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0005-168 (SFD)LICENSED CONTRACTOR DECLARATION I here ` Ovirm under penalty of perjury that I am licensed under provisions of P hapter 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^�_.-- r Exp..Date 43503:1 9 E` i1' ,/Date 7- t E-`"' Signature of-C.i_'or 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). r ( ) I am exempt under Section B&P.C.4or 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 STATE FUND Policy No. 1542853-00 (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 Cal ifornia',-•and"agree that if I should become subject to the workers' compensation. I si ns oftSection 3700 of the Labor Code, I shall forthwith comply�with,th'ose-pFovlsro � Date: Applicarit"� 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 persp'n at whose request and for whose benefit work is performed under or pursuhnt 6 any permit issued as a result of this applicaton agrees to, & shall, indenfRify & 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; °anti°'State-laws relating to the building construction, and hereb uthor�ie7pcesentatIves)of this City to enter upon the above mentioned roperEy'f'or inspector'• u.pu p s�`es. ;> 'Si nature (Owner/A ent) Date BUILDING PERMIT PERMIT# 1 DATE VALUATION LOT TRACT �}� 7'.-, � 0154,M . i0 JOB SITE ADDRESS 73 :°!42'TINC1C?C >rCI121� APN "t�AS'e`30-0A OWNER CONTRACTOR/DESIGNER/ENGINEER MR T1 OM L"G 81 CCi3d'8'i U ON ENC. YUCCA VA%1 , Y CA 42284 (760).165-8691 CB1_4 2533 USE OF PERMIT 8 'MG , FAMILY Dilii r'LL G SINOLF FAM)LY WELL1N0. -PEPI.41T DOES 140T INC:I,UDF, BLOCK: 1WAU,,`I!POOw1/=VI;WAY'APt`F7.0A.CIL I CUSTOM CONSTR17&1014 4,218.00 3F PORCHIPATIO 1,670.00 Sig 0AR.AOEICARPORT (SP) 13s9'P4,30 i'1[ AM COST OF CONYMMON 36407.70 IPEWwr '» CONSITRUCTION 2;EEP 101.000 -418 -WO $1.567.00 PLA1I CHECK FEE 101 -OW -439-319 $1.269.89 FER D&POSIT 101-000.439-'318 41,4011,00 MECHANICAL FEE 101-000-421-000 $163.00 ELECTRICAL FEE 101.000-420.000 $336.89 PI, . BING Fee 101 -OW -419-000 $194.00 STRONO MOTION FEE • REISID 101.000.241.000 $36.49 CIRADI]HO PSE 101-000-423-000 $20.00 DWELOP.ER 1Iti,4PACT FEES1,94'l,ty0 ART IN PUBLIC PLA.CM • IMIL 701.000-255000 $413.32 4 BCT'i.AL CON13ZRUCrION AND PLAN C'IMCK $5,8Q5.dI3 LESS M -PAID FM -$1,000.00 '1:t7TAL I-MMY MS DITNOW MOMS RECEIPT DATE sy . BY rt DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings ` Ducts Slab Grade Al. Return Air Steel Roof Deck — 0r I Combustion Air Exhaust Fans O.K to Wrap _ _ tJZ 57 F.A.U. Framing .(6 .p ( 5 Compressor Insulation (8 Vents Fireplace P.L. I Grills Fireplace T.O. j Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath _ Final Final S 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 I I 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 Pool Cover Sewer Connection _ p Encapsulation Gas Piping Gas Test Appliances Final COMMENTS: Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole m • 170 Underground Conduit Rough Wiring Low Voltage Wiring FbRui�es Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) 2 Notice: Document Cannot Be Duplicated Date 9/25/00 No. 21018 Owner NameTom Lang Desert Sands Unified School District 47-950 Dune Palms Road La Quinta, CA 92253 760-771-8515 • CERTIFICATE OF COMPLIANCE ' APN #. 769-930-001 Jurisdiction -LaQuinta Permit # 0005-168 No. 78-342. Street Talking Rock Turn . Log # City La Quinta Zip 92253, Study Area Tract # Lot # Square Footage 4218 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 mobilelibmes. 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 2.05 X 4,218 or $ 8,646.90 the property listed above and that building i permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issuedA. " Fees Paid By CC / First Community Bank / Mark Stoker Telephone , Name on the check By Dr. Doris Wilson Superintendent t Fee collected /exempted by Annette Barlow Payment Received $8,646.90 Check No. 096237 Signature "VU& OTICE: 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 bove 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 ollect them on the Distdct('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 Ad P.O. BOX 1504 APPLICATION ONLY Building 7g—,342, _-j"' in� 0[, 78-495 UINTA, CALIFORNI 9Address�!j llyj QUINTA, CALIFORNIA 92253 Owne �� /� �� BUILDING: TYPE*CONST. OCC. GRP. O Mailing . A.P. Number Legal Description •��%+ Zp 4 7d- -7— ' Con {actor Project Description 01-7- ANG 1 Addre s VAALID Cc.GiQ i Zlp j 72,2W -li T �4o 36! ' State Lic. C City A Classif. 4. 3 7 a 3j Lic. # a S 33 Sq. Ft. No. No. Dw. Arch., Engr., Size Z 149 Stories Units Designer !_ New ❑ Add O Alter ❑ Repair ❑ Demolition ❑ Address _ )r �� Tef- 7? � [' ^ f/ Zip State icy 21z6e Lic.# loo67. LICENSED C�4/bvisions R'S DECLARATION I hereb at ' sed unof Chapter 9 (commencing with Section 7000) of ' sio full force and l! 1 OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5,Susiness and Professions Code: Any city or county which requires a permit to construct, after, 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 five hundred dollars ($500). 1: 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.) I %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 pursuant to the Contractor's License Law.) 1'71 1 am exempt under Sec. B. & P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION Ihereby affirm that I have a certificate of consent to selbinsure, or a certificate of Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No. Company F3 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 ($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. 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 >unioacu vnwuaw1_1 Tr ■ rhe vqe PERMIT � E 6�M AMOUNT Plan Chk. Dep. 0,019! �f(1 Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure 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: Date Permit Validated by: Validation: WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION 'Tradition,- a �t� ARCHITECTURAL DESIGN REVIEW,. C17YOF 1_A 0LJ1 JTA SEP 2 0 REC`p »L SAF September 18, 2000 Via First Class Mail and Facsimile Ms. Nickie Gormley CM OF LA QUINTA 78-495 Calle Tampico La Quinta, CA 92253 - Re: Lang Residence Lot 19, Tract 28470-2, 78-342 Talking Rock Turn Dear Nickie,. Please accept this letter as approval for the above referenced residence to obtain a building per mit.Conditions that apply to this submittal will be forwarded directly to the architect, - Mr. Michael Kiner. If you have any questions or need additional information, please do not hesitate to call. Sincerely, Christina J. Dores Architectural Review Coordinator /cjd pc: Tom Lang, Owner Michael Kiner, Architect C� ��a�n&01a�L1Vd 78505 OLD AvENuE 52 La QU[rrrA --- CA 92253-1120 - PHONE 760/564-3355 -- FAX 760/564-2356 Certificate. of Occupancy City,of La,- Quinta' Building and Safety.Depa'rtmenit ��OF-�� This Certificate issued pursuant to the requirements of Section 109 of the Uniform Building Code, certifying that, at the time of issuance, this structure was in compliance with the various ordinances of the City regulating building construction or use. For the following: BUILDING ADDRESS: 78-342 TALKING ROCK TURN Use Classification: SFD Bldg. Permit No.: 0005-168 Occupancy Group: R 3 Type of Construction: VN Land Use Zone: RL Owner of Building: MR. TOM LANG Address: 48-915 WASHINGTON STREET City: LA QUINTA, CA 92253 �• — By: STEVE TRAXEL /4 Date: 09=28-01 ; Building Official ' POST IN A CONSPICUOUS PLACE _.m