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0210-162 (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 # Lic. Class Exp. Date 4.39582 7 r d ate ���}s; 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). • , ( ) 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 NIA : r€ ti Policy No. (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. ,,Va'tei 1. Applicant �. -.. _. �_., �,- _. • �- Warning: allure to secure Workers' Compensa lon`caver0a4je�'s°�Inlawful 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 �t 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 cessatlon of work for 180 days will subject permit to cancellation. q I certify that l 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)a • - // - } - •• Date X/ BUILDING PERMIT PERMIT# 0210-162, � DATE VALUATION . y � LOT42 TRACT 28470-2 ITEJOB St ADDRESS 78-6f2. `,�'ALWO 11:t�f„`"C T APN 'aiC!^:? OWNER CONTRACTOR/DESIGNER/EN &NEER ?UV'i%`iX P31.1-ANIMM,11r, TOM Li1:1BY f:C1fi=T-10TION 73% HWY 111 106 7.3-960 :SM' 1 I i JWE; 6 i, k, 92a��{; A(,t+�e1?t 3� ` CA ' ♦Yy�92260 (619)34 i -7335 c1sw "5 r, r USE OF PERMIT :If�I11 C t;i.il:, tidAl.C: PPQO Li Lid. .e PPA0.ACHJCO.MKAA;.NC94ITH AV,L R1R-.I')ERAL A a T.A`£Z LA.W9 YNC:1sIi0YNG ME K14D.ANCIECED SPRXIES ACT OF 19ri, IIS .F PPIACABLL°,ca UQ UII: D. ;f r i C`UIiIMM CON13Tf UCTION 71680 06 SF I'C31�f�ai�.?#xi:0 S�©.tiff Sly' EETIMM Corr 01r CORM1TTC'9. 014 63341k," fid) COTIS'I'RUCTION FEZ 101-000-4-18-M $ ,441, 50 PL,KN CkOXX lin 101-000.439-2118 FEE DEi'l'irit'!' 101.000.499.315 -$1,250.00 MWHA.taaCAL12F, 101-000.421-000 SIOX50 21,RCTRI CAL FFZ 101-000'4211«1300 WIN PT.UMBINO VEZ 191-000-419-000 $31:1.50 STRW40 MOTION RXG+ • RE -91D 1X91.000.2,41-000 $63.36 9;,yRADVAO F97, 101'•11010-423-000 W.00 UWlwie4rk'I'<11 W,AC`T' AM $2,40,00 .ART 1'03 PUBLIC PLACES - RESM 270-000.445••000 $1,0$3199 STUTR-TOTAL C01071!1�13=%Y AM PLM (MCK $8,941 90 XEW -PAID +may ••'�1.a5t)-M. a D �`Or9.".� L PIWffr MS DIM NOW ;,7,091 s0 JAN 14E 2003 CITY OF LA QUINTA FINANCE DEPT. RECEIPT DATE BXY-' DATE FINALED INSPECTOR A INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs . G Underground Ducts - 777 O' Forms 8 Footings Ducts Slab Grade Q Return Air Steel Combustion Air Roof Deck d Exhaust Fans O.K. to Wrap _ _Q F.A.U. Framing "— Compressor Insulation Fireplace P.L. -=2� Q �_ Vents Grills Fireplace T.O. Fans 8 Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath 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 Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines - Heater Final Water Piping �7_ Plumbing Final Plumbing Top Out v Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection iG _ Encapsulation Gas Piping Gas Test - (/ • d �/ 57 Appliances Final COMMENTS: f26d oc—_ li' 2- Q 3 /'_Z_11 ea () te,l NSv�q ► a✓ �1- �� 4 3 Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole % / Underground Conduit z 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) CERTIFICATE OF COMPLIANCEFtEDs Desert Sands Unified School.District egor%o • 47950 Dune Palms Road q Q BERMUDA DUNES r ° Date 1/7/03 La Quinta, CA 92253 C/1 RANCHO MIRAGE Cj INDIAN WELLS ti LM DESERT No. ' 24004 (760) 771-8515 - �,y> P LA QUINTAyy INDIO O Owner Duffield Financial LLC APN # 770-300-024 ° Address 7396 Hwy 111 #6 Jurisdiction La Quinta City Palm Desert .,Zip 92260 Permit # Tract # 28470-2 Study Area .Type Single Family Residence No. of Units 1 Lot # • No. Street S.F. Lot # No. Street S.F. - Unit 1 •42 78682 Talking Rock.Turn •7680 Unit 6. ' Unit 2 Unit 7 , Unit 3 Unit 8 Unit 4 Unit 9 Unit 5 Unit 10 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 (spaces that do not contain facilities for living, sleeping, cooking, eating of sanitation) 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 r 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 7,680 S.F. or $16,435.20 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/Bank of American - Jennifer Depetris- Check No. 2013261284 Name on the check Telephone 760/564-1712 Funding Residential ' By Dr. Doris Wilson Superintendent ' Fee collected /exempted by Monica Guillen. $161435.20 1$0.00 Payment Recd Over/Under Signature l• 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 the on the District('s) behalf, whichever is earlier. NOTICE: This Document NOT VALID if Duplicated ; Embossed Original - Building Department/Applicant w . Copy -Applicant/Receipt _Copy -Accounting