0302-076 (AR)r LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that) am licensed under provisions of
Chapter 9f(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
Date, ,K 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:
1;
() I, as owner of the property, or my employees with wages as their sole
compensatiori;'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'
contractorsao construct'the project (Sec. 7044, Business & Professionals.
Code).
O I am exemptunderSection jB&P.C..for this reason-
Date Signature of Owner !
` WORKER'S COMPENSATION DECLARATION
I hereby affirmiunder 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 3700,6f 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).
.(t) 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;,c
•D'ate:a 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 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 fy t�� Dates.'/*'
'; -`.BUILDING PERMIT PERMIT#, Y„
141.E d:,0.2.'-43°6
DATE r+ //ff VALUATION LOT TRACT
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CONSTRUCTION Ft,*_ 101-0000414-000
PLAN CHFCrl.. FEF 011000-439-318 $115.3
8!�".w�.'�TRIC ALS FRE 1E33-000-420,,000 E%3,9t4
;.a'TI;;UAiCI4Nlflii 73+? 31I? f lf3 101-000-241-000 $I,
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VERMU1,00 DUE NOW
FEB9,
2 2003
CITY OF LA QUINTA
FINANCE DEPT.
RECEIPT
DATE `
BY ' ��'
DATF. FINED/ ' 1
INSPEC
ti d
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings.Z,
/
Ducts
Slab Grade
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 �G
Drywall - Int. Lath
Finally
Final
POOLS - SPAS
BLOCKWALL APPROVALS
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
COMMENTS:
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)
Date 2/11/03
No. 24132
Owner David Sterling
Address 52100 Avenida Herrera
City La Quinta Zip 92253
Tract #
Type Residential Addition
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
q���Ft�s�yo
Q BERMUDA DUNES r
040 RANCHO MIRAGE d
INDIAN WELLS
PALM DESERT ,y
LA QUINTA
Q INDIO y�
773-224-004
La Quinta
0302-076
1
Lot # No. Street S.F. Lot # No. Street S.F.
Unit 1 52100 Avenida Herrera 256 Unit 6
Unit 2 Unit 7
Unit 3 Unit 8
Unit 4 Unit 9
Unit 5 Unit 10
Comments Closet Addition and Computer Room
At the present time, tie 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:
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 256 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 - David Sterling Check No. -
Name on the check Telephone
Funding Exempt
By Dr. Doris Wilson
Superintendent
Fee collected /exempted
Signature
ron McGilvrey
$0.00
Payment Recd Over/Under
NOTICE: Pursuant to Government Code Section 66020(d)(1),'tfiis 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 Dislrict(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