UUM ARY - C'O14:ITRUC'TJOH FRE 101.000.418.000 $1,966,00 P1-411 CHECK 'TE 101-000-439-318 g1fsr.93 ITS D&POSIT 101.000.439-318 411040100 M"LCHAMIC:AG FELT' 101-Cft-421-000 $194.50 ELECTRICAL, F92 101.000.420 -OO $291122 •°•�,�. . PLdJ1rIHM0IIE 101-000-419-400 W6.a3 STRONG MOTION FEE -111981D 101-000-241-000 841.83 ORA1.IM0PELF 101-000.423-000 $15. oft DWELS't"s'ER IMPACT FEB $440180 1 RWISld PLAN 101-000--441-343 $100,00 .AAWf 1N PUBLIC PLACES - ROME 270.000.445-000 $69534 8TJB-TCYrAL- CORCURTSCTJ ON AM PLAN CJWC& $7,546.47 LESS P:-PAiA 01 411000100 D U ITAE: t:'Y'.T�i%'T b'XF,9 ffliff. NOW' FEB 12 2004 CITY OF LA QUINTA FINANCE DEPT. t. RECEIPT DATE BY / .-� DATE FI ALE /r INS CTOR !Ot INSPECTION RECORD OPERATION DATE INSPECTOR BUILDING APPROVALS Set Backs Forms & F OPERATION DATE INSPECTOR MECHANICAL APPROVALS Slab Grade Return Air aw—I Combustion Air Footings Exhaust Fans . o Wra F.A.U. ming _ _ _ _ Compressor a ion Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Partv Wall Insulation Condensate Lines 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 16_ 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 / /l„/ fi Final COMMENTS: Final 13 0 ot-( Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole L sri �� S'� ) -6 �,� Underground Conduit Fixtures Main Service Sub Panels Exterior Receptacles �77• G.F.I. Smoke Detectors Temp. Use of Power Final O Utility Notice (Perm) 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 5,688 S.F. or $12,172.32 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/Pacific Western Bank -Diane Davis Check No. 242061 ' Name on the check ,•Telephone .760/568-1712 _ Funding Residential By Dr. Doris Wilson Superintendent.- Fee uperintendent. Fee collected /exempted by S r on MCGllvrey Payment Recd $2134.40 $12,456:72 Over/Under Signature C NOTICE: Pursuant to Government Code Section 66020(d)(1), 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 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 .1J�I D Desert Sands Unified School District C--:04 coo 47550 Dune Palms Road Q BERMUDA DUNES r q Date 2/4/04 La Quinta, CA 92253 RANCHO MIRAGE Cj No. 25471 ' (760) 771-8515 ' {� INDIAN WELLSDESE ��, PALM LA QUINTAT y , Q INDIO .i�� O Owner Al Ross LLC APN # 770-300-0357 Address 42-829 Cook St. Ste 104 Jurisdiction La Quinta . City Palm Desert Zip' i Permit # Tract # Study Area Type Single Family Residence No. of Units 1 Lot # No. Street S.F. Lot # No. Street S.F. Unit 1 52 78511 Talking Rock Turn 5688 Unit 6 Unit 2 Unit 7 Unit 3 Unit 8 Unit 4 Unit 9 , Unit 5 Unit 10 Comments Overpayment of $284.40 issued as a direct pay and to be mailed to above address to the attention of Diane Davis. 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 (ipaces that do not contain facilities for living, sleeping, cooking, eating orsanitation) 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 5,688 S.F. or $12,172.32 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/Pacific Western Bank -Diane Davis Check No. 242061 ' Name on the check ,•Telephone .760/568-1712 _ Funding Residential By Dr. Doris Wilson Superintendent.- Fee uperintendent. Fee collected /exempted by S r on MCGllvrey Payment Recd $2134.40 $12,456:72 Over/Under Signature C NOTICE: Pursuant to Government Code Section 66020(d)(1), 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 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 � � �a� Certificate of Occu ancy p iT COPY, t i JNTD XATM s f G G 9w5 Building & Safet Department OF T Y 1— T , ( F y „ This Certificate is issued pursuant to the requirements of Section 109 of the. California Building Y< Code, certifying that, at the time of issuance, this structure was in compliance with the 9 ,. provisions of the Building Code and the various ordinances of the City regulating building n i . construction and/or use. a BUILDING ADDRESS: 78-511 Talking Rock Turn e 1 Use classification: Single Family Dwelling Building Permit No.: 0312-001 f f F Occupancy Group- R -3/U-1 Type of Construction: VN Land Use Zone: RL Owner of Building: Al Ross LLC Address: 42-829 Cook Street #104 City, ST, ZIP: Palm Desert, CA 92253 G By: Daniel P. Crawford Jr. Date: 6/10/05 Building Official POST IN A CONSPICUOUS PLACE tir . .x