9609-100 (AR)LICENSED CONTRACTOR DECLARATION
I 'zereby affirm under penalty of perjurythat I am licensed under provisions of
Chapter 9 (commencing with Section 70o0) of Division 3 of the Business and
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
IM 11,47
Date 10 .rp '' Signature of ContractorR
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.
( ) 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 sscued:4lvjy4%LoJker<s'`compensation insurance car�•rler1 &�poIg no. are:
Carrier r 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. yr /
Date: I`l ' C` r_ Applicant . ' . � (Y � , / , ' 3 r 4
Warning: Failure to secure Workers' Com pensation.coverage is unldwf I 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 inspectionpurposes.
Signature (Owner/Agent % `/�! �j / -�*' ► Date J (2 2 —9(,
Fa �
'BUILDING PERMIT PERMIT# CONTROL#
4029
9609400
DATE li VALUATION LOT TRACT
�lJ .. 19ri . S2:3,733.40
JOB SITE
APN
ADDRESS 47-515 4'3.3. MONTANA r.
OWNER
CONTRACTOR /tDESIGNER / ENGINEER
�.ee'i �-1 l�el,i-.� :int 1; T'• i 1�.J Y�i �:
� I f t �Y 1
CS! -fl Vii',R IA 1,.::��3I'l f..'t..'�t'�� k E�I�t rLTi.iJl'Y
11) i3O X ! _r2 5
823 1'A.li.QU f L CANYON 114:' t
PALM SPti4NCiS CA !• AJ63
bell•, ; P:l211+ GsS (A 82263
(''Rl di 1797
USE OF PERMIT
01,N10Ki'1'IA1, A1l1.)t'!'1(Pffl
tit;!fx:s")"I2f.,r1f�1. A4)J.`a1`l'fc�tV
3Ol'314iet:3:P;d3COST �7.t
A'C',:RMIT FIKC Vit)INI1ViFi.HV
fl(..AN C.`N):,(✓X %1:13 1011 -000.4 3(J y 31 N$1 S?.95
MECHANICAL 3.14: 101-d)04)-421-000 $41.30
111KC7rRICA1, FRE 1014)00-.420,-000
P1:1.!t IDING FrE 101_00...') 419 -Wo b33.Sn
`3 (_-N0 Xf01'l 0 til 101400-24,11-000 , 9
r:v R A1)1NG JR -M 101 1,40423-000 $;. AIO
1X RA.,'s RLf4 iURFFK3 22549)0-443FIQ $535:1.3
MCC iN 1,URMC PLACES R1ES4C 701-000-1554000 Sq').Afi
SIcB-1'MAL,CfJ:N5.1' Ur-Pi'f:C7NANDf' AN CHECK
$1,130,x.5
n lais�►�a
I�
S0.00
D ?,A -Li P+Ha12N1111' F.ENIX Oil ENOW
S1,430.7.5
OCT 2 1996
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
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 14
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
POOLS - SPAS
BLOCKWALL AP ROVALS
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 11171
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final 141 111 f
Utility Notice (Perm)
Desert Sands Unified School District
Notice: 82-879 Higliway 111
Document Cannot Be Duplicated
Indio, CA 92201
619=775-3500
CERTIFICATE OF COMPLIANCE
Date 10/2/96 APN # 643-120-046
No., 14894 Jurisdiction La Quinta
Owner Name Landau Dev. Co.,.Inc Permit #
No. 47525 Street Via Montana Log #
City La Quinta zip 92253 Study Area 123
Tract# Lot #.. Square Footage 438
Type of Development New Residential Addition " ' °' 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: ,
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 1.84 X 438 6r$805.92-'
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 cc/Palm Desert National Bank/Imperial Sun. ''"TelepKbne, 328-2?77
Name on the check `
By Dr. Carol McGrew
Administrator in Charge
Fee collected /exempted by Pauline Pearson Payment Received $805.92
t , Check No. 75754
Signature
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 ,
LAKE, w QUnvra.
619.564-5906 $ FAX 619.564-5204
' r�L�titT�. j
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f '� s
4,,--
78-495 .CALLE .TAMPICO LA QUINTA, CALIFORNIA 92253 (619) -777-7000
\<al o� a•N `�� FAX. (619) 777-7101,
- v ., •` r •. _ s, .. • .. , i p.. • 1 � obi
;
September, 24,, 1996 r 0
Mr. Irvin Green
Landau.Deyelopment Company; Incas
Post Office Box .1725
Palm Springs, California 92263
SUBJECT- GUESTHOUSE
-DE
ED, RESTRICTION.-FOR 472525—VI'A,MQNTANA
PLOT PLAN 96-591)
Dear-Mr. Green':-
The
reen:The Community Development Department ha'seiit your Deed Restriction for a guest
unit at 47-525 Via Montana in Lake La Quinta to the' Recorder's Office,for recordation.
-'This recordation is required to restrict the use of the guest house. Upon recordation .i ..
of this .Deed 'Restriction, •a ' building permit -may be - obtained'for theguest unit.
Therefore, apo he Bu�lding�andSafety Department,s_request, wwill'provi� d e�our i.
Department's clearance "
Should'you have any questions regarding,.this matter,'please feel free to *contact me at t j
619-777-7064. =
.,Very truly yours,
JERRY.HERMAN
COMMUNITY DEVELOPMENT DIRECTOR
STAN'B. SAWA'
r Principal Planner
e SBS:cbw
Builcling and SafetyDepartrnent ;
Ltrss.438
MAILING' ADDRESS P:O. ' BOX 1504 - LA OUINTA; 'CALIFORNIA: 92253