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LICENSED CONTRACTOR DECLARATION
I%faereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 9 ((.bmmencing with Section 7000) of Division 3 of the Business and
Professionals Code, and my License is in full force and effect.
License # Lic. Class Date
r.'. r:�fa; I10
Dates Signature of Contrctor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I' ffi,eke npt-•frorn-ihe Contractor's
License Law for the following reason: �ti= ti x n1, t; t,a�-:,I is
( ) 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).
O I am exempt under Section , B&P.C. for this,reason
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION
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
I rmance of the work for which this permit is issued.
have and will maintain workers' compensation insurance, as required by
�eetiorl 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 CAI. u't)"411 Policy No. 1,07A,'42 �1
(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, indemnity
& 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 stgte-that,the above information is
correct. I agree to comply wit hall City, and-.gtate laws relating to the building
construction, and hereby auth rize rep r I entatives of this City to enter upon
the above-mentioned proeerty o-anspec ion purpose&,,
Signature (Owner/Agent__ _. Date
BPERMIT# CONTROL#
BUILDING PERMIT ��fa�..11��
DATE / VALUATION LOT TRACT
8209
JOB ADDRESS 4 99� �a..b��'Pd��I�1�Y� "�,il.��`',�',
ADDRESS
APN 631-710-064
OWNER
CONTRACTOR / DESIGNER / ENGINEER
A.N A R10S.A. C0VE' 110A.
? V BU! LDLjt 0014;,,
4999.1 EISENI-i(JW EA I.:,'R
1.1 9t)5 H0AKU)WA.i- K, .-SV1 Fr -,-r
LA QU N -VA l -A 42:253
PALM t_)E,s Ek'i' ::'A 9221 1
f:"7ifQ)$3'7 C)>tS<1 Cf3i.i; 5112 .
USE OF PERMIT
COM NIERC,' 0J,
kcnvAODCL ixND 428 S.E. tWDfFiOf 41 TO EXISTN(3 Orb',,ka)HOUSE
VALUATION .ii},tiUU.(I11 I'S
3.''IMA A*r ED CON' TT 'O it'r-'N'S-TRUXTION:+L,.:aiif,vE
i
ERMi T FEE. SUN1!N+ARY
.P.1, &N Cf i1<."•CK F EE. 10 i t}00-.2 9 _3 I IS $ 184 93
0'.)N TRU( -FT0N F -R, I()J-Of!fYMfi-000 $ -50
NX-f-1.11V11CA;., FEE 101-f100-121-000 &11, �0
tt.Ec"iiiti r�►I. E!~i Itil-Cxh}-•ix(?-Ot1J,}.a,
fyLUXIBIN10 FEE 101 -000 -419 -No
10I_000-A7YW)p
S3Y�ONG 1XIO 1'ION FEE - COA'L'4I Isi0-=-:241 -000 fib, A
'iC1_�s T%rpt ri.l., C0NS'1_'R,I1 T:110N AIND PLAN C'T•i-EC'!:-
LESS ITE-1'AID FOES
TCD"4'AL PEAiviU !H'.EEN O1. F NOW
R IyPPT(� �)� `
DATE,,
BY
DAT EFINALED
INSPECTOR
��V
NSPECTM RIECOIf D.
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs L br A
Underground Ducts
Forms 8 Footings
Ducts
Slab Grade A
Return Air
Steel
Combustion Air
Roof Deck 6
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
C;L 0Co rKW181�MZROVALS
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
If A
Final
Utility Notice (Gas)If
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
Utilrly Notice (Port)
COMMENTS:
Elm Fro — /-S- 9 9 ZZ
Desert Sands Unified School District
47-950 Dune Palms Road
Notice: La Quinta, CA 92253
Document Cannot Be Duplicated 760-771-8515
CERTIFICATE OF COMPLIANCE
Date 9/17/98
APN # 631-710-064
No. 17759 Jurisdiction La Quinta
owner NameSanta Rosa Cove HOA
No. 49-991 Street Eisenhower Drive
Permit #
Log #
City La Quinta Zip 92253 Study Area
Tract # Lot # Square Footage 428
Type of Development. Commercial
Comments
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:
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of „
.31 X 428 or $ 132.68 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 cash/Santa Rosa Cove Telephone 760 777-7621
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Olivia Aguirre Payment Received $132.68
Check No. N/A
Signature
NOTICE: Pursuant of As#6mbly Bill 3061 (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
above will begin to run. m'the date on which the building or installation partnk for this project is sssued or on which they are paid to the Districts) or to another public entity authorized to
tolled them on the Distrid('s)(a') 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
RIVERSIDE COUNTY FIRE DEPARTMENT '
in cooperation with the
California Department of Foresoy and Fire Protection
210 West San Jacinto Avenue • Penis, Califomia 92570 • (909)94D-6900 • FAX (909) 940-6910
August,17,1998
James M. Wright To: Valentine Professional Services, Inc.
Fire Chief 3276 Rosecrans St., 3rd Floor
San Diego, CA 9211.0
Proudly serving the Re: Santa Rosa Cove - Guard House
unincorporated Addition/Remodel at Mazatlan Gate
areas of Riverside
County and the Fire Department personnel have completed a review of the Addition/Remodel plans you submitted for
citiesof. the above referenced project. Please be advised the plans have beenapproved with'the following
conditions.
Beaumont
e 1) Gates installed to restrict access shall be power operated and equipped with. a. Fire Department
Calimesa override system consisting of Knox key operated` switches,: series KS -2P with dust cover,
mounted: r recommended standard. of the Knox Company, Plans must be submitted to. the
Canyon Lake mounted; P Y-
e Fire Department for approval of mounting location/position and operating standards. Special
Coachella forms are available from this office for the ordering of the KeySwitch, this form must be
e authorized and signed by this office for the correctly coded system to be purchased.
Desert Hot Springs
e
Indian wells 2) Automatic gates shall be provided with a secondary power sourceor some means to manually
e open the gates upon loss:of primary power.
Indio
e '
Lake Elsinore. 3) A minimum 2A1 OBC Fire Extinguisher, (State Fire Marshal Approved) must be mounted in a
O visible location within 75' walking distance from any point in your building or suite. Fire
La Quinta extinguishers can be.installed bya licensed extinguisher companywith a State Fire Marshal
oservice tag attached to the extinguisher, or purchased from a.retail store with a sales receipt
Moreno Valley attached. Extinguisher must be serviced yearly, by a licensed fire extinguisher company.
e
Palm Desert
e 4) Electrical panel box: All'breakers must be labeled and a clearance of'36 inches must.be
Penis maintained around the panel at all times.
e
Rancho Mirage
O 5) Automatic gate operations is nota part of the Fire Department approval ofthese plans.
San Jacinto
e Please contact -the Fire Department Planning & Engineering Staff for final inspection prior to occupancy.
Temecula A reinspection fee will ,be required If more than one (1) inspection is necessary. Requests for
inspections are to be made, at least 24 hours in advanceand may be arranged by calling
(760) 863-8886.
Board of.Supmlws
Bob All questions regarding the meaning of these conditions should be referred to the. Fire Department
District 1 Planning & Engineering Staff at '(760) 863-8886.
Sincerely,.
John Tawglione.
District FRANK KAWASAKI
Jim Venable, Chief Fire Department Planner
District 3
Roy Wilson,
District;4
Tom Mullen, By
DMdct 5 Walter Grandes
Fire Safety Specialist
EMatGEN& SERVICES DMSION O PLANNING SECTION O imimaoFFlCE
43-M Oasis St, and Fl., Indio, CA 92201 O (160) 863-1886 O Fax (760) 863-7072