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9806-123 (SFD)LICENSED CONTRACTOR.DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of I- Chlapter 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 c WIC, Date Signature of Contractor U/3114)8 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). r , (;;; I, as owner of the' property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business & Professionals Code). ( �l1`a'mexempt under Section B&P.C.JA his reason yDate 0 g ' Signature of Owneri�� 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. (yJ 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. 7 A.NJ 17. 170 00 SIF (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 'CC/de, I hallh comply with th s'�p�ovisions. �,©ate: Applicant— Warning: pplicant 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 p4 -r on 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 i . spection purposesg -.• ± Signature (Owner/Agent) Dated / g t PERMIT# CONTROL# . BUILDING PERMIT 9806_1 2.3 . DATE VALUATION 2'9 ..,4if LOT TRACT 4T94 C /L r� JOB SITE S v APN ADDRESS 51-301 AWN10A VALA.WO 7,73-oss-o'15. OWNER CONTRACTOR/DESIGNER/ENGINEER If.X E IMACI L CUMEL QA'NERI BUILDER WI'1',•1 CV14C S-1` 113 `I`E C0M.A r\.VC 45701 MOiVROE dN llla CA. 92201. • I.N DIO CA 99-01 (70li1347-3157 MIA USE OF PERMIT Ss D (i3lrz ;L-) _ PEiiTvfii',DC CKS did:+'!: R14Ut. al7E"Al.0c';K WAILS 01-1, POOL. 1>302.00 sr, l�J.t`cC'tf/i'Fl1'it3 1�'.i.6`0 Sr . fltililCAR14.3i'I' E'i.t1t)'S1' .M'i'l, tY'i Y.i�ll Jv<i McXtrSY''1� 4,i�'t.si�i'+Jfe l��►.+f.+4..id,.4��V fi�a�i.y�'r..aYi $'!';RAI eTM SUMMARY +v'QNS1'l2idC,!'10N irl~Y—, 1.131.-•000-4.18-000 -KA14 CIIFc, K ITF. $47Z90 l4.lt::UILA;htlt;'AL F Es101�ClOQ 481-•000 b�!<►.5U 1311 IC(I.1kiew, Ff!&K i01.-000-420-tiflsJl 5119.4:1 Pl,U1VfB]I NG FI EE 1014)0-40-000 S121,50 S'?•it 00 $4.29 GrL�� tNC;,1> 101 -000 -423 -OW $20.00 fl4rP1A.."s'1'}!.'M__ri, RLR l..F: 225-1300-4'14':3-342 l.Si8. i2. ,PR1rME PLAN 101-000-441-345 $25.00 t:rt3=!i t'A.L C(?N+?"1'iZt ►C.—FION AND MAN !;1•°1 CX. $3,199 32 LH.:,S PRE-1'Altrt ILFFFI $0.00 '!"CD7A)" E'F`f li rr ih foliN 4)i.W'Ni3i3• L� RECEIPT DAT jt BY ► DATE FINALED INSPECTOR OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs jr Underground Ducts Forms & Footings! Ducts Slab Grade J Return Air Steel -!YCombustion Air Roof Deck 150,1049 Exhaust Fans O.K. to Wrap F.A.U. Framing - 7 Compressor Insulation - Vents Fireplace P.L. Grills Fireplace T.O. Fans & 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 8 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 Appliances fff Final COMMENTS: Final Utility Notice /17 (Gas)1747 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 t Final Utility Notice (Perm) Desert Sands Unified School District , 47-950 Dune Palms Road Notice: La Quinta,, CA 92253 Document Cannot Be Duplicated 760-7171-8515- CERTIFICATE 60-771-8515-CERTIFICATE OF COMPLIANCE Date 6/29/98 " APN # 773-083=015 No. 17241 Jurisdiction' La Quinta Owner NameCoachella Valley Housing Coalition Permit # r No, 51-301 Street Avenida Vallejo Log # City La Quinta Zip 92253 Study Area Tract # Lot # Square Footage 1,302 Type of Development Single Family Residence No..of Units 'l Comments At the piesent , 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: I EXEMPTION NOT APPLICABLE This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of , 1.93 X 4,302. or $,1,512.86 the property listed above and- haCbufldiug +,tt permits and/or Certificates of Occupancy for this square footage in this proposed projectNn'ay noon; be issued. f . 41 Fees Paid By Cashier Check/B of A/David BrudvikTelephonr4=3157 Name on the check By Dr. Doris Wilson Superintendent Fee collected /exempted by j Juanita Green Payment Received $2,512.86 ` Check No. 2009915354 Signature f TICE: Pursuant of Ase bly 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 identfied ove will beginrun the date on which the building or installation permit for this project is sssued or on which they are paid to the Districts) or to another public entity authorized to llect them on the Distri ('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