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0201-148 (AR)
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 - ,Ezp D /Dat�- Signature of Contractor�,,,� Z'.' 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 1 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. (r.). I have and will maintainvorkers' compensation insurance, as required by action 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 OT.ATE FUND Policy No. 43692113 (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 becorne subject to the workers' compensation laws of California, and agree thdtif I should become subject to the workers' compensation provisions -df Section 3700 of the Labor ,.Coq) shall forthwith comply with those provlslons:;;1'� Date: 9 3� .Applicant -�-✓ i % % 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,in!96ction purposes. Signature (Owner/Agent) /i+ Date ., BUILDING PERMIT PERMIT# / 1: 714418 DATE J / VALUATION LOT TRACT 22982, $54482 M 86 t' JOB SITE 44 1 C.J�w�.XTAR. CUP.. ADDRESS yT " APN OWNER CONTRACTOR/DESIGNER/ENGINEER M% Clffigwpolillos EDWARD ORORGE WISH, 44-480 FOXtAL CIR 53665 �7' F"awrIt DR 1r.AQT-.A CA 92253 :( rkgmorA CA 9=13 (760)771.11.80 28m USE O�jFq�PERMIT ��pj f.4./i:1�Nwl.dJwi'Y dACkt.�4�la .►IiA�.�.l��d � l ENCU—NMR£ OF 3RD CAR 6ARA.O& AD11111014 OF 1.58 V P:&;3:.APPXaJ'fPD. PFAH&ft4i!'f.81'Tt7�,1'ION FREAM SSRO:s�ER 0" WAX 4004.5 Ptak. w.>;. ltx rfFQli2a WiTHOUr BU111101NO FP;AMi7. CONTRACT ANOI 14 T' 3,482.60 L2 EMMATED, C'ObT OF 0,01 1MR17C.11CI?N Y'AYa/�*cliS(�iySgA�y�{fPgp�}4�q 15�dY.�IAfiA.L4.Y (110MI]T lUC11l.0" ,1� E. PLA14 CHECK M 161'3_000_011N.9_3 W 01 MEC1• MKIC.�i9.� FEE, 1401-MO-41ISIAa3� E..IZZ,TRaCA! 6 n R 101-00D-420-000 �3El.�Jc► :;TT3O'1` G MOT19N FIRE- T3VIRD 103 -GOO -241 -000 S.53 IiSlt'1`rs l°tf`1g7kf: v nes 101-000-4-23-000 " $157.40 l ' JUL � r IOU" 6F.LAQUIrrrA CITY va-'roulln a . P1" (:Ixsj LFX5 PRE -RAID 171_-7,1Z1 o '3'CiTL43, '� t milt C► s'�{J"'E i` 7 •h RECEIPT DATE f BYE D INALE INSPECTOR r e. , - L,_ c� 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 0. 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 Z Final Final - -'o 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 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: Bin # 'D City of La Quin to I\ 80ding ai Safety Division W P.O. Box 1504, 78-495 Calle Tampico Permit #La Quinta CA 92253 - (760) 777-7012 v2O7 -i4e, Building Permit Application and Tracking Sheet Project Address: 4LI qj -fb%, ( C 14 C (l Oµvncr's Name: J I-. CH C ti -f Op,ld4 A. P. Number: + • Q�¢ Address: L1 y �� x�bl ( CieG(4 Legal Description: 1-074 �� `Y.trG�'z�+ g2 City. ST. Zip: i4 J, ontractor: Telephone. ddress: Z - Ota% % �!' Project Description: ,�� f0f 4 � ? ft - ST. Zip: T4/J Telephone: 760'3 3 / J< /Oo- 853 -.5Z State Lic. # : +Cin' Lic. N: NOT 6 : W 02 K DONE (.// TJ�O jT � l�''^� y• Arch.. Ener.. Designer: iKR W14 AJ $EGG/N 1400 e Address: SVevEF1r, Tkey CO�„~ U. City. ST. Zip: ;�- Telephone: Construction Type: v— A/ 'Pecupanc+•:''� j State Lic. #: Project type (circle one): New Add nalter_)Repair Demo /5® Name of Contact Person: �J Sq. Ft.:�. #Stories: #Units: Telephone # of Contact Perspn: ' S' Value of Project: (c4I %1/J 12— APPLICANT: DO Nu�T WRITE BELOW THIS LINE N Submittal Req'd Recd TR4CKING PERMIT FEES Plan Sets 3 t!T Plan Check submitted 6 aI OL Item Amount Structural Cales. Reviewed. ready for corrections 4 Z y Plan Check Deposit Truss Calcs. Called Contact Person p7, Plan Check Balance Title 24 Calcs. Plans picked up Z$ Construction Flood plain plan Plans resubmitted p Mechanical Grading plan 2" Review. ready for correctio iss a Electrical Subcontactor List Called Contact Person to Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- Review. ready for correction issue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees CERTIFICATE OF COMPLIANCE �FT�Sc Desert Sands Unified School District 47950 Dune Palms Road 24 0 Q BERMUDA DUNES t✓ Date 7/22/02 La Quinta, CA 92253 rn RANCHO MIRAGE d No. 23399 17601 771-8515 �t INALM DIAN WELLS ti / t� PLAQUINTAT INDIO y011 Owner Jim Christopoulos APN # 604-084-014 Address 44480 Foxtail Circle Jurisdiction La Quinta City La Quinta Zip 92253 Permit # 0207-148 Tract # . 22982 Study Area Type Residential Addition No. of Units Lot # No. Street S.F. Lot # No. Street S.F. Unit 1 86 44480 Foxtail Circle 158 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 50 square feet, detached accessory structures (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile home It has been determined that the above-named owner is exempt from paying school fees at this time due to the following reason: Residential Addition 500 Sq Feet or Less EXEMPT This certifies that school facility fees imposed pursuant to Education Code Section 17620 and Government Code 65995 Et Seq. in the amount of $0.00 X 158 S.F. or $0.00 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 Exempt - Edward Wise Contractor Check No. - ame on Me cneCK Telephone Funding Exempt By Dr. Doris Wilson Superintendent Fee collected /exempted by Crystal Scott Payment Recd Over® 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 thos 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 NEW FLocir�_ PO ROOM A DD'►Ti6M , C'.N►2as7-ot'zpouLos 9F_,.©EArcG F C ;e Qui,irA SCALE DATE f,46wN CSV Dor r N Li IVO -05 19'89 m /31 sb E�,N R 00 (Vi 9110" 6X4 G SI.I GING W( NDOW cr sb E�,N R 00 (Vi 9110" 6X4 G SI.I GING W( NDOW ��eT1c� PLAN ROOM A DD iri®V CNrz6g,roP,Ou>_os LI q -! F c. 1e 5CALS WWN Raj Do,,4AW LANO-05 gT(iel ` u'c, I-rr i Fotb OST iia U .I �� _ /�-tl InlSutfi"�ort 4 3��►2AM Y Rg6 JVD rrIEATEb P1ArF_ LID 0 R -3.o i1�fSUl 9-5 a Three bedrooms, two full baths, tiled entry, fireplace with hearth, living room, dining room, kitchen with pass-through, three -car garage. ICR �xiSTl Loon PLA N ROOM A DD irio m C'H►2�gT�t�6ULOS ��3�D1=NCtr 11 F c_ ;e L4 QUIIIMA e I/ 9�a53 SCALE DATE LAMrtoS r. Dinin g Room 3 Car Garage ]Liming Room Master Bedroom Bedroom 2 Kitchen jOvvn/ M� �, � � Rsnlie IWH .. hi I X Service 3 Car Garage ]Liming Room Master Bedroom Bedroom 2 H,V. AC,,LA ROOM ADD pT%OV C'H►-11�57-OPIOL)L-OS F c- aa� Lh Civ! wrA . �. 9��5-3 SCARF DATE' NhW N R V D je,014 �A/�IrzoS GARAGE