0007-276 (AR)LICENSED CONTRACTOR DECLARATION
'.' I'heieby 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
V-'Orofessionals 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,,136siness & Professionals Code).
( ) I, as owner of the property, -am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals s
Code). ` ''
( ) I am exempt under Section , B&P.C. for this reason
Date P -• ce - n. J Signature of Owner c,
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. are:
Carrier . Policy No.
(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—
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 1 -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),� ! .� ZDate- e'�
y41
BUILDING PERMIT PERMIT"
1 1
//
DATi !� VALUATION LOTf���& TRACT
! '
JOB SITE
APN
ADDRESS 5- --U0 AV'F..Id[DA D EPUZERA
77 -O85- 37
OWNER
CONTRACTOR / DESIGNER / ENGINEER
GUMURt O WZA
0V4N Rf611)H DM
51��1at� A�E1�11UAi�"RA
L&O` TMA CA 92233
CBLft
USE OF PERMIT
RYn97) IM,..fiND1MON
328 SNF. P,00M ADDITION AS PER A.PI ROVED PLANS ONLY
333(19 SF
Ir?SMI1TED COSTOF C01VWRUCHOR
17,810.40
PLAN CHECK PEE 101.000.439-:18 $122.84
CO ISTRUCTION FEE 101-000-418-W.'- $189.00
MECHANICAL FE -9 101-,000-a21-000 $19.50
19L EC`PRIGAIt i?I?:ff: 301 ••Qi -1120-Ua0 $15.95
`
PLft7i►31'3INQ FEIN IP16 00.419.000 $24.00
t
STRONG MOT3i)1+ F?Z - RESID 101-000-241--000 $1.73`
s
ORADINO RP 101.000-423.000 $2ti.00
AUG 10 2000
%ar9 F Q' UIN T
Uri -TOTAL COQ+ RITC:`IION MID K" M. .ICK
'$393.09
I LESS -PAID FTI
;' Saw �
_
Z
•�e�+. y y �y yr a Y� 7 p�
S0�LST.iyd,L£-_r9:tT.S.9.-� TTFs�S DUE -Now
.FAY .3.00
RECEIPT
DATE
BY
�/
DATE FINALED
INSPECTOR
In
A
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
_
Forms & Footings
Ducts
Slab Grade 0
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.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
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
Gas Piping
PLUMBING APPROVALS
Gas
Electric Final
Waste Lines
Heater Final
_
Water Piping_
Plumbing Final
Plumbing Top Out 9Equipment
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.H.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm) ..
COMMENTS:
Clio
36-7
v
s
Bin-#'
City of La Quinta
Building a Safety Division
P.O. Box 1504
Permit #
78-495 Calle Tampico
La QuinEa, CA 92253
Building Permit Application Tracking Sheet
and
Project Address: ,Y/ 360
ilveGt
Owner's Name: O'C11,116-le'eo('_ Z10-
Y X&If e
A. P. Number:
Address: 6-13S0
Legal Description:
City,ST. Zip:LTZ C/2'2-53
Contractor: e
/q
YV Al�
- z
Telephone:' 217
..........
Address:
Project Description: 2 /C
City.ST. Zip:
Telephone:
......... . ..........
............
State Lic. r
City Lic. #:
FVAdA170A
Arch.. Enur.. Designer:
Address:
City. ST. Zip:
Teleplibne:
. . .. ....
Construction TyRe: Occupancy:
State Lic..
....... ..................
............................
......... ...................
...........
X':
Project type (circle one): New Repair Demo
Alter
Name of Contact Person:
Sq. Ft.: q(O
# Stones:
#Units:
Telephone = of Contact Person:
.
Estimated Value of Project: g000, 0(2
. . . . ... ......... .
.......... ....
........ ... ......................
T WFUTEEEL.O.W... JN
................. --1 .... ..
................ x.
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........... . 2.11: .: . .......
#
Submittal
I , I. I
.......... .
................. ... ... ....
.............
............ ....
. -........... .. . ....... CIF.....X .. . .......... ......
»>!
...... ..........
.............
.... ............... ....
........ .....
........ ............ .
....
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I 'Plan Sets
......
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.
.........
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I pfimi:
.............
Truss Caks
Title .24 61
Gra ot: Deed
CiY.
r1annI
.Pub. I
-Ag- Approl.
T
Notice:
Document Cannot Be Duplicated
Date 7/31/00
No. 20804
Desert Sands Unified School District
47-950 Dune Palms Road
La Quinta, CA 92253
760-771-8515
CERTIFICATE OF COMPLIANCE
APN # 773-085-007
Jurisdiction La_Quinta
Owner NameGuillermo Meza Permit #0007-276
No. 51-360 Street Avenida Herrera
city La Quinta zip 92253
Tract # Lot #
Type of Development Residential Addition
Comments
ion is to the kitchen area.
Log #
Study Area
Square Footage 328
No. of Units 1
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 or replacement mobilehomes. It
has been determined 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 Government Code 53080 in the amount of
0.00 X 328 or $ 0.00 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 '
By N/A -Guillermo Meza
Fees Paid B Tele phope' `N
Name on the check ,
By Dr. Doris Wilson y
61.
Superintendent
Fee collected /exempted by Annette Barlow
Signature
Exempt
Check No. N/A
'n.nn
IOTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified
bove 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 District(s) or to another public entity authorized to
ollect them on the District('s)(s') behalf, whichever is earlier.
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
13
� �� ���f� CITY OF LA'T
U1�NT�AS B -CONT CTOR LISTJOB ADDRESS PERMIT NUMBER ff-��%OWNER J BUILDER
This form shall be posted on the job with the Building Inspection Card at 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 approved by the Building Division prior to commencement of work. Failure to comply will result in a stoppage of work and/or the voidance
of building permit. For each applicable trade, all information requested below must be completed by applicant. "On File" is not an acceptable response.
Trade / Classification
Contractor
State Contractor's License
Workers Compensation Insurance
City Business License
Company Name
Classification
(e.g. A, B, C-8)
License Number
(xxxxxx)
Exp. Date
(xx/xx/xx)
Carrier Name
(e.g. State Fund, CalComp)
Policy Number
(Format Varies)
Exp. Date
(xx/xx/xx)
License Nw*iber
(47c
Exp.
kx/ Alii
EARTHWORK (C-12)
/OLJ
C��w�tey �U�.IdC�'--
CONCRETE (C-8)
0,_ti /) C r B U
0 w
0
FRAMING (C-5)
L' •�;✓ n 2 y 13 ("1 J, e
LL-
Q Q O
LL
f—
STRUCT. STEEL (C-51)
C%n e r 3 4• /JC Y
� °�
Z
MASONRY (C-29)
v� �. f c �,
Z
V
PLUMBING (C-36)
, �drr
F_' Q
LL
O
LATH, PLASTER (C-35)
�1 vh �V 13 4/� Idle y
M
Q
DRYWALL (C-9)
0 4�� C r 3L� l ee
HVAC (C-20)
C-'I.c/01Cr 9��� /'/a/c
_�/f1fl
ELECTRICAL (G= �0)
NZ/L%�y
�"LO
,/
(vls`-C"
2-Zi3'O
WGJJ 30[0-36
M• iMAdf
✓r -Z -op
�69 9—E91;
tl�
ROOFING (C-39)
(!1 �r 17 L11l// CY
SHEET METAL (C-43)
Uwe/ C Y &I de 11
FLOORING (C-15)
JLL1 e Y ( / JJI/
GLAZING (C-17)
O w n e `• N V'r l 4'
INSULATION (C-2)
6 LL,' k1 e- p- [3 L,, I / dt a
SEWAGE DISP. (C-42)
O1 ; v n � e 13L. 1wcr
PAINTING (C-33)
6 LL/ -I e y- 9L, I I c e
CERAMIC TILE IC -54)
1-u 4 � V /06 -
CABINETS (C-6)
/p�L•'�
P
(�(�ci J9 /
FENCING IC -131
C1 Lv 2
LANDSCAPING (C-27)
Ludic ` 6 V1 l d cV
POOL (C-53)