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0211-127 (SFD)LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions'of Chapter 9 (commencing 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 . Date '`"� of - Signature of Contractor_ _. Z d f '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 OT Tne property, AM exclusively contracting with' licensed contractors to construct the project (Sec. 7044, Business & Professionals Code). O 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 issued. My workers' compensation insurance carrier & policy no., are: Carrier , S,,e &TB FUNjD Policy No. 046-73.23.2003 (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 subjectto 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.' j Date-' Al's ' �r ' Applicant I. l► Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in ,addition to the cost of compensation, damages as provided for in Section 3706 sof the Labor Code, interest and attorney's fees. IMPORTANT-. Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his application. - 1. Each person upon whose behalf this application is made ,& each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold'harmless the City of La Quinta, its officers, agents and.employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby.atithorize representatives of this City to enter' upon the above-mentioned property ,for inspection purposes'"`\ Signature (Owner/Agent) (j Date BUILDING PERMIT :PERMIT# _ n � iDATE VALUATION LOTTRACT 8�c►,919:38 44 : ?,652.4' .. JOB SITE ADDRESS.. 504,16 W0.0 -D RI X, APN � OWNER CONTRACTOR/DESIGNER/EN (NEER 79.295.EUNCHOl.AQUIN ADR. 79-295RAN OLA(,?UN.ADR LA, QUTAT1 A � CAS. 99253 1: kQt UTM cA, 92213 • (7653)'771.1941 Ck 2996 USE OF PERMIT ST GIS FAMILY D -01F7 IA11G. V.17D ••PmzpmTr Don, 14oT iNCLunE,'J1A)CV.'WAL1, POOL OR.0R:t'd'wWAY' APPROAC111; 98 t.' -Orad CUSTOM CONSTRUCTION:.%32s.Do er! POit.r:KtJ'_.VrT.O 1.1'"2.00 SF 0aAWNW(PORT 972.00 OF .XS77 T*X )ST OF PUf, VIV If Im tf1Tho/IA Y C0148TRKJCT1QN Iqa- 101.000-4113.000 si'a6s.00 , PLS C.'lI:C`Ek� iGt$-d:�i-�i.�9w:�1€31,•aU 1 K? DRPOSIT 101.000-439•`318 -$250.00 JF.1 3idt3Tlf:.A . F E '10.1400-421-000 UItiTRICAS: ft' l k I�.Liii�C�3l1iIC3 P'F.I". til-i3flC)-x.9'7-�JCII�- • .. �w�9R."�A ' STRONG MOTION FTE RUN) 101 a000-241. -000 30,69 OP-hDINQ 1. 4; l it1. �1C+51�4Z3 U(2C1 $f;g:nrJ DEV ELOPER IMPACT FEE AP.T IN PUBLIC � t�Sm T70-000-145-0100 �nD.30 T�IF3-T Yxt C"tJt� iL3c^'ICt"l!il l��T)IFL +, €CM1C .$7,2 8.91 i9ss p a.pAn) Ftm . 4250,00 D ! I namulfru' An",1^d0'l1tP $7,028.91 ' APR 2 4''-2003 CITY OF LA QUINTA FINANCE DEPT: t. RECEIPT • DATERi = L r..�i.�f rte. •.J BY DATE FINALED INSPEC R 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 — _ 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 I Z7 -79 -22 -POOLS BLOCKWALL APPROVALS - 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 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 — l� Utility Notice (Perm) COMMENTS: �r f3 ��<. �IAG,G, �or1 , •��- � l�'%fid � 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 5,325 S.F. or $11,395.50 have been paid for the property listed above and that building permits and/or Certificates of Occupancy for this square footage in this proposedproject may now be issued. Fees Paid By CC/California Bank - Judy Halpain Check No. 02365 Name on the check Telephone 760/771-1941 Funding Residential By Dr. Doris Wilson Superintendent Fee collected /exempte by Sh ron McGilvrey $11,395.50 Woo \ Payment Recd Over/Under Signature NOTICE: Pursuant to Government Code Section 66020 1), this will serve to notify you that the 90 -day approval perioc 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 b 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 Copv - Accounting CERTIFICATE OF COMPLIANCE Desert Sands Unified School Districtq�aSo 47950 Dune Palms Road r ¢ BERMUDA DUNES Date 4/23/03. - � La Quinta, CA'.92253 RANCHOIANWE LS INDIAN WELLS ti No. 24356 (760) 771-8515 PALM A UITy� LQNAr�� ; TINO©.... " ' . Owner La Quinta Orchard Partners APN # 772-040-022 Address 79-295 Rancho La Quinta Dr Jurisdiction La Quinta City La Quinta Zip.92253 Permit # 0211-127 Tract # 26524 Study Area Type 'Single Family Residence No. of Units . Lot # No Street S.F. Lot # No. Street S.F. Unit 1 44 504' 55 Woodme e� 5325 Unit 6 Unit 2- Unit T i Unit 3 Unit 8 Unit 4 Unit 9 Unit 5 Unit 16 Comments At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patio:3twalkways, residential additions under 500 square feet, detached accessory Structures (spaces that do not contain facilities for living, sleeping, cooking, eatirg 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 5,325 S.F. or $11,395.50 have been paid for the property listed above and that building permits and/or Certificates of Occupancy for this square footage in this proposedproject may now be issued. Fees Paid By CC/California Bank - Judy Halpain Check No. 02365 Name on the check Telephone 760/771-1941 Funding Residential By Dr. Doris Wilson Superintendent Fee collected /exempte by Sh ron McGilvrey $11,395.50 Woo \ Payment Recd Over/Under Signature NOTICE: Pursuant to Government Code Section 66020 1), this will serve to notify you that the 90 -day approval perioc 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 b 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 Copv - Accounting LOvl f w ` Cerfificatefof=:O�cCu atnc .r - _ o .- - wet �,,,.• Building Sa' f t' 'Department` , '. -This .Certificate is_ issued -pursuant to the requirements of Section-.109'of the CaliforniaBuilding,`>> ' .Code, certifjiing- that, at the <time of .issuance; this .,� structure ' was rt in - compliance - with the, ;° �- ylS provisions: of `the Building ,Code' and. the various ordinances of, the .City regulating_ building .. _ - ., construction and/or use. w BUILDING ADDRESS: `50=455 WOODMERE 'Use classification: S:F.D. - _ Building Permit -No:: 0211-127, Occupancy Group: R-3 • - Type of Construction, 'V -N s_' �. Land Use Zone' -.R L - ,: +''� Owner of Building: TD DESERT DEVELOPMENT - Address PO BOX -1716 - t K� by, ST,`ZIP 'LA QUINTA *.CA 92253 e ' '�. y' ,• :� :• = By: - -.G SHOWALTER 9/04: --Date 05/1 , - ; , . . F ,j • ingudOfrM ' - POST IN A CONSPICUOUS PLACE,.'