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9606-020 (SFD)LICENSED CONTRACTOR DECLARATION hereby affirm under penalty of perjury that I am licensed under provisions of •.ghapter 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 ai25 i.s 1 13 �� 7/3 1 /9 8 ate 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). ( ) 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. K) 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 ode, I shall forthwit,hh comply with those provisions: / ate: !? . C– Applicant Warning: Failure to secure Workers' Compensation coverage i/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. _ Si nature Owner/A ent Date PERMIT # CONTROL # BUILDING PERMIT %00-020 4402 DATE 012196 VALUATION �,fl�'Z�y LOT �N�� TRACT ��.ti t:t )l; JOB SITE ADDRESS 74-730 AV11;N10A LAJAKIT)k APN OWNER CONTtR�AClT•'OR /fDESIGN E�IR / EtNGINEER PACAl'-K," TiX)IZS . 787311 AMNO.M. LA 1100'IA 11.0, f�C+X 7222 LA QUINt'A ("A 5).125:1 LA (l t.t1NI A CA 92251 (e�ll�>>_'gfvt-U273 t�'1�C.t! 1115` USE OF PERMIT tiiNe 1t 7i17f't1UfWl:t)� ll t`iis1MID EXM7'i41f IKA) 8 A f—IN i" fid" - lkiii) :Q6 ST. OF Li N0, 1'}sitfv11T 1Y4SN Nt:+T ll*'f.tii'a}; I%f.r:Pt7k WALL OR 1100f.. �.K r,C� 1" i�'tz+;K:f j'il11c.'rtc�IJ 1.775.ftA �� i-'C'r)�t:ifii�et'I'i�:+ l�1S.t1tl of t:ft11tr1�i1:l�;�tK}++31t'I' •fii,tNt!•t}: ICS 11'5TA•1111) CONTOV' CONN.'�'1<ztrfrr40N Iii 1;221}.tt© PCltMt'i' P UE 8018161AR V . r QNS'MUC; +'10N 0-Y 1014XV-4 lll0K1 s,ti7 itF P1,ANr:'1fl[!I1 rfslr )%;-#f1t5.:3a�3•,ii;i its^tit ti flit:}iANI[CAf 1 }i1�i "• it71=�r)ti-�12!•t} � aril+,(HI Ft.X3 1(}1•;!4111-:11i1•ti()(I ! 1: 1.71 P4.11h,110NO1411t*3 ti11 TP.419•tNK) fi#^1,'x,4 S"MOCNt;;41Cr1'iC)N(101?.1) :- 101 -000.1,11 -Wo njf}.72 C2 V al 13}1711:>i)+iC; 101- NA) -• 123-tX11t1 S2t/.(n'r U.1 }'I!ir.`CIS .1' AN 101 -MI -441-345 31.15,110C3 z ART 11414,1111,x,' PI,.T;r,^1 q (RKR') - 70140)-25549X) $1$ iY7 ^ � S1,tft-TCYTAi,CONr+"MUC."TIONAND 111-01 $1,617.29 TOTA#, FERMI" FIERS DUE NOW �i,367.z1� RECEIPT DATE By./ NJ. DATE FINALED INSPECTOR i J 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 LC 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. Lat Final Final POOLS -SPAS BLOCKWALL APPROVALS Steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Pibg. Test Final I 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 COMMENTS: Final Utility Notice (Gas) 194ZC/ ELECTRICAL A . ROVALS 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) Notice: Document Cannot Be Duplicated Date 12/2/96 No. 15054 Owner Name Gary Rogers Desert Sands Unified School District 82-879 Highway 111 Indio, CA 92201 619-775-3500 CERTIFICATE OF COMPLIANCE N0.78730 Street Avenda La Jarita City La Quinta Tract # Lot # Type of Development Single Family Residence Comments Jurisdiction APN # 769-135-009 La Quinta Permit # Log # zip 92253 Study Area 116 Square Footage 1775 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: Fire Damage/Demo. Replacement EXEMPT This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of 0.00 X 1,775 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 564-5372/564-239 Name on the check - -0 By Dr. Carol McGrew r :: Administrator in Charge 7 Fee collected /exempted by Pauline Pearson Exempt ,'$0.00 I Check No. n/a Signature 0 AA` NOTICE: Effective January 1, 1997, Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 9D -day approval period in which you may protest the fees or 3ther 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 3ntity 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 TitT 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 - (619) 564-2246 December 26, 1990 To Whom It May Concern: The structure located at 78-730 Avenida La Jarita in -La Quinta, is now located in a "AO" Flood Zone per revised F.I.R.M. Panels 060709 0005 A & 0010 A (see attached letter). If you have any questions,;please feel free to contact me. BUILDING AND SAFETY DEPARTMENT Tom Hartung Director of Building an Safety TH:es LTRTH24 MAILING ADDRESS - P.O. BOX 1504 - LA QUINTA, CALIFORNIA 92253