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9703-059 (SFD)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 Signature of Contractor 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 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. p<) 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. 3TATE1-'U D (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 sGbject to the workers' compensation provisions of Section 3700 of the Labor Lode, 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 $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit Subject to the conditions and restrictions set forth on his application. 1. Each person upon whose behalf this application is made & each person 64 whose request and for whose benefit work is performed under or pursuantt.9 any permit issued as a result of this applicaton agrees to, &shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating tothe building crInstruction; and hereby authorize representatives of this City to enter upon the above-mentioned property for inspection purposes. Signature (Owner/Agent) Date BUILDING PERMIT PERMIT# CONTROL# 970,0 59 5034 DATE 4f ���i% VALUATION '�+1� �7 W�.)t>� . LOT TRACT 6�- JOB SITE ADDRESS 47-&H) VLA N10ff4TI.GO APN 64-34.20-04 OWNER CONTRACTOR / DESIGNER / ENGINEER l ire Iarif. A+7i 1I.f1 MlCHi-iE11-8f.ROIN 4---60 VIA P AV.FNNA 77- t85 (_'A LL .Mf N!..%"Y LA Q!f.1ttV'VA CA 9.2253 t.,A t.1{.:fiN`I`!A. CA 92253 3331 USE OF PERMIT WIT ';;i i► Cft+fiS tt ;i)�;h •• i� kilvit!' >+;li S NOT iiv4i UlAt, ESLOCK, WALLS OR. iJr;)r_ifa b`+ Jtt�dl4rPr\"f .lf� niarf:Ult s t_f.AfQAtflip:A!tP01,:'f' ?3%6.If() 84 . �'`•�'i'ltA�ti':9'�'�.) �C),� (' t�t�' fY�1431'R3,�i;(.;�D'�911t #!i'"l�.ie�.1243 i.70df;TR(jC71 IN.F%A+ Pf,0%Nr1tfr(19 f%pf? %A1,87 i�'IaI. f.1I.�I'=.rest:'!' , .•$;,Qft (#t h44'CIIA.N(0ALPfsf$ l-000 $3�1.+.Sf> f,1fA':i RA:Al, H11' 10149* 4,"titT- M) $21001 f�},f+ttpti{tft�f+`; 1%t/fa I(tt-::ftrl),(f1•d)�).(lstfi $`q`,fklt+;i ��'t:3.i'F4'f 1, ��.%,91�.�I4 f��'ii'%iM49.1I� �.41L^�?Vt�•'A'1.I.'1 �!1!4° ��:i. �s� c ttt �Yt.>3 f�tr, f f� 131; t Q i-t3i�t`i<.t:� 3t��ita �1.t1 +�r3 iNI%It.rl�t'f`!?1t�.'I'i}T21:F=16? 25.011-443-342, rAt$'i' tia }"Cf1il,l'1..�lC'try ft4.i1i i(i1__ Ei)CS ?4S>f)0 CESS ME -PAID [rS 42 50.00 APR 2 4 1997 Ptt;KA11T YrtaTA1, Fli,rI S CPOJ V,NOW . S6,727.95 GITY OF L., 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 2Q Exhaust Fans O.K to Wrap F.A.U. Framing 0 Compressor Insulation 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 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 Neater 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 COMMENTS: 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 2 Final Utility Notice (Perm) Td4 ^ � 30 VIA- kkT(60 P.O. BOX 1504 APPLICATION ONLY building 5 CALLE ES Address oC ��'�LA��N A, CALIFORNIA 92253 Addrigess "1- �y _ 3 [),x Addr� (oQ �k-- City Zip Tel. t- , a Contractor / � ► 1 t G�l �-2t ��-� c �. (� o�Tn.«c��.-.ITh � Address � �-9 Z 9 Sk.vw � I.J►�-�..�- P(fl R- 002 -7627 CitaY Zip Tel.. 2T112 -413 �?�S State Lic.� City & Classif. T F' �''� G} , Lic. # Arch., Engr. Designer °���� Address V Tel. 45-150 GLua o Q->4�;, o o Z 5'0 City Zip State �PX1A, fJ�IS qZ2! C7 Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that 11m licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3tithe usiness and Professions Code, and my license is 'n full f ice and effect. � ,/°.�^L SIGNATURE f DATE OWNER -BUILDER DECLARATION I hereby affirm that I 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 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). l7 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.) 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.) 17 I am exempt under Sec. B. & P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION 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'COMPENSATIONINSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) 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 1 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 sof this city to enter the above- mentioned bovementioned property for inspection purposes. Signature of applicant Date Mailing Address City, State, Zip BUILDING DIVISION BUILDING: ..TYPE CONST. OCC: GRP. A.P. Number lay Legal Description Project Description Sq. Ft. No. No: Dw. Size ���s Stories Units New Add ❑ Alter, Repair ❑ Demolition ❑ Estimated Valuation PERMIT AMOUNT 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 Setbacs from Center Line Rear Setback from Rear Prop. Line Side Street Satback from Center Line Side Setback from Property Line FINAL DATE k INSPECTOR Issued by: ' Da -e Validated by: p Validation: JAN % 1 1997 CITY OF LA QUINTA e. CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBINGF€7 IST FL SO. FT. ra $ 2ND FL. SQ. FT, [} POR. SO. FT. �}a GAR. SO. FT. @ CAR P. SO. FT. 0 WALL SO. FT. @ SO. FT. @ ESTIMATED CONSTRUCTION VALUATION $ UNITS MOBILEHOME SVC. POWER OUTLET YARD SPKLR SYSTEM BAR SINK ROOF DRAINS DRAINAGE PIPING DRINKING FOUNTAIN URINAL WATER PIPING NOTE: Not to be used as property tax valuation BONDING FLOOR DRAIN MECHANICAL FEES FORMS WATER SOFTENER VENT SYSTEM FAN EVAP.000L HOOD SIGN WASH ER(AUTO)(DISH) APPLIANCE DRYER GAS (ROUGH) GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED OTHER APP.IEQUIP. LAUNDRYTRAY AIR HANDLING UNIT CFM TEMP. POLE 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 SQ. FT. @ c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ, FT. RESID ® 1'A c SEWAGE DISPOSAL SO.FT.GAR @ 3/ac HOUSE SEWER REMARKS: VENTILATION GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE CONST. FEE ELECT, FEE SMI FEE PLUMB. FEE STRUCTURE PLUMBING ELECTRICAL HEATING R AIR COND. SOLAR SETBACK GROUND 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 APP.IEQUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. $ plus x$ _$ LUMBER GR. FINAL INSP. FRAMING FINAL INSP. ROOFING REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL Notice: Document Cannot Be Duplicated Desert Sands Unified School District 82-879 Highway 111 Indio, CA 92201 619-775-3500 CERTIFICATE OF COMPLIANCE Date 4/24/97 APN # 643-120-024-2 No. 15453 Jurisdiction La Quinta Owner Name Vince Lacasella Permit # No: 47530 Street Via Montigo City La Quinta zip 2253 Tract # Lot # Square Footage Type of Development Single Family Residence' Comments U, . Log # Study Area 123 3214 No.'of Units 1 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 . 1.84 X 3,214 or $ 5,913.76 1 _ the ., property listed above, and that building permits and/or Certificates of Occupancy for this square •fo6tag6<iiee 4hgqis proposed project may now be issued Fees Paid By cc/First Bank/? Bergin Construction -90 a62-90°58 Name on the check By Dr. Carol McGrew Administrator in Charge ''°iz,:.'� �:. C; i': Iii L Fee collected /exempted by Pauline Pearson-"-': n-..." -"--'Payment Received $5,913.76 �Clieck No. 37863 Signature 1 .6�..�4l1e 4 !S 3�d d A 40TICE: 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 above will begin to run from the date on which the building or installation permit 6 thisproject is s`orssued on:which they are paid to the District(s) cr to another public entity authorized to .,,act them on the District('s)(s') behalf, 'whichever is earlier. •' s} `� Collector: Attach a copy of county or city plan check a6licati6n`fo ' —to district copy for all waivers. Embossed Original -Building Dept./Applicant Copy =` Aipplicarit/Receip't' Copy - Accounting #I�E ,_-1 ........ ... to Cityo .. f La uin ........................ ... .......................... ........................ . .............................. ...... ... .::..::...:..:..:.::....: ::::::.::::::::::::::::::: "�Building8t Safe Division h . P.O Box 1'SO4 ren 78-495 Calle ico> . 'La Uinta CA 92253. Q ' . • _:�..` And'TradingSheet Building Permit Applicatioh Project Address: =.•DC7 Owner's Name. - A l(.� �. ,4? :V 1 I/hWV I O Se—1 A. P�Number: ('L1 �.Z•OC;I — �Z Address:. 4 > ="iC�O Vi r. ve�ina. LegalDescription: T� -r 2 I IS""? City,ST, Zip: ic�t i — •- ' L Telephone: - b�Contractor: Address: Z Zq S w•o Project Description: 4C City,ST; Zip: 1'o:1w�" •�es e n q ZZG D ''�7 s^.'. TeleP hone: ' S_ 7 'State Lic. 9:'City Lic. #:' Atch., Engr., Desigrier 041 Address. 4 O (L City, ST;Zip:'�?�hd�ay.��5 C/} ZZta Telephone: O P � (d� OZ..S. Construction Type: Occupancy: YP. Lic. #: a AltJectbP er Rer 'emoDcircle'one : New AddnState Name of Contact Person::" _. Sq. Ft.. 1 "7r #Stones: ' # Units: ' Telephone # of Contact Person:. 5e( t. -`j',OS7-R� A62 riloZ '-I I Estimated Value of Project:. - .` CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING Fkf5 iST FL. 50 FT ;t s 2ND Fl. SO. FT. POR. SO. FT riy GAR. SO, FT. ,0 CAR P j0. FT .,a L WALL SO. FT It S0. cT. �t ESTIMATED CONSTRUCTION VALUATION T UNITS MOSILEHOME SVC. POWER OUTLET YARD SPKLR SYSTEM BAR SINK ROOF DRAINS DRAINAGE PIPING I DRINKING FOUNTAIN URINAL WATER PIPING NOTE: Not to be Asea as prooeny :ax +al.ation BONDING FLOOR DRAIN MECHANICAL FEES FORMS WATER SOFTENER VENT SYSTEM FAN EVARCOOL HOOD SIGN WASHER(AUTCXOISH) APPLIANCE DRYER GAS (ROUGH GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED OTHER APPJEWP. LAUNDRY TRAY AIR HANDLING UNIT CFM TEMP. POLE 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 SO. FT. g c WATER • HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID a 11b c SEWAGE DISPOSAL SO.FT.GAR ® %c HOUSE SEWER REMARK& GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE CONST. FEE ELECT. FEE SMI FEE PLUMB. FEE STRUCTURE PLUMBING ELECTRICAL HEATING III 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 APPJEWP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INV. BOND BEAM WATER SYSTEM GRADING Cu LUMBER GR. FINAL INSP. FRAMING FINAL INSP. ROOFING REMARK& VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIOMMUNO FINISH GRADING FINAL INSPECTION CERT. OCC, FENCE FINAL �ws►ec�wra atiwwwww�w��wa GARDEN WALL FINAL . CARLOS ELIAS REGISTERED CIVIL ENGINEER 9 38825. Charlesworth Drive - ''Ca4dral City, California -92234 he Telephone (619) 328-7271 i March 10,'1997 r City of, La Quinta Department of Building & Safety ,, r 78495 Ca11e'Tamp ico, -,La Quints, Calif, ,92253 Gentlemen. f ,This',., - concerns the guest house to be constructed at 47a530 Via Mont4go, La Quinta • California. Ikhave reviewed the layout 'and bearing points `of the roof trusses designed ,by Houston Lumber Company'and find. that,their- design 'is.•in conformance with.my design intent., Verytruly y'ou:rs,1 oQ�pFESS/0 i ! _ Qc�, P�pg �, y C9r7 Carlos El ias /16839 . CE: j , CIVIL r ., OF CAUF���\P ' `4;, ins < i r"t • --..+ . - '�'!w - .. - + ' I. a a - OF LA QUINTA �11N'G & SAFETY DEPARTMENT 777-7012 .,ITSPECTION REQUEST LINE 777-7153 • Owner SELLA ContraCHAEL'BERGIN CO ON Permit Number 9703-059'",,1 ' POST ON JOB IN CONSPICUOUS PLACE INSPECTOR MUST SIGN ALL APPLICABLE`SPACES X09 ADDRESS 47-530 VIA MONTIGO ' SFD & GUEST HOUSE - PERM' ;DOES NOT INCLUDE BLOCK WALLS OR POOL TYPE OF INSPECTION DATE ISP. i FOUNDATION & SETBACK FOOTING STEEL ' ':• MAIN GROUND SYSTEM GROUND PLUMBING r DO NOT POUR CONCRETE CONCRETE SLAB JOISTS & GIRDERS ELECTRIGA ndirdiOR SID NOT OUR CONCRETE ROUGH E. CTRIC "ROUGH PL`�u181NG ROUGH GAS& GAS TESTY HON -NG & VENT - A/C FIREPLACE ROOF BOND BEAM 0. K. TO WRAP i1 GROUT O 4' O 8' F) FRAMING INSULATION PRE -,ROOF _ COVER NO WORK UNTIL ABO .DR,'VALL INTERIOR_ EX','EF:•_6a LATH r r POOL PRE PLASTER POOL FENCE & GATE SEWER SEPTIC TANK ; FINALS j f 9 HAS BEEN SIGNED s y (r HAS BEEN SIGNED ` 7 -) of ? - �l VE HAS BEEN SIGNED ELECTRICAL j PLUMBING FINAL GAS TEST Ct HEATING - A/C HOUSE NUMBERS JOB COMPLETED TEMP POWER