9702-057 (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
Date {/ Signature of Contract
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 wiih 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
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.
(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' compensations provisions of Section 3700 of the Labor
de, I shall forthwith comply with those 'provisions-: `�,
Date: ' Applicant ° �_ AAA /, mit
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 for,:inspectignLiposes.
/Signature (Owner/Agent)�=-�'<'� � Dat �"'"r
BUILDINGPERMIT
PERM T#
9702-01.57
°°NTR°`"
4Z
DATE �/ �/q ] VALUATION $26,335.50 LOT
TRACT
JOB SITE
ADDRESS 47-385 VIA 1+'W),Ki1rNCr..
APN
OWNER
CONTRACTOR / DESIGNER / ENGINEER
LANDAU DE i:I.,t3# NIENT IC0, INIC
IMPhRI Zf. SUN C'OtNS`M'[K:' ON
P. 0. B0 111 ? �
292 3��i.��'f�li- QUAfi't(,�� ( ),%,N ON ff.G d.
1 C AA �yy
j�.ALM SE AG.IT+( 4S CA «12263
`�l1.�.rM SPRINGS
CA 92763
i
fr> i Al►3 � 7
C 1,11 3787
USE OF PERMIT
r1UDN
'I'll A?,,;Z 130 407
I
- f.��I .6 atlld .�yt:i ':�,7+:i • i60I� �l���l..l."VDIZUt "TION
,i•�a��e7. w�Q/
Atib;$2!i`9f 11' 1� Ik:h' �!itJn�1Y1'li.�it�'
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PLAN 0ikt,'Kfff• IUI-i►l�(1-�13t)-�Ii#
5i7�.
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t�'t`3'tdv�'F?ITt 1'it'e•7V7^�t�? It}'I�!){)t),.:i.iS{-fl()(1
'R�fi�.t1ti
YrCTAFLAICAL r07. _101-000-421-00
$4 (A)
61"1 J. f, I if i C Alf, 'FL, 10 1-000-41410-M
$3 .9$
13 Ui�f3 l tvt 1 f H 1.01 _000 tF1-0(XJ
S.19 (10
`:')°t^Ef�ti Ltt��=)rftV :f` ):•tfl i()f-{)(1F3..2,1-ACri1
3"i�?
�� �,
01�t�;�Iltif�, TFF: 101. 4UU9 UUt?
$f►_+:rU
SUB-TCY'rAT, C0N'S1_VX,`ViCfN AND PLAN CHECK
TOTAL PHrR14 IT 14'Tt P.S .10JENOW
$583.86
RECEIPT
DATE
BY'
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
7 -
Compressor
Insulation
Vents
Fireplace P.L;
Grills
Fireplace T.Ct
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wali Firawall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWAL A PROVALS
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
'2
Main Drain
Bond Beam
Approval to Cover
Equipment location
Underground Electric
Underground Pibg. 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
Final
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:
Bln #
w . - �•
i.tybf LaQUinta
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'We Division' a
.Buildin g &h
P:O. Box 150'4 �.
Permit # :.........
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78-495'.Calle Tampicoz
9. Ia Quinta,'CA' 92253 `
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'Buildiin =Permit A lication and Tiracld ng, Sheet=
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Project Address ;L s'� „�" S ��.•�— %D ' ��C��
s Owner's Name: IA-/✓
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A P Number (jc �J i (� C� • `•
Address
Legal Description: t7 a.�'� 'i'2a s a^
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.Contractor: '. � ✓l�,j tai% °.
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Telephone: .'-' �.� �; �.' S
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+Address.," Q� _^� p a
Project Description`.
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Telephone: ° :• 3 ,- (P
Construction Type: Occupancy: a
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State Lic. #:' a a
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Project type (circle one):. New Add'n Alter Repair,,. Demo*
Name'of.Co' act Person
Sq. Ft.: �$
#Stories:
#Units
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Telephone:# of Contact Person. u 7 "..' ` 3 i :
Estimat id•Value of Project: : `. �7� 3.36
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CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
:ST FL. 30 FT ;t S
UNITS
SLAB GRADE
2ND fl. SO. FT. •,O
BONDING
YARD SPKLR SYSTEM
POR. SO. FT «:.
MOBILEHOME SVC.
BAR SINK
GAR SO. FT. 0
POWER OUTLET
ROOF DRAINS
CAR P SO. FT ,y
GAS (ROUGH)
DRAINAGE PIPING
WALL SO FT .%!
OTHER APPJEOUIP.
DRINKING FOUNTAIN
SO cT.
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION E
GROUT
WATER HEATER
SERVICE
FINAL INSP.
WATER PIPING
NOTE: Not to to vseo as rrocany :ax oxuatlon
WATER SYSTEM
GRADING
Cu
f aV>t of
FLOOR DRAIN
MECHANICAL FEES
FINAL INSP.
FRAMING
FINAL INSP,
WATER SOFTENER
VENT SYSTEM PAN EVAP COOL :,OOD
SIGN
WASH ER(AUTON01SHI
APPLIANCE DRYER
VENTILATION
GARBAGE DISPOSAL
FURNACE UNIT -WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FIREPLACE
KITCHEN SINK
ABSORPTION SYSTEM B.T U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE. TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. •, c
BATH TUB
MESH
SO. FT. ;R c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID rA 1'A c
SEWAGE DISPOSAL
SO.FT.GAR a 4c
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE --'—j PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING A AIR COMO. SOLAR
SETBACK
GROUNO 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 APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
Cu
f aV>t of
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP,
ROOFING
REMARK&
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIOWSOUNO
FINISH GRADING
FINAL INSPECTION
CERT. OCG
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FENCE FINAL
IAiRV I Vn O ONAI� � V A W VN � MLS .
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 4/7/97 APN # 346-110-017
r
No. 15414 Jurisdiction La Quinta
Owner Name Landau Development Co., Inc. ' Permit #
•
N0.47385 Street Via Florence Log #
City La Quinta , zip 92253 Study Area 123
Tract # Lot # Square Footage 485
Type of Development Single Family Residence .No. of Units 1 ;
Comments west nouse
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 replE.cement mobilehomes.
It has been determined the above-named owner is exempt from paying school fees at this time due to the following
reason:
s
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of
1.84 X 485 or $ 892.40 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 Imperial Sun Construction, Inc.+ f
Telephone .328-2277
Name on the check,
.� X01
By Dr. Carol McGrew
Administrator in Charge
Fee collected /exempted by Pauline Pearson Payment Received $842:40
Check No. 16423
Signature
OTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1996) this will serve'lo notify you that the 90 -day approval period in which you may protea 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 mother public entity authorized to
ollect them on the Dislricl('s)(s') behalf, whichever is earlier.
Collector: Attach a copy of county or city plan check application form to district copy for all waivers.
a Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt _Copy - Accounting