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9706-086 (SFD)N U) W ouch r-C7LO I W o Z r— O.o (0 JV �a Z M LO N ON U_ °) C Z ��IrO X W LL — mVU O rn H Z Cb 5 0 Q J LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9-4,a6mmencing 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 1d4 z 1 B 1�' -if 31/98 Date 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 pert rmance of the work for which this permit is issued. „1 have and will maintain workers' compensation insurance, as required by ection 3700 of the Labor Code, for the performance of the work for which':this permit•is issued. My workers' compensation insurance carrier & policy no.iare: Carrier Policy No. STATE FUND t23099U-94- (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 Nhould become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I s allrthwith comply with the provisions. � Date: Applicant- Warning: pplicant 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. e 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 pp construction, and hereby auth%orize representatives of this City to enter upont-.�1 the above-mentioned property for inspection purpos;7777�ate Signature (Owner/Agent)'�'�" BUILDINGPERMIT PERMIT# CONTROL# DATE VALUATION LOT 9706-0A6 TRACT rycSV1.055071 l� ,yO �i r�l1.q O S89.532.00 JOB SITE APN ADDRESS 52=205 AVENI.DA. DIAZ 773-211-0.19 OWNER CONTRACTOR/DESIGNER/ENGINEER DAVID ROSS MILLER, PACIFIC TRADES 171.95 TREl ow P.O. BOX 722 OCEANSIDE CA 97054 LA Q'UINTA CA 92253 /n 103. 1.0273 CRI # 1955 �- -�- -� - -~ r -�U USE OF PERMIT SFD - POWIT DOES NOT INCLUDC BLOCK WALLS Oil POOL. .r TRA07 ' CONSTRUCtiON 1,43100 SF ti GAR.A(IOCARPORT 514.00 S1: 6 FT. WOOD FENCE 200.001',1: • . UST.1.MA1 ED COST OF CONSTRUCTION '$9.,5.32.00 PERMTY FEC SUNfAMRY CONSTRUCTION FF.� 101-004-418-000 $591.50 PLAN CRF`CK LEES 101-000-X139-318 $501.61 Ft:G ]DEPOSIT 4250.00 M:fICHANICAL N"EF 101-000-421-000 553:50 O.:ECTRICAT.:r-Ek 101-000-420-000 S123-90 PLUNfBINO FEE 101-000-419-000 Si28.75 S oxo muriON.1EC - RES1D 101-000-241-000 $9.95 c3RAi)"1N(11 B>~ 1 101-044-:123-000 [NFftASTRUCfVRF;Ff F' 225-000-4-1-1-342 $1,976.22 PRECISE PLAN 141.000-441-345 $25.00 y PAI SVB-T'OTAi CONS".Cl UCTION AND PLAN CHECK $1032.43 LESS PPE -PAIL) .FEES -. 1250.00 J U L 16 1997 TOTAL. PERMIT FEES DUE NOW $3,182.43 °F Y YOFLA,00`!I'M17 y 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 _/0 Slab Grade 'I i ? Return Air Steel Combustion Air Roof Deck Exhaust Fans _ O.K to Wrap F.A.U. Framing Compressor Insulation r Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wail Insulation Condensate Lines Party Wall Firewall Exterior Lath 1`7— Drywall - Int. Lath Final Final / BLOCKWALL APPROV S POOLS - SPAS ' Steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Pibg. Test Final Gas Piping UMBING APPROVALS Gas Test Electric Final Waste Lines Heater Final -WAlgr Pi in Plumbing Final Plum ' ut Equipment Enclosure ower s OX for Finish Plaster Sewer Lateral Pool Cover Conn 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 Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) E14 / z t __ COMMENTS: " . I �7dG-ate �2_ —20 _•:"'."-;.r�.'..y't"=`r'r"'�;S,�i"S+'-d.=�.:..+.Y �r•rp,'.,.�.j.�,.�.6,�t.,wig:�s:J�,.`ry,.-;.....'.�.-,..:,is.;�.�.�'�^"W4`.•ii�.r`:vi..-K; ^,'`�Y i . ulcv I0 P.O. BOX 1504 AM APPLIgAll .OW 78-495 CALLE TAMPICO Bul ding c t� ',t,'0„ r 1i- Address Mailing Address City Cntlactor, T o(\ ;�-\ c � LA QUINTA, CALIFORNIA 92253 kOS> BUILDING: TYPE'CONST._JGI'��"�� .. A.P. Number Zip Tel. 1' Legal Description Project Description S. ' ip I Tel. State Lic.City & Classif. (3y7 � 3% ) I Lic. a Arch., Engr., Designer Address Tel. City Zip State Lic. # LICENSED CONTRACTOR'S DECLARATION r.I hereby affi that I fm,licensed under rovision orchap er 9•(commencing with Section 7000) of Divisi ; n 3 ofh,9,Business and Prkfessions Code -and my Ilcense is in full force and \ 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). t: I, as owner of the properly, 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.) ' 11 I, 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 contractors) licensed pursuant to the Contractor's License Law.) i ] 1 am exempt under Sec. B. & P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION Ihereby 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 n 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.) I 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 or 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 -of this city to enter the above. mentioned property for inspection purposes. Signature of a0plicant Date Mailing Address City, 'State, Zip WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION t Sq. Ft. j No. No. Dw. Size Stories Units New EA Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. OGS Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL ,,W SJ. 00 REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side Setback from Property Line FINAL DATE INSPECTOR Issued by: Date Permit Validated by: Validation: WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION Desert Sands Unified School District Notice: 82-879 Highway 111 01 922 Document Cannot Be Duplicated Indio, C619 -77A A 922 CERTIFICATE OF COMPLIANCE Date 7/16/97 No. 15805 Owner Name David Ross Miller APN # 773-211-019 Jurisdiction La Quinta No. 52205 Street Avenida Diaz City La Quinta zip 92253 Tract # Lot # Type of Development Single Family Residence Comments Permit # Log # Study Area 113 Square Footage 1432 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: EXEMPTION NOT APPLICABLE This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of 1.84 X 1,432 or $ 2,634.88 the property listed above and that building permits and/or Certificates of Occupancy for this square footage in this proposed project may n6w be issued Fees Paid By cc/Capital Bank of North County/L. Miller rf Tele�,lione, Name on the check i t By Dr. Doris Wilson .r, Superintendent Fee collected /exempted by Pauline Pearson Payment Received $2,634.88 Signature j'"� J7pRQ 1 A A Check No. 49868 40TICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified above will begin to run from the date on which the building or installation permit for this project is sssued or on which they are paid to the District(s) or to another public entity authorized to bllect them on the District('s)(s') behalf, whichever is earlier. Collector: Attach a copy of county or city plan check application form to district copy for all waivers. Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting I r I TYPE OF INSPECTION DATE INSP. FOUNDATION 8 SETBACK FOOTING STEEL MAIN GROUND SYSTEM GROUND PLUMBING - PRE-GUNITE . , DO NOT POUR CONCRETE UNTILAL A46VE HAS BEE ED CONCRETE SLAB ; JOISTS 8 GIRDERS ELECTRICAL GROUND WORK DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED ROUGH PLUMBI ROUGH GAS 8 fAS TE HEATING BVEN C FIREPLACE ROOF Z BOND BEAM O.K. TO WRAP GROUT ❑ 4' ❑ 8' FRAMING INSULATION PRE -ROOF _ COVER NO WORK UNTIL ABOT17 HAja_,8E.EN SIGRED DRYWALL INTERIOR EXTERIOR LATH POOL PRE PLASTER POOL FENCE 8 GATE SEWER SEPTTCTARR=� 44;i� FINALS +..,c,.\� _Ir• ., X47- !1.'� ..>.;. .�?F*G—..'�. Zis'�R:'. 4�� . i�'-l+'.r � 's �'.• Rr_,ri-r _—.. .y *1..., c� .:lr�: :' 3'.. 1s A'...m f'^.' �a.•QY.+'." T' f :'ri. �i.^•?F•'Tii i .. '.Y; ...tin ,'�'. iti. .t;R„�1•:��i%Tit','�" r aJ1 }.' �:•��q 4Y+.�'`- 1 k COACHELLA VALLEY WATER DISTRICT -,3�, t CASH RECEIPT DETAIL Received From:++ / L � I LX,V �.11 Date —," t . Address: 1 CJ ?/F 1_ f� i� / v I g S C i n 7 -Al �c- i A r ,r e:3,�-- i Account No. � Lot(s) U Service Address .$z ^ OS U{ /U iA D 15 Meter(s) t;l,�ervice(s) / ^� ❑ Backflow(s) ❑ House Laterals) ❑ Detector Check (s) ❑ Meter Surcharge Sanitatlon Capacity Charge d ❑ W.S.B.F.C. ❑ Temporary Construction Meter ❑ Tum on Charge ❑ Uncollected Account - Name ❑ Inspection Fee -Tract - Fee - ❑ Plan Check Fees Water I Sewer - f Tract - ❑ Bond Payment - A.D. - Bond f Assmt. ❑ Customer Deposit ❑ Other Remarks: TOTAL $ 1025r N Certificate of Occupancy City of La Quinta Building and Safety Department This Certificate issued pursuant. to the requirements of Section. 109 of the Uniform Building Code, certifying that, at the .time of issuance, this structure was in compliance with the various ordinances of the City regulating building construction or use. For the following: BUILDING ADDRESS: 52-205 AVENIDA DIAZ Use Classification: Occupancy Group: SINGLE FAMILY DWELLING Bldg. Permit No.: 9706-086 R-3 Type of Construction: VN Land Use Zone: RC Owner of Building: DAVID ROSS MILLER • Address: 17195 TREMONT City: OCEANSIDE, CA., 97054 AllBy: DANIEL P. CRAWFORD JR. Date: 12/17/97 Building Official POST IN A CONSPICUOUS PLACE