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9809-099 (SFD)_LICENSED CONTRACTOR. DECLARATION I_h6reby 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 # L -Class CtaSS Exp. Date 355655 ..... t'DateJd / / Signature of Contracts OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's f License Law for the following reason: ' ( ) I, as owner of the property, or my employees with wages as their sole• 1 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: (.) Ihave 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 STAfE.E<UM Policy No. 229`•�9P MIT 001` 7_ (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 th�f�l should become subject to the workers' compensate n provisio f *bf Sectio 3700 of the Labor C6de, I shall forthwith comply with„t ose ,rovisio s.:�,�' q)ate: 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. t A. 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 1 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 informationJI ' % 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 e the above-mentioned property -or inspec on purposes. { / Zar ature (Owner/Agent) '- �-- J Date c�tP - PERMIT#- ICONTROL# BUILDING PERMIT 9809-09 _ DATE VALUATION ,rf 9 ".M.So LOT '17 TRACT # I ) pepy SS JB`8G0A'��TDAVALD�30 T74-1& 06 s%ADD �. OWNER CONTRACTOR / DESIGNER / ENGINEER .,FUCHAR.D L SWALV1 . RICHARD LSNV.ALVE TSO BOX 5461 LA. QUfWb\- 0. Q2153 .: PO .SOX 546 LA QU1NTA CA. 9235; CANYON LAIC Cts 92587 CANIV'ON ): A:1KC:1 (,.A 97587 (7isflji7.l,ti tit 03L.If 1784 USE OF PERMIT 8rT3 ^ .P1_"1lT DOES NO tDICLU X, BLOCK WALL 012 POOL ZRACT CONS TRWHON 1.624M SF �°l�2'�G2�fk�.eA'fli3 15C+.4U �� (JAIRAODCAffi"Off 501.008F 1.: ' A CSTIR.11t'!a!i'ED C0N.S`s'T1;iJC'"(70N FK- 101-000-419-000 $63y_50 PLAN PTTI IW6 90 101.-OW439-318 MECHANICAL PEE 101-OOLI-421-000 $33.50 EL1+.4: WCAL FPE 101-000-420-000 $.130.36 t'.I,{. /[H1!�(Cs.F`Eh 101-C1( 0-c11. -l1C10 $ -Vi -7:5 S7.1i0140NIOTION E Z - RES -1D 101-000-241.000 ORA,1DIN i Asir,. 4 101-000423'1" 3NEi2A&t]iUC YLR.F' FEB 52.205.06 PRHOlS►�'.t�?,.t N 101-0)Q?r Q1-314 I .(t0 _ LESS PRL-FA;t1)FE1,8 41250.00 OCT 2 6 1998 TO ZC'A.BJ .6.'ERINUT F1�,F S DUE, NOW S1,505,07 0F LA QUINro�� RECEIPT DATE BY DATE FINALED INSP€GT9R INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms 8 Footings Slab Grade ui �, , � Ducts Return Air Steel Combustion Air Roof Deck / �� -� Exhaust Fans O.K to Wrap Framing aa T_¢ F.A.U. Compressor Insulation �i� Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath Final BLOCKWAL APPROVALS Final POOLS -SPAS steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location j(4� .� Underground Electric /� Underground Plbg. Test Final I 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 C MMEN S: Q/ 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) Desert Sands Unified School District a 47-950 Dune Palms Road - - Notice: - La Quinta, CA 92253 Document Cannot Be Duplicated 760-771-8515 - tt CERTIFICATE OF COMPLIANCE Date 10/26/98 APN # 774-163-008 No. 17916 Jurisdiction La Quinta` Owner NameRichard L. Swalve Permit # . No. 53-860' Street Avenida Vallejo f Log # City La Quinta Zip 92253' Study Area Tract # Lot # Square Footage 1,624 Type of Development Single Family Residence No. of Units 1 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 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: F ` EXEMPTION NOT APPLICABLE This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of ' F may.. 1.93 X 1,624 or $ 3,134.32 the property listed above and that build"!. ing,'�'+ s ' permits and/or Certificates of Occupancy for'this square footage iii this�proposed project ma�now b'e issued �, ... Y/ r Fees Paid By CC/Bank of America/Richard Swalve Teien ►one ft71'•5452; Name on the check By Dr. Doris Wilson Superintendent Fee collected /exempted by Juanita Green Payment"Received" $3,134.32 Check No. 2012644172 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 identified above 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 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 .r P-6 Tity/ " P.O. BOX 1504 78-495 CALLE TAMPICO VL I E? Td LA QUINTA, CALIFORNIA 92253 VV 144-Vf=. t '_N 1 G 1� � (> L I Mailing Address CJ e_4la 0J 6g. S City Zip Tel. 4,Jyuv L*Kr ga,skl� Auu 91 r..om ctor I a Zip State Lic. I City & Classif. 3 ,CSC, _�!J. G Lic. # Arch., Engr., Designer Address I Tel. City IZip I State ,I LIC. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 70001 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't"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). 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 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.) 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 contractors) licensed pursuant to the Contractor's License Law.) I ] I 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 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 thip 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, atter 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 applicant -Date - Mailing Address City, State, Zip ='A APPLICATION ONLY ILDING: TY -7 q — / l 3 GRP. '.Number r. Number --7-7q- -7Q )al Description • L % T v k) o0_' ate. Iject Description 4_14� F b`7 Sq. Ft. No. No. DIN. Size /6,17 Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ PERMIT AMOUNT Plan Chk. Dep. `> 0 • o� Plan Chk. Bal. Front Setback from Center Line Const. Rear Setback from Rear Prop. Line 4 Mech. Side Street Setback from Center Line Electrical "int Side Setback fro y e Plumbing FINAL DATE S.M.I. Issued by: Grading Driveway Enc. Validated by: Infrastructure �l1-YOF L1 JwT.a Validation: TOTAL REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line 4 Side Street Setback from Center Line "int Side Setback fro y e FINAL DATE 1 S ge Issued by: DateEP I �r'f?ermit w Jp Validated by: �l1-YOF L1 JwT.a Validation: WHITE = FINANCE YELLOW = APPLICANT Y 1 i PINK =BUILDING DIVISION