0209-181 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisio6s1of
Chapter 9 (commencing with Section 7000). of Division 3 of the Business,an_d•
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
787596 13RIC �r ' "� $1 d30: l'.(
Dat _' f ? J 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):
( ) 1, 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
performance of the work for which this permit is issued.
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 EXEMT T Policy Na
(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;," re
ate: c / J. /. Applicant-
77/
pplicant
Warning: Failure to secure Workers' C"o`mpensation 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..
I'
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 representativesofthis City to enter upon
the above-mentioned property for inspection.purposes
V f,
Signature (Owner/Agent) 11�'P •ne . >` Datet�n
BUILDING PERMIT PERMITq
..
DATE j� VALUATION. LOT TRACT ".
14 t I,1C .214
JOB.SITE ,v -
ADDRESS
D��mi
APN
7 ��-C-�5�:I
`r
OWNER'
CONTRACTOR / DESIGNER / EN (NEER
HANNA SCMME
PAM Q%AYa. 0.
.
` 68.10, �) �t�N ROAD
t 8- I Q0 .'kiJ?+iV1c��f �C�AT� ST.f C-14 c V.x;."1;1 Y
GATIMMRALCIff ah. 91234
MAIM, SPEWGIS CA 92263
(760)3 -450` C131b 4`710
.
USE OF PERMIT
1
,"--11,S�R3 •' ?057 SQXr i,Px'fNi?. prur ji 1x V, ," Ait�i' tldC:J.i1)Jl� itLO�f�
WA, A KWCES, POOUI SPA 09 DRJVE WAY APi'ROACE3I.1NVESTI"TION
FW, ASSESSED PER 19gJ711JAC: §304.5 FOR ii'dORK..OZOUN W1'THOLf'i �
TRACT C0NS'f'RUOTION 2,037,06..9E
i PC?RCHMAT30 133.001 S3'
QARh Ff.CARP0Rr 473.0 SA
rsinwilm) 'COST. OF Cta v ' rsuP ;lf
124, .90
1''kRMff FFE 9t ii/i:Ai."Y
CONS'1 RUCi1ON Fft 01.000.4.1 B-000 =10.0
T'l.r N CHECK 1 E 101.000-139-318 `�6Qa.4�
-a�Q, ofl
MtCHAVICAL FES
Elflrf•TRICl33. YFE, `10-000-420,400. 51:291%
PLUMY INO PER. . ` 101 -000-41-9-000
STRONG MOTION, -.lti 81D'.,101-000=241-000 $12.41
Q12AiyY3aS JPtg'7� 101; ( 06.42':3-000 $15.00
DWELOPPR IMPACT FEE
K...9CYSL .PLAN $109.0 .
4CJiiWIGATKYN FSE q01-000-123;000 V'B'i,Uo
9M-T07'A1'; C01ITMIJ17 °[O13 AND PLA)) CwPMC
14,919,60
ni:E S 'L�K;E-P.AID FE fS
,k
a$.25 0 00
A.
MAY 2.2 23 ..
CITY 0,= L A QUINTA .;
FINANCE' DEPT.
RECEIPT
"
DATE `
BY..DATE'T"PA' F''+--- , INSPEr,
•
I fc;
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 DeckExhaust
Fans
O.K. to Wrap
F.A.U.
Framing (o - (/ • av q 7
Compressor
Insulation . < <a
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wail Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath c0
Drywall - Int. Lath _ / ( -d' S 7
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 I I
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
Utility Notice (Perm)
COMMENTS:
5 ()q (/
L
Date
No.
Owner
Address
City
Tract #
Type
5/19/03
24431
1.
Hannes Sherber
68-100 Ramon Road
Cathedral City Zip 92234
BLK 214
Single Family Residence
CERTIFICATE OF COMPLIANCE
Desert Sands Unified School District
47950 Dune Palms Road
La Quinta, CA 92253
(760) 771-8515
Q BERMUDA DUNES r
RANCHO MIRAGE
{�J INDIAN WELLS
PALM DESERT y
LA QUINTA
��INDIO
8
APN # 774-094-011
Jurisdiction La Quinta
Permit # 0209-181
Study Area
No. of Units .1
Lot # No. Street S.F. Lot # No. Street S.F.
Unit 1 14 . 53440 Avenida Villa 2057 Unit 6
Unit 2 Unit 7
Unit 3 Unit 8
Unit 4 Unit 9
Unit 5 Unit 10
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 (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 2,057 S.F. or $4,401.98 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/1Neils Fargo Bank - Lavern Jacobs Check No. 0098902111
Name on the check
Telephone 7608578-8723
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Sharon McGilvrey $4,401.98 �.00
Payment Recd Cver/Under
Signature r.
NOTICE: Pursuant to Government Code Section 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
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- / -- CITY OF- LA QUINTA-SUS-CONTRACTOR L ST _
JOB ADDRESS J'3 �0 �(/� V1if p pERfil[IT NUMBER OWNER d eL A BUILDEAyco -Q, JAyLI
This form shall, be posted on the job with the Building Inspection Card ai all times in a conspicuous place. Only persons appearing .on this list or'their, employees are authorized to work
on -this job. 'Any, changes to this list must be app�wed by the Building Division prior to commencement of workr i=allure to'c•�mpiy. will result in a stoppage" of work and/or the voidance
of -building Permit. For each applicable trade, aWAformation requested below must be completed by applicant." "On File"pis not anIacceptable, response. -
;. •.....
Tirade / C4assrficatiori
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:' City Susiriess:License
Company Name
Classification
(e.g. A. B, C-8)
License Number
(xxxxxxi
Exp. Date
lxx/xx/xx)
Carrier Name
(e.g. State Fund, CalCompl -
Policy Number
(Format Varies)
Exp.'Date
(xx/xxJxx)
License Number
,(xxxxl
Exp, Dave
(xxtxx/xiil
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