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0204-036 (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 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 own'e'r 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 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., Carrier STAIM FUND Policy No. 10M04 (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 Pshould become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Date: Applicant '-"1Narning:-Failure to secure Workers' Compensation coverage is unlawful and shall'sbbject 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,sinterest 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 su h C e permit, or cessation of work for 1.80 days will subject permit to cancellati6 I certify that I have read this application and state that the above information IIs 4I" 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 upo the above-mentioned property for inspectyiyon purposes:~" Signature (Owner/Agerit)� �� -� = %`"` Date PERMIT��^�! BUILDING PERMIT DATE VALUATION 1 � No LOT 12 TRACT 13L1' 7, JOB . SITE ADDRESS m-goM AVE, N A VILLAAPN rww,025 OWNER. a.: CONTRACTOR/DESIGNER/ENGINEER R.013T:Ai' J, PYA /A 0. IMM CONTSTRU;i`, IOINT S 900 AVE .2 3FACE 30 L�1-�3�+i� p��tV"i9� 0,30 `►TC3 L 52291 .5.2, k IcC� Q .92^01 (760)12e2C101,41 1451 hQ1 ae USE OF PERMIT .1170 =FKKJR1 1 DOMS NOT 414CUU0Z 1d. A 'X tr dello , e'a1LJi, UN. L K, 1r AV APPROACH, :.':OOZ ' TRACT CONSTRUCTION 11666.00 Sty K)RCHIPATIO- 4).00 Sty O RAOUM:A aPORT s -° 5 Fq. WOOD MCF, e0D.t10 LIF cos 01' WITSM. 11•6�"ION '103,€192.0 ,/y�yp�� p'91"IMAM ��+11�7.Y.4lnd.7!• s�i.fiY1S°I14�fYRY . Maur)) Lt0NSTRUC i 1014 ME 103 n000-4183 000 $653.50 PLAN C"HFX K.V4_11, $541.16 DEPOMT 101-000-439-3113 4250100 s4%4XC:H,ei?0C"A,L it'eE, 101-000-421.-000 $;b'd:tlif 01 at>0O=:420-MO $116.39 E:E.1.�C°j RICAL M 101-0,00-, ;r,I.:7,�E1�t38i1f 1'!<?LT 1:i3T-O��a•4! STRCY90 ;hOT1019 ft - ,tEwSID i 0 1 -00044 1. ,000 110.3t CE12ADINC3 FLI 101�000-423-000 a 0. sWir:LOPXR IMPACT FEE PRXI.i IS& E 01,14 101.-000-441-345 LE.M3 3.. TJ—P,P,iD 4250.00 d , VOW RECEIR�Qp r _DATE BY . DATE FINALED 1G-,2 02 INSPECTO GG' INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs z Underground Ducts Forms & Footings Ducts—�J Slab Grade 07 Return Air Steel Combustion Air Roof Deck —/.3 - o Z sT Exhaust Fans O.K. to Wrap v0 F.A.U. Framing Insulation Fireplace P.L. _ _ _ Compressor Vents Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath • O Z Drywall - Int. Lath • l •oZOX Final _ Final �Eo UL 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 I I Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines I/ Heater Final Water Piping — Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Sewer Connection(o • p� Pool Cover Encapsulation Gas Piping Gas Test Appliances Final Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole • Q 2 - Underground Underground Conduit , Rough Wiring Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final �� G Utility Notice (Perm)Z - 5 9z COMMENTS: "�v'�.k1G��"�i�T'•�"�€'��t"*Y�'+X�'��'+iiFf"g,;r"t`.'�';'?�%;i?�`+/�'tl`v��{r�� `�'Yf�,�"�`�''��,�.`?�'`.rit"ft+,;t'T^Y'.y�''r�j^`�"�I�'�„`�'",� ' 3= o)Loq -0-3 Co P.O. BOX 1504 APPLICATION ONLY C n � d2"CALLTAMPICO Addressvi LA QUINTA, CALIFORNIA y 92253 Owner,—, �-- Mailing Address i a rJ �'�✓L!, > i/;)a c r *' , c } City Zip Tel. YContractor il�E?� *t _ C A c Address en u` S G �" f � :3, G City Zip Tell. t State Lic. >T & Classif. Prd ., j ! r s 7 ; rr ,c . City Lic. # Arch., Engr., Designer L. P e u Address /d I Tel. I City Zip State 4n i„ ,.1 '� Ot L I � ' `j Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I 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 Contractors 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 (5500). I' 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, Buisneyss acrd Professions Code: The Contractor's License Law does not apply to an owner of property vlho 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.) 1'1 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 contractor(s) licensed pursuant to the Contractor's License Law.) 1-1 1 am exempt under Sec. B. & P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure,, dr 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, alter 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 Ihereby 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 a0plicant - -Date- Mailing ateMailing Address City, State, Zip BUILDING: TYPE'CONST. 2 OCC. GRP. A.P. Number V 7 % 3 . -A � Legal Description r Project Description r Sq. Ft. NO. No. Dw. New ❑ Add ❑ Alter 0 Repair ❑ Demolition ❑ ae 'O"Zol . PERMIT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure l TOTAL REMARKS i AMOUNT' Z( � v r� ZONE: BY: Minimum Setback Distances: Front'Setbac< 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: Daae Permit Validated by: Validation: WHITE = FINANCE YELLOW = APPLICANT PINK= BUILDIN3 DIVISION Notice:: ' Document Cannot Be Du licated Desert Sands Unified School District 47-950 Dune Palms Road , La Quinta; CA 92253 p, 760-771-8515 CERTIFICATE OF COMPLIANCE Date. 4/5/02 APN# 773-333-025 No. 2311.1 _ Jurisdiction La Quinta , Owner NameRobin Ryan Permit # 0204-036 No. 52975° • street Avenida Villa Log '# , city La Quinta', zip 92253 Study Area #, , Tract # BLK'147 Lot # 12 Square Footage ' 1656 ' - Type of Development, Single Family Residence , No. of units '1 d At the present time, 'the Desert I*Sands Unified School District does`, not collect fees on. garages/carports,- covered patios/walkways, residential additions under 500 square feet, detached accessory structures or ricplacement mobilehomes. It has been determined the above-named owner is, exempt from paying'school fees at this` time due to the following reason:!' 4 ` d EXEMPTION'NOTAPPLICABLE This certifies that school facility fees imposed pursuant to Government Code 53080, in the amount of , 2.14 X ' •1,666 ". or $ 3,565.24 the property listed above,and teat building. permits and/or Certificates of Occupancy for this square footage in this.proposed project may now be issued .r. - Fees Paid By Cash - Jacob Torresr Telepbone 760/772-2848 f y `< Name on the check ` By Dr. Doris Wilson F • Superintendent,.,+ ` fFee collected /exempted by ,Crystal Scott _ - : Payment. Received.' f F$3,565.24 *. Check No. Cash Signature NOTICE: Pursuant to Assembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 -day approval period in which you mat 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 Districts) or to another public entity authorized to collect them on the District('s)(s') behalf, whichever is earlier., l - 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 Certificate,of.Occupdncy acs. .� City'o'f La Quints -' Building and Safety Department7 a This. Certificate• issued pursuant.to the -requirements of Section. 109 of the Uniform Building Code, -r 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:. 52-975 AVENIDA VILLA j .Use Classification: SFD =Bldg. Permit No.: 0204-036.. Occupancy Group: R3 Type of Construction:. VN Land Use Zone: RC Owner. of Building:, AO. TORRES CONSTRUCTION Address: 81-900.AVENUE `52 *#30 City: INDIO CA 92253 By: KIRK KIRKLAND Date: 10-24-02 ,'Building Official' t. POST IN A CONSPICUOUS PLACE