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9806-155 (SFD)P KC 14 w-. C) U . � LU C:) Z cn O.� C-) W LU �a m Z 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 425381. BB 7/31 MR 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 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. 1 STATE PUND (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 appli cion 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 cancellat(on. I certify that I have read this application and state that the above informati(W"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 CONTROL# BUILDING PERMIT PERM' 9806 -,SS DATE 817195 VALUATION J 1iR1{f'./0.61945 LOT ' TRACT 171131,94 JOB SITE — y � ADDRESS 7�'r-7i5 LO�/�'rl�L .E� i1 RL� APN 773-293- 24 OWNER CONTRACTOR / DESIGNER / ENGINEER :^,ANUID ROSS NITa UA. PA.O F;C T 1?EC C-'0*:S'M( (ON 17.1.9 S'T'RisMONT 1719 S "IREMONT S OC:kANSUDE CA 920_54 S OCLANSME CA 92051 (760)967-006.,9 CWT 1955 USE OF PERMIT STNOU FM1II.,Y C,6Y1±i.LINO SFD-1?ERN.(IT I NCI.LiI' U BLOCK MALL AND FENCE PER FLAN TR,rlc`,'T coni '12:UCTiO.N 1: 27.00 SJ" r� PORCH/..PATIO 30.00 SF e (JARA.0EICKRPOR T 5.45.088 JBIL00WALL Q4TIL ) 757,75 6'F%. WQ0D.L,NCb 15+0100 LF A: S 11%1A A 1r.D 0031 A. 01", \: 143 /^lr+Vi,.B ON . A e��j�yy pi�,�yyp �s y, ��p Yi MAR P �i.n.b�`,P.A Rt BF, S111Y1JO' AY V CO3N,'TFRLTC`r10N FEF 101.0w_41"00 S599.010 PLANCi3PXX; YEE 101-f+t)0-43941 S 150.94 FEE W0; ✓.11' 42510M NT-.'CRA1\gCA1.-VT:F 101-000-421-000 553.50 1 OC'i'.RICAL ME 'M-000-420-000 S+124.37 1�01,taAB04r fr a 101-000-414-0CK► 129. 7S S'iROit MOTION 1U. 1, MSff) 101-000-M-000 $9.06 GRADING RME 101-0W-423-000 S2s?:t1it 1.1,11FRAS.MUC'T U FM 225-000-443-3 31.58-2.22 PRE ISE PLAN � 301-000-�",�t1-345 SZ100 v � M) A] CONS �kz.113. l'Lti'i»fC71rJiV AND :lal.rlN CHECK $3,4F1s3.S a ,. LESS PRE -PAID FrES -$250.00 .`JC111 TUCAL Y'1N,[diV9.IT FE GN i) E NrtYW $3,198.84 RECEIPT °, t. DATE k BY I DATA I LEDTCI l/ INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings 1 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.Or Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath f Final Final POOLS - SPAS BLOCKWALL APPROVALS 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 j Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Piaster Sewer Lateral /e Pool Cover Sewer Connection f3 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 k - c Final Willy Notice (Perm) �`�j"''+h+fi-�}�Fdv�'.r �9\.r'•,�.r3'r+•�'��1�r:'�''�•'�".JC}`'�"�V�`r�{l�P�r�w�tt'��I�"����Y°r�p�i . ��r•:..-�.v.r:.•srr`,, } P.O, BOX 1504 APPLICATION ONLY Building78-495 CALLE TAMPICO Address r `?t < tl. 'i r., (4L -A QUINTA, CALIFORNIA 92253 Mailing I Address (-I t C( City P Zi Tel. SI,,. I�v.�G+t-� C;J?icy Contractor Address City lZip ITel. state LOC. L;Ity & Classif. 1 Lic. # Designer Address CityI Zip I State I Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm` that I �m licensed under provisions of Chapter ggcommencing with Section 7000) of Divi ion 3,o��f tBg §�ust�r�ess and Profs s irs�on_s'CoCe, and my�license is in full force and effect. �. J�i1J �. xC t,_ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5,9usiness 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 thathe 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 build. 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. It, 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'1 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 doesnot apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) l I am exempt under Sec. B. & P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION 1 hereby 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 n Copy is filed with the city. 0 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 thF 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_f I hereby 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 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. x 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 buildrbg construction, and hereby authorize representatives -of this city to enter the above-` mentioned property for inspection purposes. above-`. mentioned Signature of aQplicant —Date— Mailing ate Mailing Address City, State, Zip s f� WHITE = FINANCE YELLOW BUILDING: TYPE"CONST. OCC. GRP. A.P. Number —?7 - Z C)-� - Q 7 Legal Description It 0--v 1 j j� 1 k 1 � Z_ Project Description JF • b Sq. Ft. -1 -1 No. No. Dw. Size Stories Units New ❑ Add D Alter O Repair ❑ Demolition ❑ Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. 45," Plan Chk. Bal. A-Zio- ConSt. ! Mech. Electrical t Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL REMARKS ZONE: ' BY: - Minimum Setback Distances:'` Front Setback from Center Line t Rear Setback from Rear Prop. Line S@d Street Setback from Center Line Side'Setbaek from Property Line FINAL DAINSPECTOR Issued by: Date `-� + Permit Validated by: r fA ( a,f Validation: = APPLICANT V >, PINK = BUILDING DIVISION Desert Sands Unified School District 47-950 Dune Palms Road Notice: La Quinta, CA 92253 Document Cannot Be Duplicated 760-771-8515 Date 8/7/98 No. 17467 Owner NameDavid Ross Miller CERTIFICATE OF COMPLIANCE APN # 773-293-024 Jurisdiction La Quinta No. 52-725 Street Avenida Herrera V City La Quinta zip 92253 Tract # Lot. # Type of Development Single Family Residence Comments Permit # Log # Study Area Square Footage 1427 No. of Units 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: EXEMPTION NOT APPLICABLE This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of 1.93 X 1,427 or $ 2,754.11 the property listed above and that building l permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued Fees Paid By CC/David Miller Telephone„' Name on the check r J ``•�, By Dr. Doris Wilson = ' 'a 4--' Superintendent Fee collected /exempted by Ellen Patino Payment Received Check No. 055829 '` + Signature 40TICE: 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 ibove 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 pllect 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 1