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0302-117 (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 67 12013 13 (35!131 /Zr J Date c' f ' 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). ( ) I am exempt under Section B&P.C. for this reason Date Signature of Owner WORKER'S COMPENSATION DECLARATION r 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'I.ATi1,,?i NTS Policy No. a 13it90 (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: Applicant i t t ' J11 Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his application. 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. - 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspection purposes. Signature (Owner/Agent) Date BUILDING PERMIT PERMIT# DATE VALUATION LOT TRACT JOB SITE ADDRESS . %�E-5£�4. lT.€i C:Cil1.F1 �f.i��"° APN OWNER CONTRACTOR / DESIGNER / ENGINEER JOHN IZEYN01: DS A)MREriV XMICZ Ci:RPOR A'.I'09 1 -11.d 1"OEQUA A0At) 4463: DT+:17,PCM4°O a' RD YJL. jb!).oklr ' CA 94 (i 1 RALM MUR,! C":.P, 91"Z61 CV ¢11 03031 USE OF PERMIT ,'.010LE D LL'6lL.,.,Y i WELIA4`i' Si+'l11- LOTV V'.CU.09S,WAY 1PE��t.E1LEilCt�:?�3I' 49�N�..N WITH AU, Fb,i )!a4 L &1tT:A'i'$.LAWS, INC AL1MMI TH2, rT?r.3.t'.atttKREV MCI.;s`, ACT OF ,V-1 IF A11PIR!"AtiBf.,:P,IS 6t:Rt;tr. I".",V t".US'I'OM CONOTRUCfION .1,24cov's- 5 PORC1,VPF 1 C1:F RAUXUAPORT 604,00 8'N :E S"3"!1"73u) MSIT OF C=CbI l"t'rRi( 'rMON 2`13"tro9sa }PFXWr ::+'kms CONS'I'I~OUC`1 ION ME '103. -O'D06,418.00) $ 4248:34 PZAI CIIACK F'ifl S o;~ 1- f)t) d3?f�-31 1tOstl.'iy EEI)ZPOM. T -51,050.F4 RfIF.C1i.�'BsIL`AT., �F . 1 U1-t1`;t:#•4?t �=1'3d1� �147.t73 1:1,19-7lvlCAL RE 101.•0'00-420-0,00 $201: 0 ?r.,xJSo BIP: O PER 101 �-{JCstif '�19�.15 'I'I?(91a43 Mc1"P1]N 1. •` 1'.Fi% 0?1-ON-Vf1 •ft02•Y,3 Eililb73l'";�Ct)t i:ID-R1011r"r? Nlr°AVT RE SS2,40.00 AR,T 1114 PUBLIC k LJI-CE - MFOil 2704tK)-445-G0 t $193.60 ° c3i711 Q°C�L' M1450CtI: ?�1 Pa-MIp t�(�7g1�ti��A]5 Gyy'//F°11?.p�G••��:' ".. D tt I.T4, 311 PRE,1w-IY1 FER1 T *4i i •t/tM CY. GlV AUG 0 1 2003 3.. 41 FCSW CITY 07 LA '1:ANTA FIHA= °'`_FT. i>iy��hlii7.i% RECEIPT DATE BY DAIS FI BALED N INSPE OR I �' 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 , — 3 Combustion Air Roof Deck Z y Exhaust Fans O.K. to Wrap F.A.U. Framing ,. O 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 — BLOCKWALL APPROVALS POOLS - SPAS Steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Pibg. Test Final Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines 6 Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Showier Pansy O.K for Finish Plaster Sewer Lateral Pool Cover Sewer Connection Encapsulation Gas Piping ,Gas Test Appliances Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole . I— —�3 Underqround Conduit Fudures Main Service Sub Panels Exterior Rece G.F.I. Use of Power Notice COMMENTS: 700ft AiEeg, W SaoF-6,60se 'Cvz1^0.A LICENSED CONTRACTOR DECLARATION I hereby affirm under of that I am licensed under of PERMIT# BUILDING PERMIT`r C/) H penalty perjury provisions Chapter 9 (commencing with Section 7000) of Division 3 of the Business and 0302-117 ' : U) Professionals DATE VALUATION LOT TRACT $273,43930 8 Code, and my License is in full force and effect. `Q_, I p =5 M License # Lic. Class Exp. Date JOB SITE ADDRESS 78-581 DEACON DRIVE EAST 770-220-M T � W � 17. 671203 B 05/31 /2( r (Z r-- 54 f O Date Signature of Contractor OWNER CONTRACTOR /DESIGNER / EN INEER CID 0. o JOHN REYNOLDS ANDREW PIERCE CORPORATION —' U OWNER -BUILDER DECLARATION 120 REQUA ROAD 44835 DEEP CANYON RD UJ a I hereby affirm under penalty of perjury that I am exempt from the Contractor's PIEDMONT CA 94611 PALM DESERT CA 92261 ... U Z_ License Law for the following reason: ( ) I, as owner of the property, or my employees with wages as their sole (760)346-3228 CBL# 0303 • compensation, will do the work, and the structure is not intended or offered for USE OF PERMIT sale (Sec. 7044, Business & Professionals Code). . ( ) I, as owner of the property, am exclusively contracting with licensed SINGLE FAMILY DWF.L.LIldCi contractors to construct the project (Sec. 7044, Business & Professionals Code). SFD - LOT 8 EXCLUDES WALLS/POOUDRIVEWAY N () I am exempt under Section B&P.C. for this reason APPROACHlGOMPLIANCEblITH ALL FEDERAL &STATE LAWS, INCLUDING O N Date Signature of Owner THE ENDANGERED SPECIES ACT OF 1973 IF APPLICABLE IS REQUIRED 0)U Q WORKER'S COMPENSATION DECLARATION (• o 1 hereby affirm under penalty of perjury one of the following declarations: CUSTOM CONSTRUCTION 3,246.00 SF H p () 1 have and will maintain a certificate of consent to self -insure for workers' PORCH/PATIO 657.00 SF X W LL_ compensation, as provided for by Section 3700 of the Labor Code, for the f, OJ Q M performance of the work for which this permit is issued. GAR.AGE/CARPORT 604,00 SF <L) () I have and will maintain workers' compensation insurance, as required by O U Q CLvO Section 3700 of the Labor Code, for the performance of the work for which this Z permit is issued. My workers' compensation insurance carrier & policy no. are: r Carrier STATE FUND Policy No. 1615846-2003 ES D4ATED COST OF CONSTRUCTION 273,439..4 � PERMIT FEE SUAUvIARY g (This section need not be completed if the permit valuation is for $100.00 or less). -CONSTRUCTION FEE 101-000-418-000 $1,248. () I certify that in the performance of the work for which this permit is issued, PLAN CHECK FEE 101-000-439-318 $1,039.79 I shall not employ any person in any manner so as to become subject to the FEE DEPOSIT 101.000-439-318 -$1,000.00 workers' compensation laws of California, and agree that if I should become MECHANICAL FEE 101-000-421-000 $143.00 subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. ELECTRICAL FEE 101-000-420-000 $208.19 Date: Applicant PLUMBING FEE 101-000-419-000 $197.25 o Warning: Failure to secure Workers' Compensation coverage is unlawful and STRONG MOTION FEE -REBID 101-000.241.000 $27.34 j` shall subject an employer to criminal penalties and civil fines up to $100,000, in GRADING FEE 101-000-423-000 $15.00 a addition to the cost of compensation, damages as provided for in Section 3706 DEVELOPER IMPACT FEE $2,405.00 z of the Labor Code, interest and attorney's fees. ART IN PUBLIC PLACES - RESIL 270-000-445-000 $183.60 f , Z 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 i. application. 1. Each person upon whose behalf this application is made & each person at SM -TOTAL CONSTRUCTION AND PLAN CH= $5,457.67 whose request and for whose benefit work is performed under or pursuant to LESS PRE -PAID FEES -$1,000.00 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 TOTAL PERMT FEES DUE NOW $4,457.67 w 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 representatives of this City to enter upon. the above-mentioned property for inspection purposes. RECEIPT DATE BY DATE FINALEO INSPECTOR Signature (Owner/Agent) Date P.O. BOX 1504 Building !� �/1/� UINT CALLE CALIFORNIATAMPIO Address / �, .f�ilf% .1//) _ LA QUINTA, ORNIA 92253 Owner Mail' g Address Cit� Contractor Address cityo D. State Lic. & Classif. Arch., Engr., Designer g3 pe e -,e Zip „ Tel., „ D APPLICATION ONLY BUILDING: TY'P-EE''-CONST. OCC. GRP. c A.P. Number Legal Description OT 8 'M ZPI/ 70 Project Description I PtMeacp P E y2.0 Lic. # 3 o 3 / Sq. No. No. Dw. Zip C�j�� State it -�"I'e" FL ump Lic. # LI ENSED 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 Contractor's 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 ($500). 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, Buisness and Professions Code: The Contractor's License Law does not apply to an owner of property who 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.) I I 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 contractot(s) licensed pursuant to the Contractor's License Law.) I'! I am exempt under Sec. B. 8 P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION Ihereby affirm that I have a certificate of consent to self -insure, or a certificate of Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No. Company (l 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 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. Date Owner NOTICE TO APPLICANT: If, after 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 ame 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 ,of this city to enter the above- mentioned property for inspection purposes. Signature of a0plicant Date Mailing Address City, State, Zip Add ❑ _Alter ❑ Repair ❑ Demolition ❑ W n PERMIT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL REMARKS ZONE: BY: Minimum Setback Distances: Front Setback Rear Setb Sid reet S FINAL DATE Issued by:— Validated by: Validation: AMOUNT 1. Ol9 Prop.inr k fro w r Li Prpjry Lin, YY t WHITE = BUILDING DEPARTMENT YELLOW = APPLICANT PINK = FINANCE rmit Date 7/30/03 No. 24761 Owner John Reynolds Address 120 Requa Road City Piedmont Zip 94611 Tract # Type Single Family Residence CERTIFICATE OF COMPLIANCE Desert Sands Unified School District 47950 Dune Palms Road La Quinta, CA 92253 (760) 771-8515 APN # Jurisdiction Permit # Study Area No. of Units IYCI 4cn� �1ED �o Q BERMUDA DUNES r C4 RANCHO MIRAGE t=J INDIAN WELLS PALM DESERT ,y LA QUINTA '> I 0 O `^ VV O J+J 770-220-008 ,La Quinta 0302-117 1 Lot # No. Street S.F. Lot # No. Street S.F. Unit 1 8 78581 Deacon Drive East 3246 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 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 $2.14 X 3,246 S.F. or $6,946.44 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/Palm Desert National Bank - Dave Muth Check No. 086811 Name on the check Telephone 760/346.3228 Funding Residential By Dr. Doris Wilson Superintendent Fee collected /exempte by Shar cGilvrey Payment Recd 0.00 $6,946.44 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 Certificate of Occupancy Lvco®owitn G� OFBuilding & Safety Department 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 provisions of the Building Code and the various ordinances of the City regulating building construction and/or use. BUILDING ADDRESS: 78-581 DEACON DRIVE EAST Use classification: SINGLE FAMILY DWELLING Building Permit No.: 0302-117 Occupancy Group: R3 Type of Construction: VN Land Use Zone: RL Owner of Building: JOHN REYNOLDS Address: 120 REQUA ROAD City, ST, ZIP: PIEDMONT CA 924611 By: KIRK KIRKLAND Date: SEPT 23, 2004 Building Official POST IN A CONSPICUOUS PLACE