0312-131 (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 # LLic. Class Exp. Date
178260 is
PP J
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).
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.
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. IrE3t4P` Policy No.
n
(This. section need not be completed if the;permit valuation is for $100.00 or less). .
I`) -I certify that in the performance of the work for which this permit is issued,
I SQ1 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 �p�ovisions of Section 4 700 of the Labor
Code 11 shall forthwith comply with,tho provisions.,
,Date: _ __. () 'l
Applicant—/
Warning: Failure to secure -Workers' Compensation coverage is unlawful and
shall subject an employer to'criminal; penalties and civil fines up to $100,000, in
addition to the cost of com pensati on, 'damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building`and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made ,& each person at
whose request and for whose benefit work is performed.under or, pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
&.hold harmless the City of La QUinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will'subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building L
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property'for inspection purpose'1 .'
Signature (Owner/Agg�✓ �--'J Date
=�r 3IJILDING PERMIT PERMIT# ),$I.-
$7♦DATE
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DATEVALUATION, LOT1'S;�,sa;Y'TRACT
JOB SITE ]APN
ADDRESS 5zi-x.55 -- i . �`i �
74_.. `024
OWNER
CONTRACTOR / DESIGNER / ENGINEER
COVt DMILOP2v ENT
?,214 PUDGM0 U
P101 BOX 696
SA�,`"fi'sAW CA
LkQU1RTrA CA 92253
(760)W.7820 MIX 02063
USE OF PERMIT
MIQ•I F, F.t f;,Y MM ZI c "
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SID • LOT 12. PERMIT DOES N:O`S 114CL.UDY, BLOCK IPOOJ4
SPA Oli.l)3',.IVhl'7.AY APPROACH
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TRACT CO:�151TRIUCTICYN 77080,(30 Sf
POi1MWPATIO$99.00 SP
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By
,FiM&. TE� D .CONST OF64pM}NvAON
.C{ 4p7j�iyYghy$P, f9 Oe♦J��
PEW= FRF {AM6(Ry' 1
CON MUCTION Ful 1101-000-418-000 $930.00
PLAN CHECK FEE 101-000-439-318 $771.98
M1DEPOSIT 4250,tt0
EC $4►�10
'A£i�PCF�ATJPGf1L.1rL?� '012
•
ELECT-JU„AL79'.x=101.000420.000 $163.46
. f'I.1,11V#Fif2dd3 TfP.T': ' ,, 109-f�Q0-1d19��0 �IG3:'/S
,
S`t`ROM MOTION � 81:, - R611D 101.,000-7,4'l.<000 Sia
GRADINIG FFY 101-000423-000 ;x13.00
DUMOPER IMPACT FRE 32,405.00
PREC1w1A PLAN 101 41-•34S $100,00
• i ,.•;�I� S CU MIO.l 1• A PLAN C;T�1:(+'.0"..FC.
$4,60,31
D � PRE-PA1P FEFS
_F
W 150,00
s MAR 022004 T' OTA , �:k ::�I� NOW
S4 'C �a
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CITY OF LA QUINTA
FINANCE DEPT.
RECEIPT
DATE�BY
��
DATE FINALED
INSPE O
INSPECTION RECORD
.OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
V
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
ej
F.A.U.
Framing
Compressor
Insulation
Q G
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
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
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste LinesZz—�j
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
— v
Encapsulation
Gas Piping
Gas Test
_ ,p
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Gbdures
Main Service
Sub Panels
• Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
CERTIFICATE OF COMPLIANCE J��Flsc
Desert Sands Unified School District
'47950 Dune Palms Road BERMUDA DUNES
HO
Date 2/19/04 La Quin a MIRAGE
� INDIAN WECA 92253 RAN AN WELLS LS
c�
760 771-8515 -. �. PALM DESERT y
No. 25523 (), � LA QUINTA
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QINDIO L�
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Owner Cove Development APN # 774-173-024
Address 2214 Ridgewood Jurisdiction La Quinta
City Santa Ana Zip Permit.#
Tract # ; _ Study Area
Type Bingle Family Residence No. of Units 1
Lot # �No. Street S.F: Lot # No. Street - S.F.
Unit 1 12 53955 Avenida Villa 2880 'Unit 6
Unit 2 Unit 7
Unit 3 Unit 8
Unit 4 Unit.9,
Units Unit 10
Comments
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patiostwalkways, 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 i$2.14 X .2,880 S.F. or $6,163.20 have been paid for the propertylisted 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/1st Bank -"Sharon Bills Check No. , 70931
Name on the check Telephone 880-3446
Funding. Residential
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Sharon MCGilvrey Payment Recd $o.00
$6,163.20 Over/Under
Signature
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
i
Certificate of Ocdupancy0
IWZVORAIM
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OF Building & Safety Department.
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This Certificate is issued pursuant to the requirements of Section 109 of the California Building
Code, certifying that, at the time of issuance, this structure was in compliance with the
i
provisions of the Building Codeand the. various ordinances of the City regulating building
construction and/or use.
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BUILDING ADDRESS: 53-955 AVENIDA VILLA
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3
Use classification: SINGLE FAMILY DWELLING Building Permit No.: 0312-131
Occupancy Group: R3 Type of Construction: V -N Land Use Zone: RC
Owner of Building: COVE DEVELOPMENT. Address: 2214 RIDGEWOOD
4;
'
City, ST, ZIP: SANTA ANA, CA
By: KIRK KIRKLAND
I t
Date: December 9, 2004
Building Official
POST IN A CONSPICUOUS PLACE