0006-351 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
'eh&pter'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
�.y J
ry7I�'}�tF+ f Va',f, of ir�7 CSignature of Contractors - -/`
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.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.
( 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.
NATE FUND 3�2S1;3 � fit
(This section need not be completed if the permit valuation is for $100.00 or less).
( ).1 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 wit 4hose,provisions.
VDate: r=f Applicant ...
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages'as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person a
whose request and for whose benefit work is performed under or pursuant op
any permit issued as a result of this applicaton agrees to, & shall, indemnif'y'
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of. such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of;this City to enter upon
the above-mentioned prope rr0or inspection purposes 1j
.,Signature (Owner/Agent) _ * f - Date ' _J
BUILDING PERMIT PERM T#
DATE VALUATION LOT TRACT
JOB SITE
ADDRESS
APN
'
3 9, 451.0 b VKNM � LAV,() ?.fie
770.447
OWNER
CONTRACTOR / DESIGNER / EN (NEER
PJM 1"WK313.E1't..CO CARCIA
C°OWO3dEL C0..W1*R.UC'f10
78«150 CALLS TAW"= S%M;0230
LA Q'jjNVA CA 92.253
L& QUINTA 0-4 92253
(M)5464=4604 Cl T14 2261
i
USE OF PERMIT
SPI Fl1�d2.A31 I' a cif w ?�!C Y �bfC 1.0%3i: ri3�t 34✓ ,` "ti1i'Rl;i f3t01 f$?e CJR 4>3�feRCJIa.4✓',�t
DWE"WAY
TRA4: T tM"0N2TXUCT1OV 2,T59.00 3'
GARA09 6150.00 SP
FI':�S?'�11r VEX HEDOURY
CAYNS'T'3,3. (rfIC 14 FEE 101-000-418,000 �R4'iO.Gd
PLkN E:riE{;}; FEE 101 0-139.318 �7i�.tS6
PRE DEPOSIT 101.000-439.318 420,00
d4iTE✓t• AINICAL FEZ 3431-0.00.421-000 09,10
1.ta153 11v~ t�i�»;' 101.-000.419-000 S11A.11%
STRON« MOTION FRO - WID 101.-000.241.000
+i).0WYNQ na!a71-4J43r3y42a�43i3dA af3.41Q
DEVj° P' E.R IMPACT FEE �EeSSl2,fE0
�9s
,TUB-TafAt. C��ia��'�:�UCff,aN :D PTA) CHECK
$3,956.94
= 1]Ttc�"r'�AliJPi?TM•`a3
PA
4250.00
OCT.11 2000
'34 U LA
RECEIPT
DATES BY
DATE FINALED
INSPECTOR
t
INSPECTION RECORD
i OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
Slab Grade
Underground Ducts
Ducts
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
BLOCKWALL APPROVALS
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
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Seniice
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
C l0,51 c�
a _�
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
Date 1/2/01
No. 21431
Owner Name" Rigoberto Garcia
78-5
City La Quinta
Tract #
Avenida LaFonda
Lot #
APN # 770-142-006
Jurisdiction La Quinta
Permit #
Log #
Zip 92253 Study Area
Square Footage 48
Type of Development New Residential Addition No. of Units
Comments
dining room addition to existing.
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:
Add. of Sq. Ft. to New Construction
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of
2.05 X 48 or $ 98.40 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 CASH - Ismael Telephone,
Name on the check
Mt
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Ellen Patino Payment Received $98.40
,' Check No. CASH
Signature /� ill) — -
IOTICE: Pursuant of Assembly 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
ollect them on the Distdct('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
cedr°F 44umr.,
78-495 CALLE TAMPICO
LA QUINTA, CA 92253
(760) 777-7075
A ✓f -N SDA tA
APPLICATION
ION
F090
0
REV -1
11/99
W�
FLOOD PLAIN DEVELOPMENT PERMIT
BUILDING SITE LOCATION
FLOOD ZONE "AO" - DEPTH 1
ro^�d�' W,4s,�t�tlrZo 57,'f FA AA l y
COMMUNITY- PANEL NUMBER
$ 3?U
Wit ✓ed P.4-Aae,[ t -W Alv, Z 3
060709 0
811 1991
Map Revised: 8/19//
Ssis o ,49Ce5_Z 0- lq2—do
APPLICANT INFORMATION SECTION
APPLICANT NAME
��1� Cp,Q o�✓�L
APPLICANT
CO2d��L �N S t/L-*�-�'yY o �✓
ADDRESS
P �• �X 3 ��
(MAILING ADDRESS, NOT THE BUILDING SITE)
/�- �.� ^/ Z
DAYTIME TELEPHONE NO.
INSTRUCTIONS
1. A Flood Plain Development Permit is required by LQMC Section 8.11.040(A). The Applicant should complete the
Applicant Information portion of this application and submit it to the Engineering Department along with the
required documentation noted hereon at the same time the Precise Grading Plan is submitted to the Building and
Safety Department for plan.checking.
2. Documentation required for STEP 1 OF 2 APPROVAL prior to receiving clearance. for Building Permit issuance
+ Copy of the proposed Precise Grading Plan for review and approval containing all information required by
the checklist shown on the back of this application.
3. Documentation required for STEP 2 OF 2 APPROVAL prior to receiving Flood Plain Development Permit approval.
Note, this approval occurs after forms for the lowest habitable floor are set and before the Building & Safety
Department authorizes foundation construction.
• Submit a completed FEMA "Elevation Certificate" form to the Engineering Department.
• Submit 95% relative density soils compaction certification to the Engineering Department.
STEP 1 OF 2 APPROVAL
STEP 2 OF 2 APPROVAL
The Precise Grading Plan submitted for this application has been
All requirements have been satisfied. This Flood Plain
reviewed and found to contain all data required to satisfy the
Development Permit is approved.
requirements of LQMC 8.11 The proposed dwelling is eligible to
receive a building permit upon satisfying all other Building &
Safety Department requirements.
X26 Or7
THORIZED SIGNAT RE DATE
AUTHORIZED SIGNATURE DATE
a Quinta Engineerin Departm t
La Quinta Engineering Department
F090
0
REV -1
11/99
W�
CHECKLIST
FOR
PRECISE GRADING PLANS
IN "AO" FLOOD ZONE
1. Prepare Precise Grading Plan in accordance with Checklist for Precise Plans
and the following additional items.
2. All elevations shall employ the NGVD-29 convention.
3. Show and label elevation of "Highest Adjacent Grade" next to the building
footprint. This refers to the highest existing natural grade next to the
proposed building prior to constructing the elevated the building pad.
4. Show and label the "Highest Existing Elevation on Lot'
5. Show and label the "Lowest Habitable Finished Floor Elevation". Note, this
elevation shall be at least ONE FOOT higher than the "Highest Adjacent
Grade" elevation.
6: The following grading note shall appear on the plan:
All fill material placed under the structure shall be compacted to
ninety-five percent (95%) relative density.
F080A 10/88
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1. FOR FRAMING NOTES REFER SHEET S-2.
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78-5-7
LA.QUIN
DINING ROOM OWNER N
#4 REBAR 12"DOWEL INTO SLAB 12"O.C.
BUILDER C
M.BATH C PATIO C rP.O.B
a' FO
---------- --- - LA.QUIN7
- - - - - - - - - WH FAU2
xox %Zoe
N �I
13'-6"
_...... :. _......... . 34•-0« -- --.... - ----_._..... .
ADDITION TO DINING ROOM 48 SQ.FT.
SCALE: APPROVED BY:.
DATE:
-
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78-5-7
LA.QUIN
DINING ROOM OWNER N
#4 REBAR 12"DOWEL INTO SLAB 12"O.C.
BUILDER C
M.BATH C PATIO C rP.O.B
a' FO
---------- --- - LA.QUIN7
- - - - - - - - - WH FAU2
xox %Zoe
N �I
13'-6"
_...... :. _......... . 34•-0« -- --.... - ----_._..... .
ADDITION TO DINING ROOM 48 SQ.FT.
SCALE: APPROVED BY:.
DATE: