9806-156 (SFD)U
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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
743867Li
Date .—? Signature of Contractor
OWNER -BUILDER AR ION
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. `+
STN .t'I-'+ND MW W4 52
(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 p visionstion 37A of the Labor
Code, I shall forthwith comply with those rovis ns.
Date: Applicant
Warning: Failure to secure WorkCompensation coverage is unlawful and
shall subject an employer to cri in I penalties and civil fines up to $100,000, in
addition to the cost of compensat on, damages as provided for in Section 3706
of the Labor Code, interest 66 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 C. to enter upon
the above-mentioned property for is pection.purposes. Q
�!Y
Signature (Owner/Agent) at.
�- BUILDING PERMITPERMIT t/
DATE�j �JJ VALUATION LOT TRACT
( S74.145.20 1.2 BLK 116
JOB SITE
APN
y
ADDRESS 51-97.50S1�lV��.O'��'ERD+MI�"E
773-1I"24
OWNER
CONTRACTOR/DESIGNER/ENGINEER
WOuI) DC"-VrCI.C1.PMFT J'T, INC
VJMLD DEVELf, PIM1SN'.C, INC
PO BOX 11287
ISO .B0X:13287
PALM DES ?KV CA 92255
PAt.,A4 DESERT CA- T2255
(70 77.1-5571 C;BL# 5025
USE OF PERMIT
Or
-DP1r2M"i' • OVAS NOT i CUUID d BLOC K WALLS ORP001 .y
kl2tti CL�idSIlkliG"1�tC;
i'411(OHAIIA'1`ifJ
� Afi2A4"*P /f ��#t4�a�EiJ 434.0) SF
01.+' CONSTRUCTION,
IAEMMIT.MC SUMMARY
C!;iT3STRUCTI..ON FEE 101-000-41809) 5529,(11!
PLAN cilEG:K"YE.'E, $449.73
F[36 D1:SP031'1' IOI-UitO 333E - 2 +o.th�
1Vf.tsc;1b .ICAL6 61-, 953.59
YTJ;'(;',t" 1'aSCA.L 4� N..E. 101-000-420-000 $114.18
PI,I.A40190 17-11t+ 1014V)_419-000 �!21.f10
S I iZ 3.,dC +v�47`4i�Fv .i't3ls - 13SiD 101•004f241-000 $~ G1
{a14A11I,Nt!'! l:t 10,1-00042,-€300
ifniE'fd/L,,"iS �)� 1"i_Tht.t F4[1 225-000-443: 342
l+rit;>,� rfwl P7..A:N '1() 14)(19-44-1 -_345 $25 (10
,;,I,f►,J*(Yf sit, CONS'IRN(K.1' IN !U`d!?MMN {,"11i CK
$<,y 7 ; 31
ESS ��x:r �,�.r.I� .t�) � s;
412M.00
T(:1f'.ct1.I''CRAIIT VER -8 0.1M.' 11iCiW
��:72t3.J6
RECEIPT
DATE
BY '
I DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR,
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
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 /Q
Drywall - Int.,Lath p 98
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 Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
OX for Finish Plaster
Sewer LateralPool
Cover
Sewer Connection 141,
Encapsulation
Gas Piping
Gas Test Q /
Appliances
Final
-
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures
Main Service .
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
9,0
Final
Utility. Notice'(Perm)
COMMENTS:
a.
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 7/21/98 APN #
No. 17347 Jurisdiction La Quinta
Owner NameWorld Development
No. 51-975
City La Quinta
Tract #
Street Eisenhower Drive
773-174-024
Permit #
Log #
Zip 92253 Study Area
Lot # Square Footage 1200
Type of Development Single Family Residence No. of Units 1
Comments
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 1,200 or $ 2,316.00 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
Fees Paid By CCNalley Independent Bank Telep6o:aie '
Name on the check w
:,
By Dr. Doris Wilson
Superintendent fj
Fee collected /exempted by Ellen Patino Payment Received $2,31,6.,-'00L
Signature
Check No. 170529
10TICE: 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
e
Certificate of -Occupancy
City of La Quinta
Building and Safety Department
This Certificate issued pursuant to the requirements of Section 109 of the Uniform Building Code,
certifying that, at the time of issuance, this structure was in compliance with -the various ordinances
of the City regulating building construction or use. For the following;
BUILDING ADDRESS:
Use Classification: SFD
Occupancy Group: R 3
51-975 EISENHOWER DRIVE
Type of Construction: VN
Owner of Building: WORLD DEVELOPMENT, INC.
Building Official
Bldg. Permit No.: 9806-156
Land Use Zone: RC
Address:
P.O. BOX 13287
City:
PALM DESERT,
By:
STEVE TRAXEL
Date:
5-13-99
POST IN A CONSPICUOUS PLACE
CA 92255