The URL can be used to link to this page

9908-195 (AR)LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that.1 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`y Exp. Date h3 l8S�i '3 t � i?". 1201 ate �� 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. (4) 1 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. 3 AM R �Pl11L, :,ncv r i e��roex+iti (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, andhag be that if I should become subject to the workers' compensatto pro SID of /Section 3700 't the Labor Code, aJJ hwith comply witM.l4o pzvIS ons p date: Applicant •� ' """ 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 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 aut' orifi r pres°entatives of this City to enter upon th /above-mentioned prope / .• for inn pecl on purp §es. Signature (Owner/Agent) Date PERMIT # BUILDING PERMIT Os-195 DATE /- VALUATION �A��l, r^ LOT q TRACT i ADDRESSJOB SITE SOILYWERN APN ��WiZ OWNER I CONTRACTOR / DESIGNER / ENGINEER .0,0131; T,t VERA.:3a:O W4 WIF: VID-11trl'.TUDIS, CCS110 1111".11 N. 534 19.970 FIES'itQ.MINE LA, QUINVA CA 9125A LA QUINTA CA 9225:1 (760)775-'A; 33 t" j. 321: USE OF PERMIT 440 5F• CtOOST El+r3WE ANT) J197 NNA17WN EVVE ivrw r� i ►exm r%11 °D °°rare<wr�wr EV 7. P!,'.NJ C /a'ayAWO x. Al A11trA Y' lel A14 4'�1S i t�k°�f t(?9,-<jfJf� �i.?t'lr��}; �SZti�►,l i vaNr-1;TR1 r, r-TY0 'N F + r, 1411 A bre A k ROP9 -A M 'iii RECEIPT SI1113-TOTS(, CONS'l[R5, I "i'(1: N , NT) PLAt'�' i '?1)FCy} LESS PRE PAID FEES °.iCt)°IfAL P.f. HIMIT FEEN [ IJE MW DATE BY I DATE FINALED IINSPECTOR SORN) 5029.69 lf?-2tiO3 '��FC).lsi ti't`7fON� ; kVY44014 i -FP - RF`41) 101 AW1,11114Wtj RECEIPT SI1113-TOTS(, CONS'l[R5, I "i'(1: N , NT) PLAt'�' i '?1)FCy} LESS PRE PAID FEES °.iCt)°IfAL P.f. HIMIT FEEN [ IJE MW DATE BY I DATE FINALED IINSPECTOR SORN) 5029.69 INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVAL'S MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings ,v l� 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. v Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Qpywall - Int. Lath Final Final POOLS - SPAS BLOCKWALL APPROVALS Steel Set Hacks Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final Gas Piping APPROVALS Gas Test Electric Final Waste— Heater Final ater Piping L_ Plumbing Final op Out Equipment Enclosure Shower Pans O.K for Finish Plaster Sewer Lateral Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test Appliances Final COMMENTS: , Final 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 Temp. Use of Power Final Utility Notice (Perm) Building _5 – 4,f5 t^ \ Address J � r•��,,,�J Owner �/ , d- Viow Cont 0 4 a" P.O. BOX 1504 APPLICATION ONLY a7,8-495 CALLE TAMPICO WINTA, CALIFORNIA 92253 Tel, 7f? State Lic. Lr� Fity 8 Classif. �QjTG ic. # Arch., Engr., f Designer C. (� I r -k Address / G2� TSK _ Cit \ Zip State y J� (223 Lic. # 330 �... LICENSED CONTRACTOR'S DECLARATION I hereby afrfirm that a icensed under provitions of Chapter 9 (commencing with Section 7,000) of Digisj6 3Mof �u`sing`ss an Profes Pons Code, and my license is . full f c nd effect. 1[Yl �GNATURE _ ATE 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 (5500). 1__1 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, 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 irimprovements 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.) 1'1 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.) 1-7 1 am exempt under Sec. B. 8 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 n 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 thg 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., U, 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 a0plicant Date Mailing Address City, State, Zip LDING: TYPE'CONST. OCC. GRP. Number Project`%escnption, U' -0t " , Sq. Ft. ljj(Q .. `Q'� No. No. Dw. Size 11 �t ( _Stories Units New ❑ Add Alter ❑ Repair ❑ Demolition ❑ 437r- x 77, y I xA P- Lstimateo valuation PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. • Const. Mech. ,59 Electrical MAP1.310 Plumbing Ilk 39.00 S.M.I. Grading 2-0-00 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 Desert Sands Unified School District 47-950 Dune Palms Road Notice: La Quinta, CA 92253 Document Cannot Be Duplicated 760-771-8515 CERTIFICATE OF COMPLIANCE Date 8/26/99 APN # 769-830-021 No. 19249 Jurisdiction. La Quinta a Owner NameRobert &' Vera Brown Permit # No. 55-495 Street Southern Hills Log # City La Quinta zip 92253 Study. Area Tract # Lot # 5 Square Footage 637 Type of Development Residential Addition Comments No. of Units 1 ' 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 637 or $ 1,229.41 the property listed above and that building~:`' ' -- ,i�;;: ,4L -.r.. permits and/or Certificates of Occupancy for this square footage in this proposed project may now�fLtie issued Fees Paid By CC/1 st Bank/ Bob Edwards{~ Teieph6,n 775,47933 Name on the check U, By Dr. Doris Wilson "c>- •� r Superintendent Fee collected /exempted by Sylvia Carrasco Payment Received $1•3229.41 Check No. 51581 Signature f 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 ovewill begin to run from the date on which the building or installation peril for this project is sssued or on which they are paid to the District(s) or to another public entity authorized to lled 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 JUN -17-95 -:THU 3: 06, PM MONARCH GROUP FAX 110:. 6.19 776 5111 F. t -'I PGA WEST II RESIDENTIAL ASSOCIATION J ; INC.1. ' y r • RO. BOX'1'282 LA QUINTA CA 92253 TO (760) 776=5100 TAX (760) 776-5111 May 28,1999. t r ri Mr. & Mrs. Robert Brown 55-495 Southern Hills La Quinta,. CA 92253 - - Reference:- Architectural Change Request for 55-495 Southern Hills Dear Mr. & Mrs. Brown: y 'Your plans to add a Casita'to your home dated May 21, 1999, and presented to the Board at its ' May 24, 1999 Board meeting, have been approved with the.following notations: . r Your plan dated February 15, 1999 appears to have two (2) wall mounted Ilghting fixtures` Please be advised that you should have no, additional .lighting fixtures on: the front of the casita.. • Per your' letter..dated April .30, 1999, you will not be� using ledge stone trim detail and will change the entry gate area~to have a .tile. roof in keeping with the surrounding architecture. • Your street side landscaping must be compatible with that of your neighbors and contain trees, shrubs and ground: cover per the Association's approved plant palette: Meyers ferns and Cresste boulders do not meet these criteria and must be deleted from.your_plan. • Association, Landscape Maintenance Contractor and Valley Gardening Service to, coordinates any Irrigation changes associated with this change., The. property . 9 P f�e�Y; foreman, Miguel Valenzuela, can''be reached at 760/399-1844. Approvals-glven by the Architectural Committee are good for only six rid nths from the date on the approval letter.. After that time a new application must be submitted.. If you have any additional questions or -concerns, -please do not hesitate to.contact Carol Fuller, . Association Manager, at 760/776-5100, Ext. 20.•" ; Sincerely, +' y PGA WEST A. RESIDENTIAL ASSOCIATION For the, Board of Directors , Carol Fuller , Association Manager cc: Board,of Directors , i/ Unit File .. _ - -