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9601-048 (SFD)LICENSED CONTRACTOR DECLARATION I here6y aWim that'l am licensed under provisions of Chapter 9 (commencing with ��ction - 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect- 4-W69 B 17/31/95. License # Lic. Class -.% ,,Exp. Date �ftte , `9 J'j C - A onoo J. L4Sign,atureof Contractor • toof- r , V U OWNER -BUILDER DECLARATION I hereby 'aiiry�' that I am exempt from the Contractor's License Law for the following reason: O 1, 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). 1, as owner of the property, am exclusively contracting.y0th licensed contractors to construct the project (Sec. 7044, Business & Professi6hals Code). ( ) I am exempt under Section ' , B&P.C. for this reason Date Signature of Owner WORKER'S COMPENSATION DECLARATION 1 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 f6i which this Oermft.ls issued. . ( ) *1 have and will maintain workers' compensation insurance, as required by Section 3700of the Labor Code, for the performance of the work for which this permit is issued. ed. I My, workers', compehs6tion insurance carrier & policy no. are:. 'Carrier 07TA'VffiJ Policy No. tarter t MAIM J17his'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,Wo-se provisions;,),' IDate: ,'2 V 3- plicant( J 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 thecostof 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 ismade& each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this application agrees to, & shall, indemnify & hold harmless the City of Indian Wells, 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 informaltionis 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 foreinspection purposes. lSigngeMdure w Ll,�) 'r_.X-VlJ Date A ALC 0 I - BUILDING PERMIT PERMIT# DATE 21 10116 VALUATION N16T" LOT 2',/y TRACT 201 _'$2 JOB'SITE ADDRESSAPN 47 555 VIA MONTANiC_ 643-120-047 OWNER CONTRACTOR. IMT1,133MAJ., SUN COMMU(MON I 'khfn AU'D"Ei'v. Copun. Imo 14.1 L 2815 TA1HQAM.-*71 C.,"UNYONT 4111T.N. .0.0.'13CA Ox i725. muVisp-Ruios 92U3 RALM SPRING, S CA 9,2263 - (619)32 8-2277 CBL# 3,787--`, DESIGNERIENGINEER WFIMM, VEITH USE OF PERNSINGLE FAM111V Tei V.8)'_.L1'Y4G Enstw s • Ugg'. Gor. 9n1,,�,�% G Pearilt dews itotbtddo. block- watt (Yr iksol. FEE DESCRIPTION FEES TP,ACTCON"TrRUCTIOX 2,794.00 $I? POKCTYPA110 GARAWC0,1PORT 722.00 SF ENTIPAMED COS TO O.F CONSTRUM iON 167,301.30 PERMI-fFEE 393TO11i1ARY PLANCHFC-KIFEE 1011-000-439-318 RUCTION MTE 1.01-M04M000 w4EcmAmcAL,r.rm, 101-000-421[00 $111-50 ELEC1'KTCA1'„FFM 101-000"42040M ,PT.lJA48YNG FFA 1.01-000419-000 STONG 1\40V ON SEE - RESYD 101-000,24-0N 816.73 G P. 1W [ N G I'M-; 101-000-423.00 $20.00.- fNl'.RX%TR.UQ*1T1.K6.F M3 225-000.443-342 Apq.w, Pmamcpums - mir, 701 -000-*2_,55-0oo $168. ' 25 Zposff -$250.00 -,�'m SUB -TOTAL CONMUMON AND PLAN CHECK ESS PU;-PAID !'EFS _$250m00 0 T AL PERM. U F FE 8 D VIE. N O'VV $5,79.5.9 991 RECEIPT' .1 DA --"LED BY INSPECTOR JBY INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs /(i G Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel j, 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 Wail Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath Final Final POOLS - SPAS . BLOCKWALL APPROVALS 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 j Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans 9(i 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 /3 b 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) 3 Desert Sands' Unified School District Notice:. - 82-879 Highway 111 Indio, CA 92201 r Document Cannot Be Duplicated 619-775-3500 CERTIFICATE OF COMPLIANCE Date 2/13/96 - APN # 643-120-047 No. 14132 w Jurisdiction . La Quinta ' Owner Name Landau Dev. Corp. Inc. Permit # No. 47555 Street Via Montana Log # city La Quinta ` - -zip 92253 Study Area 123 Tract # 26152 Lot # 275 Square Footage 2794 Type of Development Single Fainily Residence t.t No. of Units 1 Comments 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: ; EXEMPTION•NOT APPLICABLE This certifies that school facility fees imposed pursuant to Governmeiit Code 53080,. ' in the amount of 1.72 x 2,794 or $4,805.68" 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 Imperial Sun Construction, Inc. .y= Tele "hone ; p X328-2277; Name on the check By Dolores A. Ballesteros r - ti Superintendent Fee collected /exempted by Pauline Pearson Payment Received $4,805.68 <. : Check No." 14680 Signature a n �� 1c 0 Pi A Collector: Attach a copy of county or city plan,check application form.to district copy for all waivers. Embossed Original -Building Dept./Applicant Copy Applicant/Receipt Copy -Accounting, W 1-.. wo 4- Gv /� c�� 1x 1504 &105 CA � 7 E ESTADO Addrress �v/Olrt%4 A/ ASLA QUINTA, CALIFORNIA 92253 Owner D,5✓ Lip rwc, Mailing / 7 Address City Zip Tel. Contractor / liv ( Addres$ R5 a i City` Tel.. r)m 5;,!w,-,, sIzip(,.,?., � 3 l�1�-3-) K a��7 State Lic./ (, t. City & Classif. GY9 9 fr,4(? Lic. # 3 7 F7 Arch., Engr., � Designer We1PIJA.,// ✓/`_�� Address Tel. Cijty% % 7C, ipp State/� a (92 Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. SIGNATURE DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its Issuance also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). IJ 1, 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, Buisness and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he did not build or improve for the purpose of sale.) 1 11, as owner of the property, am exclusively contracting with licensed contractors to con- struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) - 0 1 am exempt under Sec. B. 8 P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure, or a certificate of Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No. Company 0 Copy is filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) valuation or less.) ,,certify that in the performance of thg 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. Date Owner NOTICE TO APPLICANT., If, after making this Certificate of Exemption you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. . CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this.permit is issued. (Sec. 3097, Civil Code.) Lender's Name Lender's Address This is a building permit when properly filled out, signed and validated, and is subject to expiration if work thereunder is suspended for 180 days. I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives sof this city to enter the above- mentioned property for inspection purposes. Signature of applicant Date Mailing.Address City, State, Zip BULLDING DIVISION APPLICATION ONLY JILDING: 'TYPE CONST. OCC. GRP. P. Number 1,U.3 ' la o r90 7 ,gal Description ToAe 1-5o2 % 0 7 oject Description _577 D Sq. Ft. No. No. Dw. Size Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation PERMIT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical AMOUNT S.M.I. Grading Driveway Enc. Infrastructure TOTAL REMARKS ZONE: BY: Minimum Setback Distances: ' Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street SetJfr er Line Side Setback frLine it FINAL DATE RIssued by: Date� f4n Validated by: `� V 19 Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. @ $ 2ND FL, SQ. FT. POR. SO. FT. @ GAR. SO. FT. @ CAR P. SO. FT. @ WALL SO. FT. @ SO. FT. @ ESTIMATED CONSTRUCTION VALUATION $ UNITS MOBILEHOME SVC. POWER OUTLET YARD SPKLR SYSTEM BAR SINK ROOF DRAINS DRAINAGE PIPING DRINKING FOUNTAIN URINAL WATER PIPING NOTE: Not to be used as property tax valuation BONDING FLOOR DRAIN MECHANICAL FEES FORMS WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASH ER(AUTO)(DISH) APPLIANCE DRYER GAS (ROUGH) GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED OTHER APPJEQUIP. LAUNDRY TRAY AIR HANDLING UNIT CFM TEMP. POLE KITCHEN SINK ABSORPTION SYSTEM. B.T.U. TEMP USE PERMIT SVC WATER CLOSET COMPRESSOR HP POLE, TEM/PERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SO. FT. @ c BATH TUB SQ. FT. @ c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID @ 1 I c SEWAGE DISPOSAL SQ.FT.GAR @ 3/ac HOUSE SEWER REMARKS: VENTILATION GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE CONST. FEE ELECT. FEE SMI FEE PLUMB. FEE STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR SETBACK GROUND PLUMBING UNDERGROUND A.C. UNIT COLL, AREA SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEQUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. $ plus x$ =$ LUMBER GR. FINAL INSP. FRAMING FINAL INSP. ROOFING REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES11NITIALS GARDEN WALL FINAL