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0306-091 (AR)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 Ir a" tot',f�'��>=*Signaturef n L.. B A .l y o Cor tactor 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). ( ) 1, 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 SPATE FuNi.) Policy No. NO -7"9.2003 (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 becomesubject to the workers' compensation laws of California and agree that if11 should become subject to the workers' compensation pro sions of Section 3700 of the Labor Code, I shall/forthwith comply with those provisions., ,Date: ;p -1 74 k'!'.?'.Applicant Warning: Failure to secure Workers' Compensation coverage is unlawful arid 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 authofte representative of this City to enter upon the above-mentioned property'for Inspection purposes. Signature (Owner/Agent)4..-'' G� ! Date"' T BUILDING PERMIT PERMIT# DATE VALUATION. LOT , TRACT WAS.`ti= 23 29283 JOB SITE / APN ADDRESS 49-304 VU CONQ UIUrADOR 6149=210-W7 OWNER CONTRACTOR/DESIGNER/EN &NEER TD ]' FSFRT 177 `VE,0PUM' SPARKS CONSWUart0'9 FO BOX 1736 79-295 RANCHO LA QiI1Ai". ADR. LAQUWA CA 52253 LA.QEDM.A. CA 92253 (i60Y171.194.1 CLO 29516 — IISF OF PERMIT — IRF=3..VfLA LAW.111'1`0N 960 S.F.CUSTOM ©ZIATCHED QUEST 9UITF Cc`ONSTkUC'1't4Lr V'CIUMT ' HO1J3Z :(W LIEU c7F OTANDARD W`& EST HOUSE. SUPPi:t3MW PERMIT TO 0191478 CUSTOM C01v1; TRU rT1014 582.00 9F PO11&WPATIO 152.0 S? O,t•1ta�gt�f'AT2.1�.011.'I6 • ' 31t,4Q ��'' ESIZI&KIRD POST Or C010MUCWON 53,45511.00 .PFaM'ff7F'ZE SUIVWARr: CONSTRUCTION _117W 101x-000-41.8-000- 3431" ' PLAN CHECK rZE 101-000-4.39-218. $333.26 M&C 101.00,0421.000 " $211 0 F..�..L.CTRICA).. FFIR 101-00 -420-000 $41.59 PLUmsbl dFRE '' - 101-000,419-000 3331110 STP,ON I` MOT1013 YIM, - R&SID 101-000-241-600. 911.8 -TOTAL COQ(/fes'" 1: 01.1' i4T11'91?LW CHECK $867.20 ' • D e � � L359 I';RE-?�f�73 FFA $0.00T .. ,?_ASR �' UMS!WE.�MV.• $967.20 AUG 21y 2003 CITY OF LA QUINTA% . FINANCE DEPT' 5 RECEIPT { DATE �%- 3 P'°• BYE /' DATE INALED INSPECT INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings - 3 Ducts Slab Grade Return Air Steel Combustion Air Roof Deck C — 3 Exhaust Fans O.K. to Wrap Q — i -3 F.A.U. Framing C- Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines ol Party Wall Firewall Exterior Lath IQ / - Dryw all - 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 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 Lateral Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test Appliances Final Final s Utility Notice (Gas) 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 -� Utility Notice (Perm) . COMMENTS: 01/16/2003 12:26 Bin , Permit # 0306-09 7607777011 LA QUINTA PAGE 01/01 030 ora City of La Quinta © Building ff Safety Division P.O. Box 1504, 76-495 Calle Tampico b Quinta, CA 92253 - (760) 777.7012 Building Permit Application and Tracking Sheer � b 1� Project Address: 9 — 30� > A. P_ Number: a -/U Co -7 Legal Description: % JZ Z`t-LE, j X07 Z 3 Contractor; Address: 0 v City, ST, Zip: (c%i Telephon l �l �C State Lic. W : &— % q G:cin, Lie. Arch., Engr.. Designer: Address: City. ST. Zip: Telephone:' State Lic. V: Name of Contact Person: A/0 Telephone ;V of Contact Person;*( d Submittal Plan Sets Structural Cales. Truss Cales. Title 24 Calcs. Flood plain plan Grading plan Subcontactor List Grant Deed H.O.A. Approval IN HOlJSE:- Planning Approval Pub. 'Wks. Appr School Fees d Cin'. ST_ Zip: Tclephont�(��� Pr�ojtect Description: CA, Q(2Z,3 T` 7777 A--�-4rre� -�"7- // 6gj 0"r- ConstructionTV pc Pro)cct type (circle Sq. Ft1 �c> 77/ —1'7 t;(/ Estimated Valuept APPLICANT:DO NOT WRITE BELOW THI! Rcc'd MkCKING Plan Check submitted l Reviewed. reads for corrections Called Contact Person i Plans picked up Plans resubmitted Re�•irss, reads for correcfi s/fi isfluc Called Contact Person Plans picked up -Plans resubmitted Review•, ready for correction5f19Sue/ CAllcd Contact Person Date or permit issue �v %AA�ll- A04100 �T1R1MJ� LINE la Occupancy: SN Add'n Alter Repair Dcmo Stories: ;V Units; 7 — joo 0 PERMIT FEES Item Plan Check I)gposit Plan Check BAIance Construction Mechanical Electrical Plumbing SAM. Grading / nVcloper Impact Fee b A.U.P. i Total Permit Fees Amount i CERTIFICATE OF COMPLIANCE ���r�Eflso Desert Sands Unified School District 47950 Dune Palms Road z o BERMUDA DUNES r Date 8/21/03 La Quinta, CA 92253 rn RANCHOMIRAGE 760 771-8515 INDIAN WELLS No. 24846 ( ) ¢ PALM DESERT y tj� LA QUINTA ,�. -�INDIO .y�i A Owner Desert Development APN # 649-210-007 Address P O Box 1716 Jurisdiction La Quinta City La Quinta Zip 92253 Permit # 0306-091 Tract # 29283 Study Area Type Residential Addition No.lof Units 1 Lot # No. Unit 1 23 49304 Unit 2 Unit 3 Unit 4 Unit 5 Comments Guest Hous e Street S.F. Via Conquistador 582 Unit 6 Unit 7 Unit 8 Unit 9 Unit 10 ` # No. 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 111 500 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 imposedpursuant to Education Code Section 17620 and Government Code 65995 Et Seq. in the amount of $2.14 X 582 S.F. or. $1,245.48 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/Palm Desert National Bank, Judy Halpain Check No. 087681 Name on the check Telephone 760.771.1941 Funding Residential By Dr. Doris Wilson Superintendent Fee collected /exempted by Sharon MCGllvrey Payment Recd $1,245.48. OvedUnder Signature C 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 Ithose 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 Embossed Original- Building Department/Applicant Copy-Applicant/Receipt Copy - Accounting r