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9904-044 (SFD)LICENSED CONTRACTORDECLARATION J hereby affirm under penalty of perjury that I amlicensed 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` 0/r Si nature of Contractor. Vr, g ti .> OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's License 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& Professionals Code),. „ (. ) I, as owner of the property,'.am exclusively. contracting with licensed contractors to.construct;the project (Sec. 7044, Business & Professionals Code). . 1 • O I am exempt underSectior ``t B&P.C. for this reason Date Signature of Owner . 'WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of k perjury one of: the following _declarations: have and will maintain a certificate of consenttoself-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 ,.�- r , Policy No. r Carrier - f:,;,��r�.,.�INS � �.Cr y (This section need not be completed if the permit valuation is for $100.00 or less). J ) 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 proves ons. 'Applicant f� 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 t 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 propertyfor.inspection purposes. / Si�ature (Owner/Agent) 1. •�. j Date 1 PERM BUILDING PERMIT 3IT# _`sr'� c i�� '' , -.r•i� '. )`//`44-044 FE DATE L-� "'�. VALUATION ' `S1,65J172e.1 0 LOT - 2127 TRACT 7 C51 52i-, • ap F f JOB SITE, &- Y° ki 114-11, m�-S Sih9R ""i ADDRESS _ r OWNER CONTRACTOR/DESIGNER/ENGINEER I;..e KE.L.A.QUINTA.€_'-faMNI NTTIL.'i,.!A.C: t"..Arls`•lDKi°&COMPANY' f 1570 F.iRCSOkEiOLL-OW f,a.t� � E. CLTITE 2.08 15770 BZttX4KI4QVU.3W DRIVE SUITE 208 S.AN't'A.ANA CA 92.705 SAWA A.NA, CA 9".70 k (71.4)751.-9.1.51 - - CBI,# 4485 - USEOF•PERMIT A LV I: 'w'1.i, Nl.iily ?Sf t,4, -i 1111 A -Pa- b tNA(J 1 INULLIt th i9LLA A W AL,1.1 Oft K)OL. TRACT CONS'1'1 UCION 24713,00 >:r (k!@3ZAa .H/C r' U10_1 I - ES"t1 el -ATE ,J a�1 i� op""YY ii�UC 8.10 9� 6Vu�lOYi t�i.�+�/.. ,. -P ZR MiTF EU, SCIM MARY CUNSTt2;UCTICst FEE 101-000-418-0100 W0.90 tyT AN SST a"iC• f RFf jt11�t1(lt)- i - i3Z �1 +t 7R lI 1)LT- 0S1` 101-0604 9IUR - :. 4250.00 WLwH N! Ai.1Tj"s Y _ . I�Jd-G00-�i�.1�1�`cr�i ELEC kICAT ,.' `ill -000-470.000 $ IFt L 11.0 - 5 F;2014 ; tYi0tP0N F%E . R13,310 101 A ^+-24.-000 0a lrs,S i t N:i RAS't'fiUC11.RE F11 225-000-441-342 ART kl^f;w REdI13'IM 00-0155.000 POO RUCID IK LESS PRE. -PAID FEES 41250.00 !(C3w 1,1.66 RECEIP v DATE �1°t`1\; \ I BY It� DAT FIN D INSPECTOR ' INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION ' DATE INSPECTOR BUILDING APPROVALS MECHANICAL•APPROVALS Set Backs Underground Ducts Forms & Footings T T Ducts Slab Grade f - _ Q Return Air Steel Combustion Air Roof Deck ZS -'F Exhaust Fans O.K. to Wrap F.A.U. Framing - - "7 Compressor Insulation r!, yZ_v f S Y 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 -tea 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 O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection - Encapsulation Gas Piping Gas Test -Zg - 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: •4 u�l'ItrGv P.O. BOX 1504 Building78-495 CALLE TAMPICO Addres[. T w 06A 00)0(0. �� -1 LA QUINTA, CALIFORNIA 92253 Owner mannty Address V;70 . but \c1 ( V d city n Zip Tel. Contractor /1 Address ty State Lic. I City & Classif. Lic. # Arch., Engr., Designer Address Tel. City IZip I State I Lic. # 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 I am exempt from the Contractors 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). I], I, as owner of the property, or my employees with wages as their able compensation, will do the work, and the structure is not intended Proffered 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.) I'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'7 I am exempt under Sec. B. & 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 n Copy is filed with the city. O 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 (8100) valuation 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. 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 ateMailing Address City, State, Zip 1Ro4 - 04+ APPLICATION ONLY BUILDING: TYPE'CONST. O,:,C. GRP. A.P. Number ( ,4-5 - i i o - n -S Legal Description Loi. � 7�.�%. -1It Project Description l D Sq. Ft. -)No. No. Dw. Size i'>c� Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation PERMIT j j , AMOUNT Plan Chk. Dep Plan Chk. Bal. Const. Mech. Electrical' Plumbing S.M.I. Driveway Enc. Infrastructure TOTAL REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from Denter Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side Setback from Property Line FINAL DATE INSPECTOR Issued by: Date Permit Validated by: Validation: WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISDON Notice: Document Cannot Be Duplicate Desert Sands Unified School District 47-950 Dune Palms Road La Quinta, CA 92253 Duplicated 760-771-8515 CERTIFICATE OF COMPLIANCE Date 4/15/99 APN # 643-110-028 No. ' 18575 Jurisdiction La Quinta R Owner NameLake La Quinta Comm., LLC Permit # No. 78-960., Street Via Florence Lcg # City La Quinta Zip 92253 Study A ---ea, Tract #f Lot # Square Footage 2713 } ------------- 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 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 t -ie amount of 1.93 X 2,713 or $ 5,236.09 the property listed above and that ]=wilding .permits and/or Certificates of Occupancy for this square footage in this proposed project may riov' be issued Fees Paid By CC/Life Bank - Robert Walker Telepho'�e '771636 Name on the check a By Dr..Doris Wilson .v- Superintendent F' 'Payment Fee collected /exempted by Ellen Patino Received '�� ... J$5;d36.0,9, Check No. 44003 fi"'N� Signature r tOTICE: 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 ibove 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 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. Embossed Original- Building Dept./Applicant Copy-:Applicant/Receipt Copy - Accounting ceitv 4 OF TN�� PUBLIC WORKS CLEARANCE LETTER FOR CUSTOM HOME LOTS ` Dear Builder: Prior to issuance of a building permit, you will be required to obtain clearance from the Public Works Department for one, or more, of the following: 1. Verification that rough grading is complete, and the pad elevation certifications prepared by a licensed surveyor, or engineer, are on .file in the Public Works 'Department. 2. Verification that infrastructure improvements and other required tract improvements are complete, or sufficiently advanced to warrant building permit issuance. 3. Prepare an engineered grading plan that provides for on -lot storm water retention,' and have it checked and approved by the Public Works Department • Tract 26524 (Estancias) • Tract 26769 (Mountain View Estates) 4. Prepare an engineered grading plan that provides for building pad grading in accordance with the existing soils report and tract grading plan,. and have it checked and approved by the Public Works Department. • Tract 28034 (South Valley Estates) FOR INTERNAL USE BY PUBLIC WORKS DEPARTMENT TRACT: LOT: Z?!7 �9 PUBLIC WORKS AUT ORIZATION DATE FAPWDEPTXDOCSXFORMSIPW CLEARANCE LETTER.ss