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9609-171 (SFD)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 6957_% B1 tj 9i3OM Date 1"11"97 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). O I am exempt under Section B&P.C. for this reason Date Sianature 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. his 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, sh I I I 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 I Code, I shall fort with comply with thosep((ovisi ns. r Date:I-'T'`� Applicant2 y✓ ..-r'. Warning: Failure to secure Workers' ompensation 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. 0 1. Each person upon whose behalf this application is made & each person at g 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 propertrty>for in'sp ctfon purposes. 'j Signature (Owner/Agent) `- U �` Date 7- BUILDING PERMIT PERMIT # CONTROL# ia_ 4 615, DATE 1117 l7 VALUATION ' jj.9,:,?331,4)gf LOT TRACT r� JOB SITE ADDRESS 7 40' 1L INI t - APN OWNER CONTRACTOR / DESIGNER / ENGINEER 11,1 ItC3'I 1? r y y tt 3N3I .ElAYT)UN CO. . 5252 (AZANG . ;STB. 208 70310 Sl'.t1.L.1,i11` G DR-' CYPRESS CA 0651(1 BERM ODA DUN RS -CA 92201. (619)772-29.35' 0:1,11.0 3802 - t USE OF PERMIT ��thi"t'=t i iz*.i LrrLS 306i t= <3. 6� C idi�C)t;'Std r� !. Ji f 'sl`E' PLAN. 4"WIP1104vtCONNISTRU rlolli 3110;.11ti ,1i 1Tt:lsdt.,'t9lt''A;f'i0 - S��.00i S.f t:r?ll.elt;e�iCAltl�i:rl�'P '7.t9.Ult Sl' 41'1'. WAU *OO.fi•1'Lf 41NUMINMID CaST C.,r, CONSTRUCTION, 319.331.90 PEIRS i! ib' FEE SUMMARY f ONS )IR :'1` 1114L.f3 .1.61-000-419-00 $.1409,50 MAN i"1.11 C 1 FE $1, 1, S6,054 PLAN C<IIFZK DEPOSIT 4750.00 lbils'C;IIAIdj ii:C l' -f � AW -000-421-000 $137.00 Flt kC:'T1ttf'At, t'i*�s 101-100.42(.)-000 2b3.02 f�f 11��4+4�t�•'h��S tt?1-tJi1`D-419d?i}c1 �21�1.?� ;tll mrVi('3TtCf�l;('nE;3j lift -06,2,11.000 Cfl'.ti6"tINO li;l-(1tf0-�1Z3�fii1(1 S2ti.Ck!► 1fdEi.2ZAW11SC TUf ii `�S-f30iD-�i 3- d l 3fi.�3+iii.i►0 PR'l C;'t:q; NIA -3. ,101-0001)-441- +45 �1S.i30 ART IN1:rF-iUTC PLACES(jWS) 1701.44-2SS-01XI $ 5a3.33 pAffy'UTAt, CONS i'RUC,T`(ON AND KAN CW- ,,rK $9;186,77 ESS i> E— FEES -PAID 754,00 .: - t 1'7 . 37 89,0 -7 CITY OF LA QUINA r �R,ECEIPTDATE BY DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs — W Underground Ducts Forms & Footings -NDucts Slab Grade _ _ Return Air Steel Combustion Air Roof Deck L — Exhaust Fans O.K to Wrap F.A.U. Framing - °11 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 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 I I 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 7 • 22_ Appliances Final Final lD—1 Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole 7_") (i 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) COMMENTS: J o3�- [ Pc _ s -SITY OF LA QUINTA 'LDING & SAFETY DEPARTIGIENT 777-7012 OAC% ,( cpSPECTION REQUEST LINE 777-7153 oks, o . �, Owner SPIZER Contmcto Permit r`mber 9609-171 POST ON JO.B IN CONSPICUOUS PLACE INSPECTOR MUST SIGN ALL APPLICABLE SPACES JOB ADDRESS 78-840 LIMA SFD - PERNUT INCLUDES 300 L.F., 6' GARDEN WALL PER SITE PLAN TYPE OF INSPECTION DATE INSP. FOUNDATION & SETBACK FOOTING STEEL MAIN GROUND SYSTEM GROUND PLUMBING PRE-GUNITE DO NOT POUR CONCRETE UNTIL ALL ABOVE AS BEE SIGNED CONCRETE SLAB JOISTS & GIRDERS ' ELECTRICAL GROUND WORK DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED ROUGH ELECTRIC ROUGH PLUMBING �= ROUGH.GAS & GAS TEST HEATING & VENT- A/C FIREPLACE ROOF BOND BEAM O.K. TO WRAP GROUT ❑ r ❑ 8' FRAMING , INSULATION PRE -ROOF COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED DRYWALL INTERIOR - EXTERIORLATH POOL PRE PLASTER POOL FENCE & GATE SEWER SEPTIC TANK - FINALS ELECTRICAL PLUMBING FINAL GAS TEST 1 _ HEATING - A/C HOUSE NUMBERS JOB COMPLETED _ Gl'7 I r P.O. BOX 1504 APPLICATION ONLY -°yp !J � %` 7&105 CALLE ESTADO Address / r7 '�T 0 QUINTA, CALIFORNIA 92253 it Owner Mailing Address r. r City Zips Tela(, Contractor Address City . n JZip Tel.. State Lic.City & Classif. p-, -3 % Lic. # Arch., Engr., Designer Address Tel. City Zip I State laylo Lic.# LICENSED CONTRACTOR'S DECLARATION I hereby affVT that I am licensed under provisiogqs•,,ppf Chapter 9 (commencing with_,Section 7000) of Div'si n 3 of fh�e Buli ess and Professiotrs'Code, and m license is iq ull�rce effect. �` �_ SC y Y / r(v SIGNATURE 111 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). 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.) 1'1 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 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.) i l I am exempt under Sec. B. 8 P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION I 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 0 Copy is filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed ff the. permit is for one hundred dollars ($100) valuation or less.) I certify that in the performance of lhp 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 ame 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. 1 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 building construction, and hereby authorize representatives -of this city to enter the above.. mentioned property for inspection purposes. Signature of applicant -Date- Mailing ateMailing Address City, State, Zip BUILDING DIVISION BUILDING: TYPE CONST.. Q' � L�{vr1 OCC. GRP: t2 - 3- A.P. -A.P. Number �b !4/� 03/ Legal Description Project Description Sq. Ft. Size No. No. Dw. Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ cv iifp Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. -7!;70, -Do 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 Setfacfrom ae� Side Setback frio' rop. _ e FINAL DATE Issued by: Validated by: Validation: — RV_ CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL. SO. FT. g $ 2ND FL, SQ. FT, t<4 POR. SQ. FT. @ GAR. SO. FT. @ CAR P. SD. FT. WALL SO. FT. @ SO. FT. @ ESTIMATED CONSTRUCTION VALUATION g UNITS MOBILEHOME SVC. POWER OUTLET YARD SPKLR SYSTEM r. BAR SINK ROOF DRAINS DRAINAGE PIPING DRINKING FOUNTAIN URINAL WATER PIPING NOTE: Not to be used as property tax valuation BONDING FLOOR DRAIN MECHANICAL FEES FORMS WATER SOFTENER VENT SYSTEM FAN EVAP.000L HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GAS (ROUGH) GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED OTHER APP./EQUIP. LAUNDRY TRAY AIR HANDLING UNIT CFM TEMP. POLE KITCHEN SINK ABSORPTION SYSTEM. B.T.U. TEMP USE PERMIT SVC WATER CLOSET COMPRESSOR HP POLE, TEM/PERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SO. FT. r& c BATH TUB SQ. FT. © c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID @ t V. c SEWAGE DISPOSAL SO.FT.GAR @ 3/<c HOUSE SEWER REMARKS: VENTILATION GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE CONST, FEE ELECT. FEE SMI FEE PLUMB. FEE STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR SETBACK GROUND PLUMBING UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APP./EQUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. g plus x$ _$ LUMBER GR. FINAL INSP. FRAMING FINAL INSP. ROOFING REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL Desert Sands Unified School District Notice: 82-879 Highway 111 Document Cannot Be Duplicated Indio, CA 92201 619-775-3500 CERTIFICATE OF COMPLIANCE Date 1/17/97 APN # 769-590-031 No. 15186 Jurisdiction La Quinta Owner NameHarold Spizer Permit # No. 78-840 Street Lima City La Quinta zip 92253 Tract # Lot # Type of Development Single Family Residence Comments .,ttrus Golf Course - 3721 Sq. Ft. Log # Study Area 107 Square Footage 1 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: Under Mitigation Agreement EXEMPTION NOT APPLICABLE This certifies that school facility fees imposed pursuant to Mitigation Agreement in the amount of 628.00 X 1 or $ 628.00 the property listed above and that building permits and/or Certificates of Occupancy for this square footage in this proposed project may.now he,issued Fees Paid By Cashier's Check/J.N. Hayden Tele. hone.- , ,._ . Name on the check R N ✓ I By Dr. Carol McGrew a Administrator in Charge_�,'' Fee collected /exempted by Elle` Patino Payment Received $628:00--' Check No. 36767 Signatur 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 above 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 Districl('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 •11/08/1996 16:09 7148593729 PCM ANNEX PAGE 02 C US COURA Homeowners Association November 1, 1996 Harold Spizer P O Box 308 Cypress CA 90630 Re: Citrus Course Homeowners Association Account #371.0039 ® 78-840 Lima . . Dear Mr. Spizer: The Architectural Control Committee for the Citrus Coum Homeowners Association has approved your plans for lot #39, 78-840 Lima. A deposit of $5,000.00 has been received and applied toward construction fee deposit. Please note the comments from the Architectural Control Cornitiittee on your plans. If you have any questions, please feel free to contact me at PCM. ( Thank you. Sincerely, FOR THE BOARD OF DIRBCrOR9 pan Buckner, CCAJA- Community Manager DB/wb c; Board of Directors o ent, 23726 Birtchu Drive • Woe Forest, California 92630 a (800} 369-7260 CARLOS ELIAS REGISTERED CIVIL ENGINEER 38825 Charlesworth Drive Cathedral City, California 92234 Telephone (619) 328-7271 October 1, 1996 City of La Quinta Department of Building & Safety 78495 Calle Tampico La Quinta, Calif. 92253 Gentlemen: This letter concerns the residence to be constructed at 78-840 Lima, La Quinta, California. The design ofthe, roof trusses by Houston Lumber Company is in substantial conformance with the structural framing plan. Very truly yours, Q�pEESSIpNq PPS FV �Fyc� W 0) 9 Carlos Elias CE; jL IL rTF OF C ;�` 1�p'