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9806-054 (SFD)LICENSED CONTRACTOR DECLARATION 1 hereby affirm under penalty of perjury that I am licensed under provisions of CtPapter 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 CVHC Date Signature of Contractor OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's t License Law for the following reason: () I, as owner of the property, or my employees with wages as their sole E compensation, will do the work, and the structure is not intended or offered for r sale (Sec. 7044, Business & Professionals Code).; � ( ) 1, as owner of the,,properfy, am eicjusively contracting with licensed contractors to construct the project (Sec.' 7044,',Business & Professionals I Code). ( ) I�am exempt ^under .-Section . r ; B&P.C. fo this reason VD a a Signature of Owner W WORKER'S COMPENSATION DECLARATION !' hereby affirm underl 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. ' TR[iCi INSURA*W-M IA2W7 4370 00 06 i (This section need not be completed f 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 th s� provisions. ,Date: g 1 9 Applicant 0�>-� 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. l agree to comply with all City, and State laws relating to,the%Building construction, and hereby authorize representatives of this City to e' er upon'll the above-mentioned property for 'ct pection purposes. ' +`r "t ,Signature (Owner/Agent) Date �Vn 1 BUILDINGPERMIT PERMIT# :• ^CONTROL# + 9806-0.34 DATE VALUATION LOT TRACT tis JO4AIT ✓ ( V ADDRESS 51400 AVElIDA VALI,U0 APN , 773-4484-018 OWNER CONTRACTOR/DESIGNER/ENGINEER GABRIE.L IMA.P.UNEZ7 OWNER 11 BUILDER ivrnq evflC 81: 51 AVE 46,102 45701 MONROE ST STE is I DIO CA 92201. 2201- ' INDIO'.. CA 92201- :(760)347-31 7 •, CBI O • r ._(76q)3447-315-7 `" r USE OF PERMIT Fla - SFD (I302DR) - PM21T DOES NUT iNC.UbE BLOCK WALLS `Olt POOL. TRACT CONSTRUCTION 1,302.00 SF P0te.'vW1kT10 1.50.00 S1; GARAGMARPORT 517.00 SF ESTIMATED CWF O (:ONST RUCTION. 82,4946.50 PLRINH i`F'EI SsUM1ti A Y CK)NSTRUC"1'1'C3'N FEE 101-11Qii418-000 $563.00 P!r . JN CHECK FEE. 10t -00Q-439-318 477.90 MECHANICAL PEE, 101-000421-000 $flO.Sfl ELECTRIC,AL fTE 141-000-420-000 S119.4 PLUMBING FEE 1.01-000-4.1.9-000. $12:1.50 STRONG MOTION FEE - KEE= 101-000-241.000 GRADING FEE 1.01 -WO -423-000 s2obo INFR.ASTIZUCTURE.FEE 225-004-443-342 51,81$,72 PREC'(SEPTI M 101. -000-44 J -X45 625.00 'gWEL-QAL CONSTRUCTION AND PLAN CHECK A I.. 'SS' Pit1r-PA11)T11'sFS $0.00 JUN T•DTAI<.. PER114:I.T FEWS .DUE'iaiOW $3;)89:3.2 a RECEIPT : DATE BY f' '— . DATE FINALED INSPECTOR {' z+ INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck ( Exhaust Fans O.K to Wrap F.A.U. Framing 4 -2 r/ Compressor Insulation — Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath 4 —,2- ZDrywall Drywall- Int. Lath X- -- Q S Final 7 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 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 6 - (0 - pAppliances Appliances Final COMMENTS: Final G Utility Notice (Gas) // l / S 7 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 �y Final Wfiity Notice (Perm) Si Desert Sands Unified School District t 47-950 Dune Palms Road s: Notice: La Quinta, CA 92253 Document Cannot Be Duplicated 760-771-8515 CERTIFICATE OF COMPLIANCE Date 6/16/98 APN # 773-084-008 No. -17185 Jurisdiction La Quinta Owner NameCoachella Valley'Housing Coalition Permit # No, 51-400 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 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 mobilehomes. It has been determined the above-riamed 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 1,302 or $ 2,512.86 the property listed above,and that' building permits and/or Certificates of Occupancy.for this square footage in this proposed project may now be-issuedfe , Fees Paid B Cashier Check/B of A/David Brudvik ` y Telephone: 347-3157 Name on the check za.� By Dr. Doris Wilson ,T Superintendent ` Fee collected /exempted by Juanita Green Payment Received $2,512.86 ` r Check No. 2009914990 Signature NOTICE: Pursuant of Assem y 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 identifiedabove 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 collect them on the Districl('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 t� 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-riamed 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 1,302 or $ 2,512.86 the property listed above,and that' building permits and/or Certificates of Occupancy.for this square footage in this proposed project may now be-issuedfe , Fees Paid B Cashier Check/B of A/David Brudvik ` y Telephone: 347-3157 Name on the check za.� By Dr. Doris Wilson ,T Superintendent ` Fee collected /exempted by Juanita Green Payment Received $2,512.86 ` r Check No. 2009914990 Signature NOTICE: Pursuant of Assem y 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 identifiedabove 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 collect them on the Districl('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 f{ _ ' +�fl••',ry' • 'r Jk+r•� -'r. n "' v...,.r r �•,,rV �r rL+vJ.�1�""%r�"'-'"-•` .1': ,i- �,tY�'•:. ",�C...,fi'y�h'4Et'�,ry -•- � ; �'".... Twit 0 u�,tcv P.O. BOX 1504 APPLICATION ONLY Building•.. 78-495 CALLE TAMPICO Address j —q00 A�� il69 "ieS� LA QUINTA, CALIFORNIA 92253 V v-- 6sW 41 t 4 M fiteY1 NE Z. Mailing Addresses J �eo ,/02— V City IZi4ZZ Tel. /N0i0 0l 3(41—COS G OWik(6L t3aAL,002— Address State Lic.I City & Classif. Lic. # Desig„y, , ner Address Tel. ' City (Zip (State I Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is In full force and effect. SIGNATURE DATE 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 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). l: 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 .'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.) 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 contractoris) licensed pursuant to the Contractor's License Law.) I'] I am exempt under Sec. B. 8 P.C. for this reason Date(0 2�Owner Ae PAR OWN6712 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. O 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 lhp 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. BUILDING: TYPE'CONST. OCCG.fGRP. A.P. Number -7-7*3a 01a 4 —0© Legal Description ,� p Project Description-% 1 i qLp— I I1 e-5+ ii Zt4 y Sq. Ft.No. / No. Dw. Size f�40 Stories Units Add ❑ Alter ❑ Repair ❑ Demolition ❑ on PERMIT AMOUNT Plan Chk. Dep. 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 CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line 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.) Side Setback from Property Line Lender's Name Lender's Address FINAL DATE INSPECTOR This is a building permit when properly filled out, signed and validated, and is subject to expiration it work thereunder is suspended for 180 days. I certify that I have read this application and state that the above information is correct. Issued by: Date Permit I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives sof this city to enter the above- mentioned property for inspection purposes. Validated by: Signature of aOplicant Date Mailing Address • ,.,_�•;a+,-a»�'"'-°1 v V_ali_dation: City, State, Zip zi WHITE = FINANCE YELLOW = APPLICANT 1A. PINK = BUILDING DIVISION Coachella Valley Housing Coalition i` Plaza I, 45-701 Monroe Street, Suite G., Indio, CA 92201 TEL: (760) 3474157 , FAX (760) 342-6466 _ !. . e ATTORNEY-IN-FACT AGREEMENT I/We hereby appoint COACHELLA VALLEY HOUSING COALITION, and/or any of its authorized agents as my/our attorney-in fact.for the purpose of executing any notices'of completion, waiver, of liens and/or executing contracts,with subcontractors, and/or release of liens and/or, handling buildingpermits relating to that Certain real property described below. All that certain land 'located and being in the County of Riverside, State of California, described as'follows:, LOT 17 OF BLOCK 65 OF UNIT 6 OF SANTA CARMELITA AT VALE LA QUINTA, AS SHOWN BY MAP RECORDED IN BOOK 18, PAGE 67­.OF' MAPS, RIVERSIDE COUNTY RECORDS. D to GABRIEL MARTINEZ k6- Date R INA MARGARITA MARTIN --Z f:\sfamily\anna\mi.spfor\attnyfa