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0211-164 (AR)LICENSED CONTRACTOR DECLARATION .I hereby affirm under penalty of perjury that l 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 # ' 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: �Y ) 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). a ___ ( ) I, as owner of the property, am exclusively contractingPwith licensed contractors to construct the project (Sec. 7044, ..Business &—Professionals Code).� ( ) I am exempt under Section , B&P.0 or this reaR'ry Date ., 4 �r;• ' Signature of Owner /Q n.4 ~ l ,. %/1 �,,,tr�.,.�,,. ix' -'7 WORKER'S COMP/ENSATION DECLARATION I hereby affirm under penalty o f perjury one oWe followirhq declarations: () I have and will maintain a certificate of consent to self-insuk for workers' 'compensation, as provided fohy Section 3700%f the Lab$e-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). 'j�). I certify that in the performance of the work for.whirh this permit is issued,,- Ifshall not employ any person in any manner so as to become subject to the workers' compensatiori 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: r ; It Applicant : '"1• ,; �: 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. .1 certify that I have read this application and state that the above information iso 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. Si nature (Owner/A ent) 4 Date PERMIT # BUILDING PERMIT DATE � VALUATION LOT TRACT 295�i3 JOB SITE f .; ADDRESS 4--', V• O J,4. ARETRA CGIV1 . ` APN r604-4604)21 OWNER w CONTRACTOR / DESIGNER / EN &NEER d �,J"Z RAV%F'11i"Li.A OV%AVrt2w.L ... BLfi Jill.d/. EZ. 4 5-950 MENA C ��l Arr ^^ l�l,.u`� LA n 92253, M`c, USE OF PERMIT iii C',' O1')'C ) :tj R . ' e. V4s1"� PLAMS , Wl?.RR,GY CAWS, J 7k%a FuzsJmumnt .. (�� �ryry(/•.��.}� +� //�� �} �} rr44j�qq /C PIAN Sl -MOCK MM IT'js —_. \ 01-t of.J••ll I *_Oot) � � txw MM 4 ANl4 AL FEE.101.000.421-0(30 $15.00 ELFT tRiCAL. PRIVA $1.9.00 PLUMBINQ FIRE 101-00"'.19-000 $30,00 STRO 401MO 1014 F - RE'SID 101-000-241-000 �i,i►1 B -T( )." MWOMAY, D MAK X_'.%,+ d: } .91, " I �:�.. � ����� �►�� ? ��,r�.x� �`��cL��'� �i�, iiia -P.M.'i2 r IMES DUR HOW RECEIP DATEy 1 /� BY DATE FINALED INSPECTOR r 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 O'Z 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 _ • O Final � 0 5/' BLOCKWALL POkOVALS Final POOLS - SPAS 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 Appiinces ' Final Final Utility Notice (Gas) ELECTRICAL APPROVALS T mp. 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) COMMENTS: ' `"' t Total Permit Fees s Bin # City of La Quinta Building 8i Safety Division Permit # , I P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 D Z Building Permit Application and Tracking Sheet }( Project Address: �S �1t� 64%LC, C �, k wner's Name: U vi le Gur A. P. Number: 6 - (���� a % God Address: Legal Description: '�� rn` g City, ST, Zip: v t��� 9z?z 'cam Contractor: /� DD f• _. ��� ��r�s elephone: Address: �L Project Description:T� Cir city, ST, Zip: 4« cics.eco i•o r\ o ,I c Telephone: P h one. ...........................:. I t 1 ii � ndD�.l J r r,1 D �C State Lic. # : City Lic. #: Arch., Engr., Designer: Address: City, ST, Zip: Telephone: P hon e. Construction Uon Type: Oc _ cu P a nc : State to Li Project e (circle one): New Ao Alter Repaira ir Demo Name of Contact Person: �4/✓ 34A&/ ries: #Units: Telephone # of Contact Person: 6p� ONI-53 of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Rec'd TRACKING PERMIT FEES Plan Sets 2 Plan Check submitted (I 11610 Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Calcs. Called Contact Person Plan Check Balance Title 24 Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical ` Grading plan 2"' Review, ready for corrections/issue Electrical Subcontactor List Called Contact Person Plumbing —J. Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- 7rd Review, ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.I.P. P. Pub. Wks. Appr Date of permit issue School Fees ©�/ 0 `"' t Total Permit Fees 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 (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile homes. It has been determined that 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 Education Code Section 17620 and Government Code 65995 Et Seq. in the amount of $0.00 X 290 S.F. or $0.00 have been paid for 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 EXEMPT - Dan Barry Check No. - Name on the check Telephone Funding Exempt By Dr. Doris Wilson Superintendent Fee collected /exempted by Monica Guillen Payment -Recd Over/Under � s Signature h6Z' Y11JA114i NOTICE: Pursuant to Government Code Section 66020(d)(1), 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 issued, or from the date on which those amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier. NOTICE: This Document NOT VALID if Duplicated Embossed Original - Building Department/Applicant Copy - Applicant/Receipt Copy - Accounting CITY OF LA QUINTA BUILDING & SAFETY DEPT. APPROVED FOR CONSTRUCTION 1 RE-I�pr 0SEE OF $30 Wilt BE CHARGED IF THE APPROVED ` PLANS AND 10B CARD ARE NOT ON t; ;HE SITE FOR A SCHEDULED INSPECTION. .NO EXCEPTIONSI C."4es Y\/ e s 9V11 LGS PIG,. �3 hCQ �� l ..._.._. TP (on L.AlSCe�c�� ewer qh4 v ►gook }-o ��b►n, kcY ��-. � , . Z. R -51\t\ k %ooke1 _ I . 2(a Q-1, door vi .y5 F', -e tDoo r r 22 X 2s Fixed W Aj6 JS ys95o Lc,,Qe��� Floor PICk n ....•/� ud�f �. it�;•:�, s..,i.'�.n,... .. ..t ',F>'L•{�llf 11 i.{� ��;'.. .........