9511-001 (SFD)t
' LICENSED CONTRACTOR DECLARATION
I hereby affirm 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. 479669-13, 913065
License # Lic. Class Exp. Date
Date- SignatureofContractor A A A Ai
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License 2r/e
following reason: vr•
( ) 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.
(This section lne,,.(gAot be completed if the permit valuatio%s.fgrl$�yUU.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 Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.
Date: Applicant
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 td,6
any permit issued as a result of this application agrees to, & shall,, indemnity
& hold harmless the City of Indian Wells, 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 lr
permit, or cessation of work for 180 days will subject permit to cancellations, e!
I certify that I have read this application and state that the above informatioN,ps
_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 Q51 -
above -mentioned property for inspection purposes.
Signature - (Owner/AgertT) J Date i
ALC MBUILDING
PERMIT
PE'!r".�-on
DATE 3,11:1 elP N
VALUATION Zt+1. ,W'Y-JV
LOT A t !
TRACT Lo l a,
JOB SITE ADDRESS 47-435 Via . N �90�`d'uft
APN
OWNER
-
CONTRACTOR
BRIA��('�:,'�sjlja'tIt��i1 tJ"'Yf���'
q p�(^�^y (' [,�`(' (/'�;)
1,A 1d�' U 1) y�E.1wd. PIM
{p '(s��'r(��dj'I[:r01..10N
�, 2825 fI,S1C6,h,�il4 �2 CANYON lfia!L��7 JIDI
"2825
P.O. BOX
P.ALIVI SPRINGS +':;A 92163
RKLM:SPRINGS CA 92263
(619)32..?2277 OBIX 3787
(6).9) ?2W2277
DESIGNER/ENG[NEER
YffiNDEILN.Mail
Gf�.i2t?l�li
USE OFPERMITy.,1NGLE I'ArJlILY DWEE ,,j...t'i` CY
'PAI 7, OMPItOrik 0A 1-00'7
i,tikia tat �uitlttt r�'l::ln.'?-tt .
Pormit does riot inchide black wall or pool. .
FEE DESCRIPTION
FEES
°i':RAC"i.' c:,'IONS'I.' ICv l'I:i7N Z937-00 3F
PGItCI-gPATtO 120M SE
GAIZAGE/CAR:taO T 690.00 YF
1WHIMA>t:ED COST OF CONSTRUCTION
.10,909.10
I° 3;R.lVa.IT F1'i.E SUMMARY '
P1,AM CHEEC X F 3 f�i �()i)-439 f 4.8 %1�-Fi9
`f32 STf:L':'lIO ;r 101-000-41?,000 $933.so
IIM13 7;TAN[CA PU— 101 0th �2 i -{if�i � t+iS.6�i
U.X X °riz:(CPkL FEE 1.01-000-420-000
{'tdl 3fi�iC'r) t ? 10 1 -0f)0 -419 -MO 52.07.00
CSI' 0 $13.19
S MC3'I 1QR :eY'-1Z1'S1i? 100=0Q0=211 00
i'eFe, KI)I O ,fes 106.-000-E123--000 00.06
tNFRAR'i`i UCTURE FEE 225-000-413-342 $3.89237
P?TIcrl!"Fl, PLAN W1 -O()()-441-345 .. $9-100
ART tN PdJ]iLIC PLACES - RESI> 701.000-255.000 �at►�.7
�..�, SUB -TOTAL CONS Ri.`C110 vT .AND PLAN' CHECK
$6,402.43
LESS P1tC f'NI7 } Ii3SO.C)Q
'1' 4D1 Aij ,1°EE:M1T �� KES 'DUE NOW
.$6,402:43
P!OV p 8
1995 t�
i
TOTAL PRO.r`l C PERIT PKES
6,402.43
RECEIPT
DATE'
BV
DATE RNALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
2
Underground Ducts
Forms & Footings
if /
Ducts
Slab Grade
2 /
Return Air
Steel
/
Combustion Air
Roof Deck
2
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Z
Vents
Fireplace P.L.
7
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
t,2 zj
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
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
// Z
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
FinalJ�1fv
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)
QCOMMENTS:
7 fid
s
DESERT SANDS UNIFIED SCHOOL DISTRICT
82-879 Highway 111
NOTICE: Indio, CA 92201
Document Cannot'Be Duplicated 619-775-3500
Date 11/8/95 Type of Permit La Quinta
No. 13847 Permit #
Log
Owner Name Landau Development,
T No. 47415 Street •Via Florence '
City La Quinta Zip 92253 Study Area 12
i APN # 643-100-018 26152 217
"Tract # Lot # 0 Square Footage 12937 "
Type of Development Single Family Residence No. :)f units 0
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 1.72 X 2 937 or $ 5,051.64 have been paid to D.S.U.S.D. 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 Imperial Sun Construction Telephone ;j'328`2277
Name on the check `' ^
L,
By Dolores A. Ballesteros .
Superintendent
Fee collected /exempted by - Pauline Pearson �
Payment Receivedv-"
Signature 44 g 2_0 A" ja-" $5,015.64 Check No. 14266
Collector: Attach a copy of county or city plan check.application form to district copy fir all waivers. _
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting
r
SENT BY:Classic Office 4— 9-00 ; 1'20PM Bob Hoe Chr slor-+ 7607777011;#
LJA
KE LA U I NTA
April 8, 2000
TO: Mr, Greg Butler FAX: 777-7011 QjLe Fa
Building.& Safety
City of La Quinta
Mr. Stan Sawa FAX: 771-1233
Community Development
City of La Quinta
FROM: Rich Vane
Chairman, Lake La Quinta HOA
Architectural Committee
Subject: Project Approvals
The following projects were • approved this week by the Lake La Quinta
Homeowner's Association,
o Lakeside rear yard patio flatwork, built-in barbecue, retaining wall and
landscape modifications
Builder: Gregorio Martinez
Owner: Dorothy Forstmann
Lot 216 at 47-415 Via Florence, La Quinta
a Garage air conditioner
Owner: David Thom&
Lot 208 at 47-410 Via Cordova, La Quinta
This is the final action taken by the current HOA Board of Directors. Elections
this weekend will install 3 new members and I will complete my two year term as
the Chairman of the Architectural Committee and Vice President of the Board,
Again, thank you for all your assistance and support.