0403-278 (SFD)LICENSED CONTRACTOR DECLARATION
s,l,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
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.
( ) 1 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
i permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier M"IMPT - Policy No
(This section need not be completed if the permit valuation is for $100.00 or less).
(Y) 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 (,.should become
subject to the workers' compensation provisions of Section"3700 of the Labor-
Code,
aborCode, I shall forthwith comply with.thos`,e`provislorras. !
Dates", 1 !Applicant / i4'
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).--t •�Date��* t
BUILDING PERMIT PERMIT#
DATE VALUATION LOT TRACT
JOB SITE
APN
ADDRESS 54-465 I?,VEMDA RKRWOtAi.
77-1-245-023
OWNER
CONTRACTOR / DESIGNER / EN 1NEER
PAT MARMW/COVE DEV -
1;.ECs'ACY HOME.�3
:LA,Q.J1T1�'A CA 92253
..-
USE OF PERMIT
SIVU?.. E, FA2!6XTDWEJ�L-1140
1331 S.I . S") 1}WRIMPC DOES NfYr FNC LUD9 BLOCK 3i4WA, P001A A
O.q DRIVEWAY .f PP1�C)ACH
TRAC-T G"-ONSTRUC:!'iC11
PCIRCHIPA 110 1�3.f3G }g
CARAWc.•rRPORT 46P,00 Bir
�('j�pt �9N11,$1s C"OSIT OF OOi:dMUCM0$
II114197120
g 'meq �yy'��pp yA� [ r''p,�p;��
PMRIA' 1 FEE SIJS:Si'w8ARY��
C0TtSTRUC C1{019 WrE, 101-000-419-000 $631.10
y
PL A111 CHECK t~?F, $567.0
Fall DEPOSIT 4230.00
M EC'.}a':ANICA.L fFBE 101--0%0-421 •C1C3Q `66.50
L�.FZCTHAC:,AL Re101.000.420.000 S 1 U 67
PL1JfitfBflN0 ME 1 Ct1-Q04s-Yz-! 9-OC)0 $1 �+J.00
0T 13.O:NC} MOTION RE9 - PIFS"T D 101-000.24.1.000 stills
GRAD11,40� E, 101-000-423-000
DOVELOPER NPACT FEE
PRITIC199 PLAN 101-00"41-.345 �IVU.�FJ
P^-'-,•.•- --�' '°A L.i l:jyl.. 1'Y .ro 6,.•A.di�.fe AND FLAN 6.,a7M',
erl�yYdi'C�. CiY}.
[MAR 2 6 2044 EIMY11 FESS IATE NOW
MM)
CITY OF E ®I=P . t
FIN
RECEIPT
I DATE _ - f
BY
DAT(NAL D`'w.
INSPECT - .
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
%
Underground Ducts
Ducts
Slab Grade
_
Return Air
Steel
_
G (((
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
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
- do
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
FoQures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power - Q
Final
Utility Notice (Perm) , •" s. .
CITY OF LA QUINTA SUB-CONTRACTOR LIST.
JOB ADDRESS PERMIT NUMBER ��� f g OWNER 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
Date
3/25/04
No.
25735
Owner
Pat Doherty/Cove Dev
Address
2214 N. Ridgewood
City
Snata Ana Zip 92705
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
Lot # No. Street S.F. Lot # No.
`Unit 1 11 54465 Avenida Herrera 1851 Unit 6
Unit 2 Unit 7
Unit 3 Unit 8
Unit 4 Unit 9
Unit 5 Unit 10
Comments
-'All
BERMUDA
sc�o
Q BERMUDA DUNES
RANCHO MIRAGE t�
?A INDIAN WELLS ti
PALM DESERT y
LA QUINTA
Q INDIO y^i
774-245-023
La Quinta
0403-278
1
Street
S.F.
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 (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 $2.24 X 1,851 S.F. or $4,146.24 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/1st Bank - Sharon Bills Check No. 71035
Name on the check Telephone
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Sharon MCGilvrey < Payment Recd Iso.00
$4,146.24 Over/Under
Signature /&4
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
rr Embossed Original - Building Department/Applicant Copy - Applicant/Receipt Copy - Accounting
Sladd4n Enginee ing, r
6782 Stanton Ave., Suite A, Buena Park, CA 90621
39-725 Garand Ln_, Suite G, Palm Desert, CA 9221
004212
(714) 523-0952 Fax (714) 523-1389
1 (780) 772.3893 Fax (780) 772-3895
FIELD MEMO
Project Name . bJ a k." 7W _
Site Address 5 q - L(•6 5 love 1.1 a v -e a •-a
Ga Qu. r ti4+y '
Job Phone
Date 5/ t3/!
Job No. 522-" "7-"(e
Work Done
'._.;. e r -1- C- Crn'�.l a,. c �--I,A � o � �� x'64 (~ � r�r. G%C •
Test Summary 1 Footings Inspected t t_
Test
No
Location C�6tp ��
lev-
Dry
Density
Moist
%
"A Reialive
compactlon
fief. Max
pcf
Moist
%
r Gf
z•1 �(
7
�1 >(
i z y
-
V
123-0
Comments
;r }
Field Tech.
Super. or Agent
24 hour notice requested to schedule Field Technician. Thank you for the opportunity to be of service,
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Godes certify�n thf� hoz;; t� f :5 , orn�aui/ding
a > nrav�sii� �Bu�ldir .. rar e, x this strc, c W e in ;co►npl�ance v ' h
a�•, ofr the ,w.r-se..:and °the ;carious ,fir t
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6.5 AVWIDAHERRERA'.
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Ccterof Buldrf PA`f DOHERTY/COVE DEVELOPMENTf "o 5
a
y
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