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0111-167 (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 Date 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: (c�if I, as owner'of the property, or my employees with wages as their sole, Eohipensation, 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). () .l am exempt under Section B&P.C. for this reason Zate 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 Policy No. (This section need not be completed if the permit valuation is for $100.00 or less). (6 1 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. '15ate: 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 authorize representatives of this City to enter upon, the above-mentioned property for inspection purposes. = w � A Signature (Owner/Agent) Date_'; f BUILDING PERMIT PERMIT# DATE I / VALUATfON r�i�t� LOT S TRACT ADC JOB ADDRESS 78 745 AV�kV � yYq .y��A( APN 70 y* OWNER CONTRACTOR/DESIGNER/EN (NEER, :Kol3wx H ;EyTzim OWNER 33MI.Z'J R PO OX ) 226 LA QUAI°x'/`a C A !V1253 MMJ USE OF PERMIT SIM . fl•DT d: 114 Uatf; BWCK WALL4 POOL, SPA OR T)RNWAYAPPtii3AC'H TRACT;MINSTRUC"T];C;'H ;I,1 $0.00 SF PW%C<Hh11.AT10 402.00 SV fti�.11r�C)S?b"C F�i'C3 i'1' Q6140 SR UT.lxk! C(M OF iyOi' MUC:'DON 1891&17120 . �V811R 7'.I�.T..•O'.lSr� CS f.i111.73�'1.h3.61�y CONST `RUCTION X 10100? -419.00 ► 95A,5 it PIAN C'I'TiECK WE s-tv' 'i =DEPOSIT -ISM00 MECHANICAL,MP, 101-4200-421-000 $65,50 ELEC1?FUC AL 1+`i1 101.000.420.000 t 172,47 PLUMBI'A O FEE 101 _000 -415' -tit; $16..9.'75 S.lsR,O3t0MOTION FRE -R&SID 101-000.241#000 VISA ORAI INO11 E 103-000.42,3-000 ,: MEWR C IMPACT F E ,f , rM a tt PC ' zi3T 1 R " , qt r C F is $4,117.60 IM -3 PRrEXPAM IMUS -V250,00 T(XrEAL VR1?h1rC FEES DUE NOW 0,667,60 CITYC)FLA111ItVIAP -� pop RECE ) l CI F, ti . BY DA FlN7 / INSPECTO INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE TINSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs f4- U3 Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck _ Exhaust Fans F.A.U. OX to Wrap —Q Framing - Compressor Insulation _ _ _ Q v� Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Line. Party Wall Firewall Exterior Lath Drywall - Int. Lath 9=t-7 Final Final-�_ U �' _ 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 Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Sewer Connection 7=1� �j� 4 Gas Piping _ Gas Test11- Appliances Pool Cover Encapsulation 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 —03 Final Utility Notice (Perm) Date 11/18/02 No. 23871 Owner /robert H. Price Address City La Quinta Zip 92253 Tract # DCT 5 Type Single Family Residence CERTIFICATE OF COMPLIANCE Desert Sands Unified School District 47950 Dune Palms Road La Quinta, CA 92253 (760) 771-8515 APN # Jurisdiction Permit # Study Area No. of Units 4���FiEDsc�o �c=��1�1IZ2� or Q BERMUDA DUNES RANCHO MIRAGE INDIAN WELLS d d� PALM DESERT y ^ LA QUINTA INDIO VQ © .Y.J 770-092-006 La Quinta 0111=167 1 Lot # ' No. Street S.F. Lot # No. Street S.F. Unit 1 2 78745 Avenida Ultimo 3150 Uffit 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 or 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 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 3,150 S.F. or $6,741.00 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 America - Robert H. Price Check No. 2013188987 Name on the check Telephone 564-2617 Funding Residential By Dr. Doris Wilson Superintendent Fee collected /exempted by Juanita Green Signature $6,741.00 Payment Recd Over/Under NOTICE: Pursuant to Go mment Code Section 66020(d)(1), this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified Above will begin to run from the date on which the building or installation permit for this project is issued, or from the date on which those amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier. NOTICE: This Document NOT VALID if Duplicated Embossed Original - Building Department/Applicant Copy - Applicant/Receipt Copy - Accounting 02/23/12002 16: 46 7605641202 DESERTHOMEDES.I�lERGS FAME 01 n "Ea-27rP042 0E1:18 FRQM:Lfl f'ts81_FL WOR 760-777-TI55 TO -r0 ;: —i: P -.I I - fwd � � ��•, i tTA it E F E 37 2, 7 2002 78-405 EALLE TAMPICO ' %A MAMA. CA 812Wa 47" 777.7076 .e mai �$`'� c�t«' s�.•.a�„v} t APPLICATION *- -+10 Utz. --- ,990CP FLOOD PLAIN DEVELOPMENT PERMIT �44w _ BUILDING SITE LOCATION FLOW Zags aIi4 COMAdllttlt'tY• PANEL NUMEOR t -A 6?10(0-rh . -11*3 Z. �: pi 4 p(i8511 _ AMICANT INKAWATtow KCtwtti :fit 1N�.--++en.+a...+..�•..v�w+.�+..++..r.3.n..1. Yf..a..--e APPLICANT NAME A - ADP6 1110 APPLICANT ADDRESS �.•►�' Ott a 0`I1A CA •OLZZ,VS *rat aloe seAAutrM �tnstgar¢. eaT ram ntn, ..- , p.�..---•........�,a.a�..-._ ._..�y>� mea... 0AYT1ME TELEPHONE NO, INSTRUCTIONS a A Flood Plein Development Perth is roWlred UY LOWIC Section $,t 1.040(Al, Ttie A.pptiemtrt shfluW CoMplete the Applicant tnfomtetion portion of this application and cvbrnit it to the Engirlepemo mfrs t>l atdnat eAIN. Me tegv►rod docuMoMation rotW h6rean at tete anme time the Precise Grad" Ptun i& s± xbMittad w tha Rultelfto qmd gaiety Depertmt nt for plan mcking. 2. 00curnentellon regtltred for STEP 1 OF 2 AFPRf?VAL prior to fecalving Civaronce for OuRding Permit ii-m-eaw--0 • Copy of the proposod Preolso Grading Plan for rovievv and approafil containing all, Intortnatioft require, by the chech4st showr, on the back of Itis application. 3. Doeumentotion required for STiT 2 Of Z AF4` OVAL pr1or to reoeivirtp F100%1 P1010 Deveiopm4nt Pan -Mt ArVrOvul. Noto, this approval ocewn attar itRms for the lowsat hobitebie floor ate set and Won t". RUit(Ii 9 & Wetd Dupattment euthor!•aes foundation construction. w Submit a Comolcied FEMA 'f 10vPVofi Ccrrificott+'` toren to Thi! EIVIne9flrg DOGITA1911a. IF Submit 95%+elmfva density salts aompactlon cettificatlan to tha E=nyineering Departmamt. SIMV?; R AMQVAL Tho Procis• Gnsdinp Plon tubnn lted fat thin eppflaation hue ee+tn A11 requiromtrntr bTrue linen *,M606#4. 1'hts 1:109d FUln towOwed wA fewncl to o4numn OR dW rnqukW to v8U0V 'W0 onvalopittt�m Nm* Ir flpasavad. SAq4t*Mt7nb* of LOMC 8.11 'Tho pK*0#&d 4rvo>8MIX i* 619Wo to relo W6 buftAlnp Permit LqMt tsetlif'�tttp tell oti»f i<! & i!, Sof Rpamntatt tN>k+►r»rrtr. � L N, a 1 nt2TMFmFFP NATUIIL >aATt LA QUITM npinywity t)*v AUfMA HATUA Pa7p . to Culp n arec0t0.nry t}eg� FILE: Uppn Stop 2 rlpprovol, otipinty go" in "tteo4 rw el NAvatopm*m r'omm Tim uwpx vurr w "raw, -V PLAN CHECK NUMBER 7M PCN Please use is Pian h ck Number (PCN) on all correspondence white plans are in plan check y; Certiicate of OccupancyA ,o o . ! 1 i � CI0F'T9 Building & Safety Department This Certificate is issued pursuant to the requirements of Section 109 of the California Building Code, certifying that, at the time of issuance, this structure was in compliance with the provisions of the Building Code and the various ordinances of the City regulating building f > construction and/or use. i u. BUILDING ADDRESS: 78-745 "ENIDA.ULTIMO I Use classification: SINGLE FAMILY DWELLING Building Permit No.: 0111-167 t 1 Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL , Owner of Building: ROBERT H. PRICE Address: PO BOX 1226 W City, ST, ZIP: LA QUINTA, CA 92253 By: KIRK KIRKLAND ;. rsr Date: Februa�2, 20042004 Building Official - POST IN A CONSPICUOUS PLACE d