0001-077 (SFD)LICENSED CONTRACTOR DECLARATION
U) n, I hereby affirm under penalty of perjury that I am licensed under provisions of
H 4hapter 9 (commencing with Section 7000) of Division 3 of the Business and
c,1 Professionals Code, and my License is in full force and effect.
O M License # Lic. Class Exp. Date
r- Cy w LO t3S 8t)3 3 t! r30J20t
oZ r- Date signature of Contractor
to O
U C) OWNER -BUILDER DECLARATION
HLU I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
Z ( ) 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 with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code). F
c'') () I am exempt under Section , B&P.C. for this reason
LO
N Date Signature of Owner
ON
Cn
CL Z WORKER'S COMPENSATION DECLARATION
C:) 2 Z I hereby affirm under penalty of perjury one of the following declarations:
r= H O () 1 have and will maintain a certificate of consent to self insure for workers'
X W LL. compensation, as provided for by Section 3700 of the Labor Code, for the
O J Q performance of the work for which this permit is issued.
ED Q U ( ) I have and will maintain workers' compensation insurance, as required by
O U Section 3700 of the Labor Code, for the performance of the work for which this
a rn H permit is issued. My workers' compensationinsurance carrier & policy no. are:
1-tZ Carrier f)TXrC FUNK)— Policy No. 15,12664-9.9
00
J (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.
Date:" �) S' u"J Applicant l f�'•
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, indemnity
& 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. l 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) ^� {`- 7:; Date 2- -190
BUILDING PERMIT PERMI T#4�„u'�, {
DATE VALUATION S1.10,199,10 LOT i TRACT
JOB SITE _ 53-440 A'4�1L1 g97E� .jJ fi
APN 774-0724109
ADDRESS
OWNER
CONTRACTOR / DESIGNER /ENGINEER
L1prruypMIRyg}LE
17RDY3BLE IGONSUC ry N CO., 314 0.
80-655 AVENUE 43
80-635 AVENUE 43
MAO CA. 92201
INDTO CA :1
.9220
i -7(V1))347-9755 CB1.10 5291
USE OF PERMIT
SINi.AS.Filt ILl'DWI ELL Nt G
:i lU-i*Idtl�7t a i)OfiS SIV! iNC:i.U!A BLLit.`K WALLS GK P00L.7S?:,,PLAlV
i=tlav:G�;: t�i:Jlbesl3iJG`t'1F�A1 f?£J�<. iL4i.Jt,'!'tY3�l� I:SSi7t1NG"� �Jk :SA�2f;: �LRN'!'.Y4��.
TteACT��.�vsi)2'Ji:a f✓ii' t,78:i,fx� S
TIOR HfPA.TIO !.83.00 ;SF
(rAtU\AYWCr1R'09l' 474.00 SF
S F'P. 'wooD f-Eg3CF 200,01) LF
ESTINTA,T`ED COST OF Cf,9NSTRUMONT
1104.E Ao
CONSTRUCTION FEE 1014000-418-000 5678.1 i0
PT. AN f`FW(K iFPV, 1 f111.O lll.r91ti -11 R_ 4141 AR
'F :rr•r�i e n e5r/`n 7 /'.`t7T '1 fit t1JlA Arl'i !l/!!t Wei" lin
.rvyi".l..l'it11.V J'�•nl..r'la � S �l q. -' V V V' 41 k ^V v u mu+�.vu
:k.I..LC.'9'27(C AL I.' +r 109-000-420-000
P11tlflt BINE ITEE5 J01-000.419-000 niK75
-
,9'rR�T7�IpVwG f-F.R _ RESIn !
••
f�,r,QTTON
{R�9i.-00!3(0-241-/0�{►��
OR AD A'�4I .f,TT . 101-44It 4213-000 L6�.VV
r •
DEV .().PFR JuA4Pi,(r1 FEE. 91.907-60
i .
5
11REC1'iF.P1,AN' 101-M-441-34.5
• f;
t~ r R. nFp%-)Sf IT, 101-000-434-31 E 42501M
,
5
ta
«+-•"rr`ri :AL C~tlNFt'� t. Tc770N AN!) P1_� N c`'t-t VK
$1,17'-% '! j
Lll;,' I 3�' RIE -i} ID i L s
_V50 v1i
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
7INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
v
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
— OZE3
Exhaust Fans
CK to Wrap
F.A.U.
Framing
- - pa 5'
Compressor
Insulation
— p -
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
? -
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
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
Gas st
ces
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 o0
Utility Notice (Perm) ji
COMMENTS:
%I
Desert Sands Unified School District
47-950 Dune Palms Road
Notice: La Quinta, CA 92253
Document Cannot Be Duplicated 760-771-8515
Date 2/2/00
No. 19984
CERTIFICATE OF COMPLIANCE
APN # 774-072-009
Jurisdiction La Quinta
Owner NameWilliam Tribble Permit #
No. 53-440 Street Avenida Diaz Log # WT1781
City La Quinta Zip 92253 Study Area
Tract # Lot # Square Footage 1781
Type of Development Single Family Residence 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:
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of
1.93 X 1,781 or $ 3,437.33 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/Prime Bank/William Tribble, Jr. Teleph. one;'
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Mary Ann L. Borja Payment Received 0;437.33 -
A n 1
Check No. 2195
Signature
NOTICE: 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
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
RC District - Planning Review Form
This form is to be used by CDD staff for review of single family dwellings in the RC (Cove
Residential) District, in order to determine the applicability of compatibility' issues or need
to require the filing of Master Design Guidelines by the applicant. It shall be transmitted to
Building & Safety as your correction list. Please attach additional explanations as necessary.
APPLICANT: TRIBBLE CONSTRUCTION
PROJECT
ADDRESS: 53-440 Avenida Diaz
APN:. 7747072-009
LEGAL: LOT' 15 . BLOCK , UNIT . S.C. @ V.L.Q.
CVD BY: Fred Baker
BIN NO:. CASE NO. 2000-181 ..CHECK DATE:
Inform the assigned Building plan checker .upori..your..assignment to this case. The CDD
Executive Secretary maintains a log book to track applications and, assign case numbers.
REQUIRED ITEM
Y-1
N I COMMENT/CORRECTION
,'„•.., , :. \.n n .\. \.. d^\::�. ,`::"illC4}�`
`;:\�`::';:.:;i\:i �..tiC: L,,I}.;•'::\\..\\:t ":<.'S:.::;•.S:CS�:.A•: '::}\`.•~'•c^X•.:•:..f;.}•:,hh.�.:....r:.Cv.: :i•: i•:o.. .::!}•Cv,.r``%.,,,;.:a:
}:..u,:h,+...\:]•`:;L.}:.:.}::..7h:\\:\,}: Z;:...\...:....::;\A•'^\�\`C`'?.\:w i'F.;<� �.;:.,�. \::.:£
a }. ?:\�:�`'C:•`{'•4�•• '��\�.'�". �� '. r ?.\}:
Y..:.
G3AP, N 'T ':: `\:::..o.L\
".:,.v:. }:•nv rjl:v�:}:l:C`\:`�2 ::.\\fn`:' ��:`\'•�
.` v};:..g.'a: •.}:..:.�..\..�:•�
Cr`}. A. \�.��'�}�?J' G';C<(b{} �i,C\` • 1}�'C:` \��` \
`: `::w .� \•:; •.::`'ti o.: �:.::}`.;t::\Z�4: \:<L>::x 3:.11111:•?:��Y,
n..:.::•::aR.;•.�}"L.. :.:+...Sao-....
Case logged and number assigned
Verify legal and APN information,
OEM '
_ r
�x IBtT
Consistent with MDG on file (as applicable)
MDG filing required (5+ filings since 9/3/981
Consistency nth'street/surrounding CAS
area*.'
LCrs
rialsitectureUIREMENTS:
The zoning code, architectural and landscaping manuals, .and/or assigned inspector should
be consulted where 'uncertainties arise. The completed checklist shall be maintained -in the
Building •& Safety address •file.