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Home My WebLink About0309-168 (SFD)LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of HChapter 9 (commencing with Section 7000) of Division 3 of the Business and 04 W Professionals Code, and my License is in full force and effect. O =) M License # Lic. Class Exp. Date r— C f LO I LU k B IM ~o Z r- Date / {' - / . Signature of Contractor J U C) OWNER -BUILDER DECLARATION HLu fl- I hereby affirm under penalty of perjury that I am exempt from the Contractor's U) License Law for the following reason: Z ( ) 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 LO N Date Signature of Owner ON rn Q WORKER'S COMPENSATION DECLARATION j cc I hereby affirm under penalty of perjury one of the following declarations: O () 1 have and will maintain a certificate of consent to self -insure for workers' C uj �- compensation, as provided for by Section 3700 of the Labor Code; for the D J Q performance of the work for which this permit is issued. D Q U (' I have and will maintain workers' compensation insurance, as required by r. i C) Q Section 3700 of the Labor Code, for the performance of the work for which this L rn F- permit is issued. My workers' compensation insurance carrier & policy no. are: ? Z Carver 34 FUR` +, C } Policy No. CY Q (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'thoseoprovisions.,,, Date: i �. e' /•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 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. Signature (Owner/Agent) ^ ' ' ." Date t BUILDING PERMIT' PERMIT# �J/&// DATE VALUATION LOT Qa�h.�,�h 6`>b� TRACT JOB SITE APN ADDRESS OWNER 897 CONTRACTOR / DESIGNER / ENGINEER PM R.00 WoS.'.e WCU; LU"' �'.E! l�IS �� •�"s `�a:� )LlvI��' � z<�t" ". 68 I;1IMT 13Z ZTE 102 j:+:t*a k3TCV.iM]" V 1' -Y, I.:t3; BAN DIEGO CA. `.2131 �:i ? 3 SAW DIEGO 92.131 USE OF PERMIT sfru , LZIT 30.:%l.,.A'N 91;, VWXMIT SJOVI NOT IWCL UDr3: BB..E7C 'WALIZ, P00Ae. SPA OR DR-NEVAY M Y;Rt^tAM, 75%'REDUO-DON TO PLUNK FIC DUE TO MULTiPLE ISSRf fl34CF, OF S.A:' S PILX I TYPE A3�i:�9ro':� or(11f�"I�D`►i"�1L�U1011' i"GIIN p�l�:s,mw5 ti5�'i }suvw&RYY �:0%T�:4;2iI�`.'�`1t�I'?}�?.�• .S�a,.Ctd��I�..�.��nti�� a`.�s�,:�ii . PIAN CHM."K FU >,:,c"z �; ilQ�1"Ui+'�G •.6n.?ntn1 �:Qs4.ir CZCH�A��;j�'.�e�, n1 Y:.'I�Tri.i t��-t� 'i r�{ 'r Heir -419•:��,� �F�� 30 SIM0'1V P;'d - RE -IND 01_000-:91! _000 G1T.a` DN1+ O FEE, z til -000 -4Z3 6M 1. ,FwV)?..:l.!C:?i V1a IMPAf".:`,i' FXX . � f(y' \ � A^� ,Jt � 7• %lya-.. {gyp p frUB -_TM.- L ONSJ.ei.��^i. i.I�,✓N J'TA4 n.e�'� Y: l-,A� � •—f�l..�Lu,'�i+ ��`t:t�e•�. �'�.�.'�?.��, .J.��-`moi �`.:,�fr;) OCT .13 208 C!-7.1 CL Cc"S�".S .. t�A . RECEIPT DATE -BYE' DATEFINALE INSPECTO 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 . y 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 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 LinesHeater. Final Water Piping Plumbing Top Out / �^ /e'7 7 Plumbing Final Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection ., —141, Encapsulation Gas Piping Gas Test Appliances Final :.." COMMENTS: _.. Final Utility Notice (Gas) ELECTRICAL APPROVALS 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) o,30Q- /lr Date 10/10/03 No. 25067 Owner PM Renaissance, LLC Address 9968 Hibert St., Ste. 102 City La Quinta Zip 92253 Tract # 29053-1 Type Single Family Residence Lot # Unit 1 3 Unit 2 Unit 3 Unit 4 Unit 5 CERTIFICATE OF COMPLIAL Desert Sands Unified School District 47950 Dune Palms Road La Quinta, CA 92253 (760) 771-8515 No. Street 79,a g Derek Alan Drive g9? APN # Jurisdiction Permit # Study Area No. of Units S.F. Lot # No 2650 Unit 6 Unit 7 Unit 8 Unit 9 Unit 10 Q BERMUDA DUNES O RANCHO MIRAGE INDIAN WELLS �PALM DESERT %.y LA QUINTA , v INDIO l� 649-630-025 La Quinta 1 Street Comments Certs #25065 through 25084 used for CC#220712 in the amount of $119,801.48. S.F. 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: EXEMPTION NOT APPLICABLE This certifies that school facility fees imposed pursuant to Education Code Section 17620 and Government Code 65995 Et Seq. in the amount of $2.14 X 2,650 S.F. or $5,671.00 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 CC/Pacific Western Bank - Bob Turpin Check No. 220712 Name on the check Telephone 760/801.3623 Funding Residential By Dr. Doris Wilson Superintendent Fee collected /exempted b Sharon McGilvrey Payment Recd 1$0.00 Over/Under $5,671.00 Signature ��—.�� i11�1� NOTICE: Pursuant to Government Code`5ection 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 - ,- Certificate of Occupancy0 o C OFT Building Y p & Safety Department This Certificate is issued pursuant to the requirements of Section 109 of the California Building Code, certifying that, at the time of issuance, this structure was in compliance with the provisions of the Building Code and the various ordinances of the City regulating building construction and/or use. BUILDING ADDRESS: 79-897 DEREK ALAN DRIVE Use classification: S.F.D. Building Permit No.: 0309-169 Occupancy Group: R-3 Type of Construction: N-V Land Use Zone: R-L Owner of Building: PM RENAISSANCE LLC Address 9968 HIBERT ST, STE 102 City, ST, ZIP: SAN DIEGO CA 92131 By: G. SHOWALTER _ Date: 06/01/04 Building Offici POST IN A CONSPICUOUS PLACE