9910-132 (SFD)F1
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
s2d23C� a ,� 09/~W20I
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:
( ) 1 have and will maintain a certificate of consent to selfvinsure 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:
Carter Policy No.
(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 Pe tion 3700 o0the Labor
%Coder I 'hall f rthwith comply with those provisions.
•/ Date: i a t c) 4 Applicant //r I •lit.(�+t . t�`
Warning: Failure to secure Workers' Compensation coverage is. unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to • the conditions. and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit. work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance .of such
permit, or cessation of work for 180 days will subject permit,to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives
,of this City to enter upon
the above-mentioned property o in
nspection purpoo�s�es. r, 11
1Signature (Owner/Agent) f e49`Date f<L� ile
BUILDING PERMIT PERMIT#���x
DATE VALUATION aili9.l�b LOT 4 TRACT.
JOB SITE-�rr EISENHOWER.
APN �7'%jS-x 11.1•:
ADDRESS
OWNER
CONTRACTOR/DESIGNER/ENGINEER
10 ROX 10012
94M NE 102ND, SLAV` 101
PALM OFSE '{` CA 92260
€'OVI..AND OR, 9'77,213
(°{i)3)29a-421.7 C:i3s..# 5773
p t
USE OF PERMIT
i\i s FAMULYWt:z.UR4
* j
:ifsD -P M- N`M I�i�'1.v�sS 1t�Y l` �a' 11i OCT� WALL. i�i�t � tiu's::8 1�fJ1
POt%"I PA7110 65:1* S(
t t;�,:t A.trFSfi.R3dFc,1$�'l.'. a09.00 SF
n,; ;fesr, WALL 'J.om "LF
5FT. Wuf 01D FENC'li 130A) L
j�
"GIVI . IlFYY,P'R, II.11111) CM -f 01` AB YkO j{+ 6. T4.'A i,jlr
1,'il f / tfiR!�41't%
Pl+;sM J[T FEE '15iIN1 AR
C-QN s'IRtft;'rfON l t k: it7l-[Df3{� 4I13^000 5°jf�.4
1'r..AN' C ? ECK ITS $49A.6!?
WXl;IANI-esq,1M.111s 10.1 -('1011 -121 -ti o S I l.AO
AL.F,>~'MSCAL=t'sl:,, $129.21
lei tJ�it!{"'f F k �i Hi14W•4.19-)(f0 31.1O.7.y
ATRo140 lycfOTIOtZ WEE - RESID IM -000-249.M
,3RADING MUM
L%1-MOP33R. IMP arRF
PRJ_1C,IS. "f0IAN W1.00A41-3..' $9(fs►.��t►.
fE i3- f'ON' t'!t� te- TION �?�ii? Y�+#.,�i�i tr11 VK
$3,406.47
.f_+ .,
LESS ,PIZE-PAID 1.`FES
•-$2Gti ;14i
.4,156.+47
/.w6
TK
RECEIPT f;
DATE
BY tit
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Z
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
Zy Q
F.A.U.
Framing
.. 0,0 ?
Compressor;
Insulation
— g'0 137
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'APkOVALS
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
Water Piping
QHeater
Final
Plumbing Final
Plumbing Top Out
Equipment Enclosure
ShowerPans
OX for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
—1& 57
Encapsulation
Gas Piping
Gas Test
— cftD 57
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas) 6-0
ELECTRICAL AP ROVALS
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)
G l
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qg�o -��� ua►�,tcv � - •
P.O. BOX 1504 APP4CJTION ON
Buildin
�� ` R 78-495 CALLE TAMPICO
Addrress S4 - t b7 )E_j_QN E ► ilA, Ig 1X. LA OUINTA, CALIFORNIA 92253
e,cI1
Addreg �. J . *7J X d J G 1� I
Address
CityJ-,;klm C� IZipl ITS
BUILDING: TYPE'CONST.t�"�� 6CC.1GR#P.
A.P. Number
Legal Description '(4- *—Lq% Util%f T7 %111\17• UMIAW(l
Contractor Project Description
y et S1� Gain S 4/GC �' ,• •---
Addrr�eyss^` r/�
1 ) 7 G A Cs // wv�v L, t �l u
State Lic. City
& Classif. ':�; r4 (6 Lic. #
Arch., Engr., ,,•
Designer 0 In v
' S f ` ' L' -A
Address!�`� �IY `t. Te1:;rbIr+ 1 P�
City 1 t ` State
4 U I (/l �' Zip ti Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Business 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 that. he 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-1 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
builds 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. If, 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 properly, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not 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.)
i7 I am exempt under Sec. B. 8 P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
Ihereby 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
(] Copy is filed with the city. O Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This sectionrneed not be completed if the permit is for one hundred dollars ($100) valuation
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.
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
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.
I certify that I have read this application and slate that the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives -of this city to enter the above-
mentioned property for inspection purposes.
Signature of aoplicant Date
Mailing Address
City, State, Zip
Sq. Ft. No. ry No. DIN.
Size �`1 g Stories 1 Units
0 Alter O Repair ❑ Demolition O
PERMIT AMOUNT
Plan Chk. Dep. O
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
' t
FINAL DATE INSPECTOR
Issued by: Date Permit 4 l
Validated by:
Validation: OCT 03 LCi
WHITE = FINANCE YELLOW = APPLICANT 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
CERTIFICATE OF COMPLIANCE
Date 10/27/99 APN # 774-215-021
No. 19517 Jurisdiction La Quinta
Owner NameRichard Scott Permit #
No. 54-185 Street Eisenhower Drive Log #
City La Quinta Zip 92253 Study Area
Tract # Lot # Square Footage 1421
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 1,421 or $ 2,742.53 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/PDNB - Richard Scott
Name on the check
By Dr. Doris Wilson
Superintendent
0
Fee collected /exempted by Ellen Patino
Signature
Telephone
x ice"
'T
v-
r�
Payment Received r $k742:53 ,
Check No. 75526'!,i,/.'
IOTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified
ibove will begin to run from the date on which the building or installation permit for this project is sssued or on which they are paid to the District(s) or to another public entity authorized to
ollect them on the District('s)(s') behalf, whichever is earlier.
Collector: Attach a copy of county or city plan check application form to district copy for all waivers.
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting
,rVT/.l
--_ - y
OCT 1 REco . -
Rr /)ictr.rt _ P/ann' n ,RP.t Pw Fnrm
This form is to be used by CDD staff for review of single family dwellings in the RC (Cove
Residential) District, in order to determine the applicability of compatibility issues or need
to require the filing of Master Design Guidelines by the applicant. It shall be transmitted to
Building & Safety as your correction list. Please attach additional explanations as necessary.
APPLICANT: .1 �',v� Sc 5 pGi�a ase �� C Oto)
PROJECT '
ADDRESS: -/0� F se�,"L
APN:. %�— ,$)_ l6t.')-
LEGAL:
o.LEGAL: LOT _, BLOCK �C UNIT , S.C. @ V.L.Q.
CVD BY:
BIN NO:. CASE NO. ..CHECK -DATE:
Inform. the assigned Building plan checker upon your assignment to this case. The CDD
Executive Secretary maintains a log book to track applications and. assign case numbers.
REQUIRED ITEM
Y-1 N I
COMMENT/CORRECTION
•: }�:�:::. :,,�,..?: ..•. L \.: ,v\......:,, •. , ,u \2.;ns...�.::�,Cn,,,:•.J�.\•.. \
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� i5\U\li�\.v:':��\�( •v �, � \
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Case logged and number assigned
Verify legal and APN information
Consistent with MDG on file (as applicable)�,�ie�`
MDG filing required (5+ filings since 9/3/98)
Z�
Consistency with-street/sur'rounding area:.
olors _
Materials
•Architect' `
t,1�•
OTHER REQUIREMENTS:
lqv�—
The zoning code, architectural and landscaping manuals, and/or assigned inspector should
be consulted where uncertainties arise The completed checklist shall be maintained in the
Buildin& Safety address file.
e Pal, ,6�
FROM PHONE NO.
4
77564A COUNTRY CLUB DRNE # 113
PALM DESERT, CA 92211
(760) 408-3495 FAX (760) T72-9715
Oct. 26 1999 03:48PM P1
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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
ollowing:
BUILDING ADDRESS:
Use Classification:
Occupancy Group:
�ITRI
54-185 EISENHOWER DRIVE
Bldg. Permit No.: 9910-132
R 3 Type of Construction: VN Land Use Zone: RC
Owner of Building: RICHARD SCOTT
Building Official
Address: P.O. BOX 10012
City: PALM DESERT, CA 92260
By: STEVE TRAXEL
Date: 02-17-00
POST IN A CONSPICUOUS PLACE