9608-092 (RER)LICENSED CONTRACTOR DECLARATION
I 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
v V rofes'sionals Code, and my License is in full force and effect.
License # Lia Class Exp. Date
Date 4 Sign lure of Contract' t_y
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).
() I am exempt under Section B&P.Ch-for this reason fi
D to - { / 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.
(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
Code, I shall forthwith comply with those provisions.
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 e�above-mentioned proppirtflor inspection purposes •
Si nature (Owner/A entl lo -10— /-> /'"•'"Date
I
BUILDING PERMIT PERMIT# CONTROL#
960M.0192. 3920
DATE VALUATIONLOT TRACT
JOB SITE '
ADDRESS 79-2 40 KA U C1
AF�O "+ 30 — 0,23
OWNER
CONTRACTOR / DESIGNER / ENGINEER
� 3�M
9.240 .,.AKA Cr
LA.QLI N'TA, CA M53
C OL.#
USE OF PERMIT
lt�til.l)t:1V'!°1010, �l�:11'1l;?3�ts'd,
_
AI DINO130'NASR00M 180 SV.
BUN IUS RUCOM tzpJ.fty ;Sr
,t
i't,ANr HRICK r. FIR 1()1-000-439-i I8 su' ' l
101-000418-000
ME'C;<.f..trfWA4. r :: 101 -OW -421-000
ji[0.000-420.000 .
tONc l A1f_'Tbt~`,N.N1 L . i:f.?`a1t3' 4400-2,10-000
��id Z7iw i.if co Vs1 ucrio • i�;IVD P4r�,N (1-113CK
$l��t't..i
/nom f1 LESS PRF -1 AID FEC'S
$01R)
� f TAI, 1'E1tRO3' kE.,,.5 DUE Nt3VV
S3A. ,i2
SEP 0 3 1996
RECEIPT
DATE
By f
DATE FINALED
INSPECTOR .
V `,::;$
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-
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
BLOC
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
COMMENTS:
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)
f/t 1//,/Z�
78-495 CALLE TAMPICO - LA QUINTA, CALIFORNIA 92253 - (619) 777-7000
FAX (619) 777-7101
SCHOOL FEE LETTER
Date: September 3, 1.996
Owner Name: EVERETT PERRY
79-240 KARA CT.
La Quinta, CA 92253
Project: ADDING BONUS ROOM 180 SQ. FT.
Type -of Construction: RESIDENTIAL REMODEL
SQ. FT. ADDRESS
180 79-240 KARA CT.
-
Total Square Footage: 180 -SQ. FT.
APN
604-313-023
MAILING ADDRESS - P.O. BOX 1504 - LA QUINTA, CALIFORNIA, 92253
Notice:
Document Cannot Be Duplicated
l' Date 9/3/96
No. 14822
Owner Name Everett Perry
No. 79240
City La Quinta
Tract #
Type of Development
Comments
Desert Sands Unified School District
82-879 Highway 111
Indio, CA 92201
619-775-3500
CERTIFICATE OF COMPLIANCE
APN # 604-313-023
Jurisdiction La Quinta
Street Karaj Ct.
zip 92253
Lot # Square Footage
Residential Addition
Permit #
Log #
Study Area 232
180
No. of Units 1
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:
Residential Addition 500 Sq Feet or Less
EXEMPT
This certifies that school facility fees imposed pursuant to Government Code 53080
in the amount of 0.00 X 180 or $ 0.00
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 N/A ;Telephone ;
A'
• Name on the check
By Dr. Carol McGrew
Administrator in Charge
-
Fee collected /exempted by Pauline Pearson Exempt $0.00
Pi
Check No. n/a
SignatureAl IIA'A ,fkA A p4—
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
Ti'T
4(v
Q9&r0
78-495 CALLE TAMPICO — LA OUINTA, CALIFORNIA 92253 – (760) 777-7000
TDD (760) 777-1227
May 18,1999
Everett Perry
79-240 Kara Ct '
La Quinta, CA., 92253
RE: Residential Remodel Permit 9608-092
Dear Mr. Perry,'
The purpose of this letter is to inform you that your Residential Remodel Permit 9608-092, for
the project at 79-240 Kara Ct, has expired. In accordance with 1994 UBC section 106.4.4, no
further work may be performed until a new permit has been issued.
Please contact Daniel P. Crawford Jr., Building Inspector I, at (760) 777-7012 to obtain any
information you need regarding a new permit and/or any required inspections. Should you
choose not to complete the project, we would then have to pursue any or all of the following
actions:
1) Abatement of the project through the City Attorney's Office and Code Compliance Division.
2) Notice of non -conforming structure placed upon property profile.
3) Action filed with Contractor State License Board. Optional if Owner/Builder.
Please contact us at your earliest convenience prior to 10 working days to resolve this issue, and
for any questions you may have.
Sincerely,
Mark Harold
Building & Safety Manager
l
Daniel P. Cra o d Jr
Building Inspector I
cc: file
dpc
MAILING ADDRESS - P.O. BOX 1504 - LA QUINTA, CALIFORNIA 92253