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0001-085 (SFD)LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of 1,,hapter 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: ( 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). ( ) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business & Professionals Code). O I am exempt under Section B&RC.)for this reason ate Signature of Ownerklp ,6 - 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). 1 I certify that in the performance of the work for which this permit is issued, I 1w, hall 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 provisio s. mate: "// Ekb Applicant �' %1c' •a Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost. of compensation, damages as provided for in Section 3706 of the Labor Code,'interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his application. 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspection purposes. a fiature (Owner/Agent !q4 Date f� 1 r rl BUILDING PERMIT PERMI#ti.v�1�=�yv� DATE VALUATION j11�7gdtY6.���7 LOT A TRACT JOB SITE 5�< 165 A ENIDAVAQsI I�ii.c�Y) APN r 76 -2 2.4 14 ADDRESS OWNER CONTRACTOR/DESIGNER/ENGINEER luaD 0 V I Y 6e'-trl c1lirki vt /nI 0 iit P3 :r 1. 1'ibiY 9.l�F 1�,• .11 Vq l�b_,Jq�4J�f Y1_,S..leli. �F iYW t•=ha4:,t. WAY 79";60 j60QI..1FK�YN WAY . t4hX-NitjDA Di sNFS (A '32201 )WH MI -P )A D4,i?vFS CA 122W USE OF PERMIT 1N" 'vk_.lb, WAy ~h. >v! -o ri?,A11•t• DOl LLl %M -s c 1e�cl. bk !$Lt n_ `' ,V,L.`., tjk P�,A11. d�lvi"Ct �`4!l,v�►A�l�i: z �.ia+r r-,�.1a, rE �n• ESTI YIlATEM CONY OV CONS= t+MON OY114if t43:St)NaMACIAt" . k!(JN.11`i %IC11•tQNF1+1' A01-000-4125-0430_ kj/�M-4W� 'AA�IR G55fa i� PI .. %tw OZZt'1Wy- F -WR 101 �tryry p *'4 , IRE 10' °41Uo 1/ 'ili10� 1�: Y igY4l C11A� N14 I t1L1:'1.k1%!A1.i-. 1411-1b7/i1^-3 J 131iif �)1'?a),.1�3 �1<i���113I�iv 1� 4r'1s lUl-ilil'il-��}'�-U(lt} 31.�i+ t43� s;'t'iZ�it^lt X%1( Yrfo?l VEI. -12} �.1i) 5tt's �a2t�.wlidrs I T�i� e01.'�"u'flt)-•323=C()9 �` !3�itY i° L.Vwj:WER s"`iiik'rAcV 1'€0+; �1�.'i90>e4U P1U,.C'-_tA;,PLAN 101-)0-341-'345 SYtut.ttr► ART 1W VIURIJ(' PT,A.t'*-:,t - tzt•-�;tf `7ti!-tl ti -?55 nt}� l y'l?�rtt X 11' lot 080- 0"_118 f IK-11(11'Al.f'ON, i(`421.t�''�'14.4i!�� ANn Pf,+AA1 C TIP(W �A 1a 7��!•�d,�.� _�f�7. pt.f.�si�y�1`g1r.+�'n-t .i•{J Sh�U iL 11:I �i /)•U LIgL�11�P� 9/ P', NOW' < f.: na /�i K REC�IPT DATA ti BY!) n F F 01 F INsvGrTnG rA • 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 - c1b S 7 Exhaust Fans • O.K to Wrap F.A.U. Framing 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 .tea Final Final a BLOCKWALL APPROVALS POOLS - SPAS Steel Set Backs Electric Bond Footings Main Drain Bond Beam -Z—,::F0_ s Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines Neater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K for Finish Plaster Sewer Lateral Pool Cover Sewer Connection 00 S7, Encapsulation Gas Piping Gas Test , p Appliances Final Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole—a _ Oa 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) COMMENTS: ` N"W� -,z /� Building Address Owner E.1211`t Mailing Address D r --aC_. cr City JZip %"6k% �..1lu f \ Contract+o�r ! Address Cityr—� y t-1 Uri 1\ 1 Jt,.'rt t4 t State Lic. & Classif. Arch., Engr Q P.O. BOX 1504 APP TION NLY 78-495 CALLE TAMPICO AL UZ-30 LA QUINTA, CALIFORNIA 92253 OrL, BUILDING: TYPE'CONST. OCC. G Lic. # Designer �V c` Address 1 } P1.14 -1,r IrA City Zip o -I 1 a<'�t ri ( LICENSED CONTRACTOR'S DECLARATION 1 hereby affirym that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is infullforce and effect. 1 —%tz— SIGNA7URE�- 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 lila 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 fhat. he is exempt therefrom, and the basis for thealleged exemption. Any violation o/ Section 7031.5 by 'any applicant for a permit subjects the applicant to a civil penalty o/ not more than five hundred dollars ($500). I'! 1, 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 /or 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 I 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.) I) I am exempt under Sec. B. 8 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 r7 Copy is filed with the city. O Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WO R KERS' COMPENSATION INSURANCE (This section need not be completed it the permit is for one hundred dollars (8100) valuation 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. 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 will, 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.P. Number -11 A — �'�' - c c� Legal Description [` r7 al-� `% r' V 269 t � Project Description � F17D 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 DAT Issued by: Validated by: Validation: INSPECTOR WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION Permit Sq. Ft. No. Size Stories No. Dw. Units New Add ❑ Alter ❑ Repair ❑ Demolition ❑ C�rj�cY : Gr��IE � ��,�►� 3�d - 3 X28 Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. 4- Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure REMARKS 4F it UTOTAL _WU 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 DAT Issued by: Validated by: Validation: INSPECTOR WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION Permit Notice: Document Cannot Be Duplicated Date 4/19/00 No. 20316 Owner NameJeny Lugo Desert Sands Unified School District 47-950 Dune'Palms Road La Quinta, CA 92253 760-771-8515 CERTIFICATE OF COMPLIANCE APN # 774-212-016 Jurisdiction La Quinta Permit # No. 54-105 Street Avenida Vallejo Log # City La Quinta zip 92253 Study Area Tract # Lot # Square Footage 1658, 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 reason: This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of 2.05 X 1,658 *or $ 3,398.90 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 Jerry B. Lugo Building & Development Telephone 345-4236 Name on the check " ';NJ 6 By Dr. Doris Wilson Superintendent a . Fee collected /exempted by Signature k,,W A 00 1 Peggy Reyes .: '7 Payment Received `,>a $3;(98:90 Check No. 222418 t,:`-` ,•.� 40TICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1888) 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 nm from the date on which the building or installation permit for this project is assued or on which they are paid to the District(s) or to another public entity authorized to ;ollect 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 _ P.O. f3 k 1504 � p APP TIONVNLy - - ,Building : ) f 78.495 CALL E TAMPICO > Are 7 AA -V& %,E,10 LA ouINTA, cauFORNw 9n53 Owner . Ilir G BUILDING TYPECONST OCC. Mailing Address` A.P. Number" �i� ��► C R City Zip Legal Description - COntraC r 7 Proj"scdptlon Q Address City Zip Tel.: State Lic. j City , 8 ClassIf. ✓ 3 . Q Lic. N Sq Fti 'No. Y No. Dv.. - . Arch., Engr., Size - ,7 Stories Units ':.. Designer �`S �,....,I NII4,> -Add O v Alttar 0 - ' Repf3ir 0 DerWitiOn.0 Ad ress Tel. AAX 3 2 Q Ci ZipState LP �r� �[ Lia A LICENSED CONTRACTOR'S DECLARATION I hereby aH that I am licensed under provisions of Chapter 9lcommencing with Section i 7�g00iLof Divis n 3 of the Business Professions Code, and my license Is In full force and NA - DATE • � � ' - � +. .I OWNEWBUILDER DECLARATION F' I hereby affirm that 1 exempt from the Contractors License Law for the following Estimated Valuation mason: (Sec. 7031. S.Bushfbda ess and Prb/essfons : Any CRY or countywMuYr ngisa a pemdt to constrict. afar. krprove, demolish, or repair arty structure. prior to,ft Issuance also relates the applicant for such permit to rile a siprnad amenent trier M is licensed Pursuant to PERMIT ' v :AMOUNT, , the Provisions of the Contractor's license law. CNprs S (corenehdp with Section 7000) of Division 3 of the Business and Professions Cade. or that. he Is exempt dwafrom, and the basis - - - z - + �:' •. for the alleged exemption. Any violation of section 7031.5 by any applicant for a pan Plan Chk. Dep. subjects the appkcant to a civil penalty of nor more than five hundred dollars ($500). C-1 I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal. �' '"''"• ++�...Y,p;,_ n i do the work, and the structure Is not intended Of Offered for sale. (See. 7044, BWsness and Const. •� # n-` Professions Code: The Contractor's License law dbas not apply to an owner of property will builds or improves thereon and Who does such work himself or through -his own employees, provided that such inlorovements are not Intended.or offered for sate. 0. however, the building MBCh. ,. or improvement is sold within one yes of completion. the owner -builder w/ have the burden Electrical of proving that he did not build or &wove for the purpose of safe.) Il I, as owner of the property, amexclusively contracting with licensed contractors to cow Plumbing _ .q strucl the project. (Sec. 7041, Business and Pro/asakss Cade: The Cardreeta'a License Law does not apply to an owns of property who bunds Or improves thereon. and who contracts for S.M.I. "s - such projects with a contractor(s) acensed pursuant to ft Contractor's License Lew.) I? 1 am exempt under Sec. B. 6 P.C. for this reason Grading Driveway Enc. Date owner Infrastructure 1 01 WORKERS' COMPENSATION DECLARATION T I hereby affirm that 1 have a certificate of consent to self -insure, or a certificate of Workers Compensation Insurance, or a certified copy thereof. (Sac. 3800, Labor Code.) - Policy No Company - -� - - - (] Copy is filed with the city. O Certified Dopy Is hereby fumished. TOTAL CERTIFICATE OF EXEMPTION FROM REMARKS _ a . .. _ WORKERS' COMPENSATION INSURANCE (lois section need not be CORplered N tiro pemW b for. am hundred dofars (5/00) valuation - J orress.) 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 Date Owner e._ I NOTICE TO APPLICANT: If, ars madrg this certificate of Exerpoon you shell Daconro ZONE BY: - + _•i subject to the Workers' Compensation provisions of tiro Labs mflr Coda. you ust MwDn comply with such provisions or rids perm, anaf be deemed revoked.. Minimum Setback Distances:: Front Setback from Center Line - - Rear Setback from Rear -Prop. Line CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line ' ri I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, cwt cede.) Side Setback from Property Line• - Lenders Name Lenders Address FINAL DATE INSPECTOR r. - 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. - - _ - •ra`• F ;• 1 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 -of this city to enter the above. . ' mentioned property for inspection purposes.' Validated by - Signature of aQplicant Date ` ! Mailing Address - Validation: City, State, Zip WHITE = FINANCE YELLOW = APPLICANT PINK s BUILDING DPAWN O Customer Depos O Other Remarks: . opy to: k z TOTAL •�Y Water Service - 15, n Cash .r 1 `. CvwD-.3a (tt ise) 711 V, ': F COACHELLA VALLEY WATER DISTRICT ' DETAIL ��2Ry t =• r CASH RECEIPT ,vt-'�3'`!5- 36 Date, oo Received Fro Andress:�K �✓'•`�/ , D.O : ,� Lot(s) Tract. Account No.O G.A. Code ' Srfvlce Address O W •, . Y:. 46 Meter(s) IT - 00fervIce(s) a= ❑ Backflows)' _ ❑ House Laterals) ❑ DetectorCheck(s) ❑ Meter Surcharge z anitation Capacity Charged -AV; O W.S.B.F.C. _ O Temporary Construction Meter =:V ❑ Tum on Charge ❑ Uncollected Account - Name ❑ Inspection Fee - Tract - Fee - - ❑ Plan Check Fees Water I Sewer -, Tract -i O Bond Payment - A.D. - Bond— t. Assmt,4 It S" O Customer Depos O Other Remarks: . opy to: k z TOTAL •�Y Water Service - 15, n Cash .r 1 `. CvwD-.3a (tt ise) n� A . OWNER / BUILDER INFORMATION Dear Property Owner. An application for a building permit has been submitted in your name listing yourself as the builder of the property ' improvements specified. Foryour protection you should be -aware -that as "Owner/Builder': you are the responsible party'of record on such a permit. Building permits are not required to be signed by property owners unless they are personally performing their own work. If your work is being performed by someone-other,than yourself, you may protect,yourself from possible liability if that person applies for the proper permit in his or her name. Contractors are required by law to be licensed and bonded by the State of California and to have a business license from the City or,County. They are also required by law to put their license number on all permits for which they ,apply. If you plan io do your own work, with the exception of various trades that you plan to subcontract, you should be aware of the following information for your benefit and protection: 11 If you employ or otherwise engage any persons other than your immediate family, and the work (including materials and other costs) is $200.00 or more for the entire project, and,such persons are .not licensed as contractors or subcontractors,`the you may be an employer. If you are an employer, you must register with the State and Federal Government as an employer,and you are subject to several' obligations including State and Federal income tax withholding, federal social security taxes, worker's compensation insurance, disability insurance costs and unemployment compensation contributions. There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with respect to work 's ohipensation insurance. For more specific information about your obligations under. Federal Law, contact the Internal Revenue Service (and, if you wish, the UrS. Small Business Adminstration). For more specific information about your obligations under State Law, contact the Department of Benefit Payments and the Division of Industrial Accidents. If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their work personally orethcough their own employees, without a licensed contractor or subcontractor, only under limited conditions. A frequent practice of unlicensed persons, professing to be contractors is to secure an "Owner/ Builder" building permit, erroneously implying that the property owner is providing his or hey own labor and material personally.. . Building permits are not required to be signed by property owners unless they are performing their own work personally. / Information about licensed contractors may be obtained by contacting the/Contractors' State License Board in your community or at 1020 N. Street, Sacramento, California 95814. Please complete and return the enclosed owner -builder verification form so that we can confirm that you are aware of these matters. The building permit will not be issued until the verificatio� is returned. Very truly yours,-' f r,, f*.r CITY OF LA QUINTA . DEPT. OF BUILDING AND'SAFETY 78-495 Calle Tampico La Quinta, CA 92253 (760) 777-7012 FAX: ( 0) 777-7,0.1 V, w OffSSI A f! ATE —%o t/ev /-c C) PROPERTY ADDRESS 00c>/ — O YSr PERMIT NUMBER(s) , ,r. 1 Certificate,of Occupancy- City of La Quinta Building and Safety Department This Certificate issued pursuant to the requirements of Section, 109 of the Uniform Buil ding Code, " certifying that, 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:. 54-105 AVENIDA VALLEJO Use Classification: SID Bldg: Permit No.: 0001-085 Occupancy Group: R 3 Type of Construction: VN Land Use Zone: RC Owner of Building: JERRY JUGO Address: 79-860 BOQUERON WAY City.: BERMUDA DUNES, CA 92201 By: STEVE TRAXEL .,s Date: 04-24-01 Building Official POST IN A CONSPICUOUS PLACE