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9904-230 (SFD)- LICENSED CONTRACTOR DECLARATION 1 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 # Lia Class Exp. Date � ( 4,253f t 13 ,07/31i20f Date �+ u .Signature of Contractor a� , a OWNER -BUILDER DECLARATIO I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the following reason: ' ,,,t f - ( -) • . I, as owner of the property, or my employees with wagesas their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business & Professionals Code). 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. (�) 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. S J'ATG FUND 124,0990 (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' compensationprovisiolnis� of S ction 3700 of the Labor Code, I skull ferahwith comply with hose prauiLions " 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 authorize representatives,of, this City to enter upon the above-mentioned property for inspection purposes. p j Signature (Owner/Agent) \,r D(I LCI I1 I BUILDING PERMIT PERMIT"14434 DATE VALUATION S. 93,814.84) LOT 3 TRACT BV9, IR 1 / JOB SITE ADDRESS .53-065 ktt''MIDA Vit11..i.UO APN 774-052-015 OWNER CONTRACTOR/DESIGNER/ENGINEER T)AVID ROSS MILLER PACI°FIC'TI.tAm,s CC?NS'I'ltIJcTioN 1719 S'I'i RIVION'C r` / . 1719 S Tii.Etvil.►N'.a' S t"3C EANSIDE CA, !r2054. S 0CUAN1,31D E 92054 �760196741f,W Coll# ,955 USE OF PERMIT SM - K'tivi' T DOkS NOT IivC'l.UD I'3t,OCK WALLS Oi2POOL TRACT C:O:tv°,AMUCTION I,500-00 :3„ FUW.'1IrPAT C) 10.00 3F F.STIMA , D COST OF 0DIN iif'RUC' ION 9.3,814,80 PERWIT I'FEK SUM MARY C'f_�1+f S'i'tt1JC:7'.I��N F.E1»:. 19 t -{I(1(1-4 i 3�-{PtJi) �612.'�► T, AN CH Ff.T I(?3-f}Of1.4�0.3iR R4i,5;�s RRIZ 1;.ET10 71T 10-1-000-439.313 1v3F.C,1WQCAL FEl's joi-U{N?-421-000 $53.IV) E1X1CfRICAL i•'k 10I-4N3!}-A"IU-Ct0(I fit �7.'l8 4';MI-M.13.oAFG FEE 1Q1 fi100-9i4 �N3(7 3128.78 STRONG 1tiiM10IN" RAI- R12,141.C) 101-4)00x241-000 u9,3 GRADING FEE 10140-423;400 52e1.Ofl twIifwR.Lff.: rLgzis Fu,1 +- 2'25-000-+143-342 i�RIiC'(S Pi.AN 101-000,4.41-345, S1000) iR-'tY:1'f {, 4,C1 S"'!' tt l4't"t4')R 7rjr1 Ta�,A CHECK $3,647-6? LESS PRE -PMD .FEES 4250,00 to 134A I D %'®`€'Ai."[tt1li'1;' Fer"' Now S3.397.62 JUN 0 41999 t �'I' RECEIPT.%,Ty ® AT,• Eq �g A�� B, �� x DATE FINALED INSPECTOR 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 _ q 57 Compressor Insulation — (o - F s• 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 Z S- BLOCKWALL APPROVALS POOLS - SPAS Steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Pibg. 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 Appliances Final 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) 57 COMMENTS: ` . '-' ..1r..' , ,.. .ly-'!'L,l�--.,T .- .r. -..---.y.. w-,.. �r.k .. ., .... 3.�' ,,.�+...r. J... _ _ .�--•�-_ r P.O. BOX 1504 APPLICATION O LY' Building A , V� 1 `, �' 78-495 CALLE TAMPICO Address H l l� LA QUINTA, CALIFORNIA 92253 ner Mailing Address City Zip Tel. Address City lZip Tel. State Lic.City R 5r & Classif. `S ;-` 7 ` • >, CR' Lic. # Arcn., tngr., Designer Address Tel. CityI Zip I State I Lic. # t - LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am -licensed under provisions of Chapter 9 (commencing with Section 7000) of Di'vision 3 of the Business and Professions Code, and my lice in full rorce and effect 4 \\�\ , t 4±{ i ( If^� _SIGNATURE\ .'T_ �+ 11 "7 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 bast 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 (8500). 17 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 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 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.) 1-1 1 am exempt under Sec. B. & 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 (7 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 ing 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: ff. 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 ateMailing Address City, State, Zip ILDING: TYPE'CONST. OCC. GRP. '. Number )al Description eject Description { �� Sq. Ft. LL No. Size Stories New ❑ Add ❑ Alter ❑ valuation No. Dw. Units Repair ❑ Demolition ❑ PERMIT AMOUNT Plan Chk. Dep. �s(� 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 x Issued by: /� Date Ppit,4 t P _` 9w". Validated by: c O 6 Validation: 79gg IV. 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 Y Date 6/4/99 Y APN # 774-,052-015 No. 18855 Jurisdiction La Quinta Owner NameDavid Ross Miller Permit #9904-230 No. 53-065 Street Avendia Vallejo Log # City La Quinta zip 92253 Study Area Tract # B219,U21 Lot # 31 Square Footage 1500 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-named owner is exempt from paying school fees at this time due to the following a reason: - EXEMPTION NOT APPLICABLE This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of 1.93 X 1,500 or $ 2,895.00 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 Pacific Trades Construction TelephoneF 760/967-0069 Name on the check ' By Dr..Doris VVi1so Superintendent^ Fee collected •/e erupted -by A JiRie O'Neil Payment Received $2,895.00 r Check No. 13488 Signature F TICE: Pursu of Assembly -Rill 3081 (GFIAP549, STATS. 1996) this will serve to not fy you that the 90 day approval period in which you may protest tha fees orother payment identified ove will beg' o run from the dale on which the building or installation permit for this project is sssued or on which they are paid to the Districl(s) or to another public entity authorized to llect 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 Case logged and number assigned \j ` Verify legal and'APN information �j n Consistent with MDG on file. las applicable), MDG filing required,(5 + filings since 9/3/98) — .-C-onsistenc-y.-with-street/surrounding-area: F ' Colors ' Materials. v Architecture vt 4 [16 [AG OTHER REQUIREMENTS: The zoning code, architectural and landscaping manuals,-and/or assigned inspector should be'corsulted where uncertainties arise. The completed checklist shall be-maintained in the! • Building:& Safety address.'file. { Certificate .of Occ u-panc T City bfLa uu nto Building and Safety Department �MoFti° This Certificate issued pursuant to the requirements of Section 109 of the Uniform Building Code; certifying, Mat,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: 53-065 AV.ENIDA VALLEJO " Use Classification: SFD - - -Bldg,, Permit No:: 9904-230 Occupancy Group; R 3 Type of Construction: VN Land -.Use Zone: RC - Owner of Building: 'DAVID ROSS MILLER Address:. 1119 S.TREMONT City: S. OCEANSIDE, CA .92054 By: STEVE TRAXEL Date: 12-8-99 Building Official POSVIN A CONSPICUOUS PLACE