9512-030 (SFD)LICENSED CONTRACTOR DECLARATION
-- .I ;F6bi 611irm that -I am licensed under provisions of . Chapter 9 (commencing with
Sediori.7060) of Div'iiso'n.,3 of the Business and Professionals Code, and my
License is In full force and effect.
_U,eeris,e1# Date
I lie
ate Signature of Contractor
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's Licehsii Law for the
following reason:
1, 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 AProfessionals.Code). . . I
O 1, as owner- of =the -P " roperty, am exclusively� contracting - with, licensed
-
contractors
,
contractors to construct the project (Sec. 7044 Business" & Professionals Code):
( ) I am exempt Under Section . I , BiP.C. for this reason
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following d6clarations:
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 W'hi6h'this permit is issued.
O I have and will maintain workers; i 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.
(Thl"S'sectGhll AM be completed if the permit valuatioK060006.00 or less)
Y 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 mpensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those p'rovisions_,� .
Applicant; _0
Warning: Failure to secure Workers' Compensation coverage is unlawful and shall,
subject an employer to criminal penalties and civil fines up to $100,000,1 in
addition to the cost of compensation, damages as, provided for in Section 3706
1
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.
11. Each person upon Whose behalf this application, is made. & each person at
whose request and f6r whose benefit work is performed'under or pursuant to.
any permit issued as a re , sult of this application agrees g to, & shall, indemnify
& 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.sukh'",
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 n the
aboveLmentioned property for inspection purposes.,
igrmdure. (Owner/Agent) t"Ju Date
ALCM
BUILDING PERMIT
.IO
PERMIT9-
AM
DATE
YALU A TION
is3,9w22,3
LOT ACT
B SITE ADDRESS
APN
47-635 V1 7
A FIX)RENC
"3_1 1"24
OWNER:
CONTRACTOR
IMPERIM, SUN CONSMLICIION
LANDAU DEWLOPIMENIT
2825 TAF1QUrfZ CANYON #,E)l
P.0'. BOX" 1725
PALM SPRINGS C.A - 0263
TALNISPRINGS C.A. 92263
(61 Q1A1P_T)7'1-'r.Rix 1787
'DESIGNER/ENGINEER
USE OFPERMIT
SING" LE FATTAILN'DvJ LLI VIG
SFD Petco it does n%A1nc1adeb1ock-wAUor 1160L
FEE DESCRIPTION
FEES
TRACT CONSTRUCTION 2..937-00 SF
820'00 SIT
GARAOFICARPOKY 00.00 8F
ES17ALATED COST OF CONSTRUCTION
183,909.10
MMMIT FEE SUMMA.RY
PLAN 0316 •K "X 101-0M439-318
�ONSTRUCTJONYFE 101-000418-000
FEE 101-000-421-0(x)
$1
XCMICAL FES, 101 -OW -420-000 196. 60
TILVAISING ['FE 101-PQDA19-000
3TONIG TN OpT10!q'FEE A PES[D 100AA0-24-000' $18.39
QWLING.17BE 101466-423-000
INFRASMUCTUMFE, E 22.5-000-443-342 $3,892.57
PRECISE PLAN 101<000441-34$ 525.00
ART mp.mfC. I=L N? o_.REgft 701-000-255-000 $209.17
.G D13YOS-IT - e254.40
SIM -TOTAL CONSTRUMON AND PLAN CHECK
•$6,402.43
..LESS PREPAID FEES
-$250.00
TOTA PERAHTFEES DUE NOW
56,152.43
F,
RECEIPT
DATE
BY
DATE RNALED
JINSPECTOR
.-I I , ..1 I . ., ! ,
INSPECTION RECORD
.' OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
&V 1A
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof DeckExhaust
Fans
O.K. to Wrap
Z
F.A.U.
Framing
% 4le
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
QG
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL
APPROVALS
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
7
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
COMMES:
d
Final�L
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)
Building
Address
Owner
Mailing
Address �7
City
�iGGlt�Gt/'
P.O. BOX 1504
,,78-105 CALLS ESTADO
Uf�UINTA, CALIFORNIA 92253
Dt=�/I`.IO. pM ENT.
J
tgoX 1�'2.5•
Zip Tel.
e_T/11L(o1!;S t,IA
Contractor
Address
CityZip Tel..
Pa1t•� s�2►►•�s 9�Z/Z(o`�SI ro(q J
State Lic. City
& Classif.. D41 q Lic. #,,
Arch., Engr.,
Designer. ��1.t101' W. V r 1 T1 .
Address Tel.
01V3110 - l I II
City Z'`,&ip State
AMM svalu�s ft_t Lic. # C - 52g7
' 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 1 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 the e applicant for such permit to rile 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).
(7 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.)
ri I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, BusinessandProfessions 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.)
17 I am exempt under Sec. B. & P.C. for this reason
Date ta+ 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
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This 'section need not be completed if the permit is for one hundred dollars (S100) valuation
,Orless.) -
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 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 Address -
-City, Stale, Zip -
APPLICATION ONLY
BUILDING: TYPE CONST. - OCC. GRP.
A.P. Number &Z -3 - "`// 0,_ aa -y
Legal Description LOT
Project Description
V k) v �'
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition 0'
A/'
PERMIT AMQUNT \
Plan Chk. Dep.
Plan Chk. Bal.
Const. /
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback foom Center Line
- Rear Setback from Rear Prop. Line
Side Street Sett-ack from Center Line
.Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
i
FINANCE
Desert Sands Unified School District
Notice: 82-879 Highway 111
Indio, CA 92201 l
Document Cannot Be Duplicated 619-775-3500
CERTIFICATE OF COMPLIANCE
'Date 2/29/96 APN # 643-110-024. -'
No. 14188 Jurisdiction La Quinta
Owner Name Landau Development Permit #
No. 47635 Street Via Florence Lag #
City La Quimta Zip 92253 Study Area 123
Tract # 26152 Lot # 223 Square Footage 2937
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 inobilehomes. 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
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.
�r 41
Fees Paid By Imperial Sun Construction, Inc. Telephone;,- 328-2277
Name on the check w, t
By Dolores A. Ballesteros ''`
�:
Superintendent
Fee collected /exempted by Pauline Pearson Payment Received $5,051.64
Check No. 14976
Signature 1 c -AA
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
CARL.OS ELIAS
REGISTERED CIVIL ENGINEER
38825 Charlesworth Drive
Cathedral City, California 92234
Telephone (619) 328-7271
License No. 16839 _
Expiration 6/1997
July 16, 1996
City of La Quinta
Post. Office Box 1504
La Quinta, California 92253
Re: Lot 223 - Tract No. 26152
47-635 Via Florence
Gentlemen:-
Please
entlemen: Please be advised that I authorize Mr.. Mike Mendoza- to inspect
and approve the.structural,construction put'in place by Imperial.
Sun .Construction, Inc., in accordance with U.B.C. Coda 307 on any
of the single family dwellings located on Tract 26152., La Quinta,
California
CARLOS ELIAS