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9606-066 (SFD)LICENSED CONTRACTOR DECLARATION I h3reby 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 Contractor '°f�� i 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. ( ) I have and will maintain workers' compensation insurance, as required by Section 3740, of the Labor Code, for the performance of the. work .for which this permit is''isse .IMy workers' compensation insurance carrrier�&`polity 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' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply witti those provisions. .s Date: %/ /' ri Applicant- ,,; � w- 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 inspection purposes. Signature (Owner/Agent)/ ���° �// '� Dat BUILDINGPERMIT PERMI CONTRROL# Z 7 1 DATE y/ r3'1 VALUATION' ?j{y(� �,fj�9 LOT ���, TRACT I T ADD ESS 4JOB SITE7-SO VIA MONIi(A) APN ti"�.Q,.Z��t:� OWNER CONTRACTOR/DESIGNER/ENGINEER Akih1?{(77i'{' IN't )"1A0CJ3'.1'f' '4S¢-",: �V., l.t .. .tv �Yl !�j,Fl1')1 6i t�j STI ld 1+R,.lf�.�w xi_! \.�./ f♦ f;.�.=l c4lh i 0, i10N i'� 2 :Y `1t'Lria;rl iZc"kulr ry�)1. 11,At.Ai SPRINOS CA 9 263 PALM S111U GS (."A 92263 tii�1'r/7f t:15 6141281717 7 E`flf.#E 37917 vdE.iiv%�L t 1. vi i `tai USE OF PERMIT SIN' iLk'' rAN110' dMEI.lAN('; Sf;L�-l%Eft-If't f100 NOT iN(."i. ME. lsIX:WX WAIL. (lit, tit P(yf,.. _ _ .. A,.1J",.`_1. -t ,V..i 3374`x_ -.L ♦ ry ly o':,`-v.v {,i'AiZt1<: FYt".ARPOii`f.° 670 90 SF F.S �1��� it"�;i) i:C:S'�' �.a' CClts'� d..Fi S'�.`�1QIb 1.�+5,lbZ.Lt➢ 'kttli��At(T its E: �f rttfw:c� LlN:MLR".TIC. NFHS 10.14041 OOO S8711:00 #'L.NN t711FJ`K FEE 14i f)(}EA 9�'.►<.i:t& �"J l 2t RX DEP080T MtEK14ANWAL btrN, f01 -00-421-t) O St11,SU r;J ("l:t2Y1hLFETi 401-000-420-000 S ItVIA9 4'I�LT&1131*F(aL3r STOI) G &4N,*YVK_)N FF8 - OEM) 101-000-2.11-000 f4.ti:a iIK..AUI NO .lf't?,F, 101-000-423AW 520.00 1'I'Jt%I`LA',1VM. 3t M_ 'R FIE 1254r[i0443-M' 1153 7I 4i T017 LM13=T'{"'r'_'li:(7"itli�i:Igpl.t�t.!11!'fgl=}7y+ur1C l,� ``C,(?E1G'�.//?,,yy+ 1e�:i9& F1E�,�">:'kt'•t.1:,3 .��ie.4` S D ; e: @ AL 1'�t ltfl��i` 1l''t+9f+'.5 �iEi�� j�`i�`� °5��%�f►, i11 I NOVO 1 1996 .. RECEIPT I 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 J, Combustion Air —RooPl4wk,� 16f Exhaust Fans F.A.U. mg Compressor ion Vents L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wal wall enor Lath Drywall - Int. Lath Final Final BLOCKWAL APPROVAL 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 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: JI P.O. BOX 1504 APPLICATION ONLY Bullding �,/ 17 G V /,1 �J� I? _ /�. 9 L(AQUINTA CAL CALIFORNIA 92253 Address' .l / I 'P /•` �V i .� 7INA) de J 00 Nc, Mailing Address f Q 1 7 a City Zip Tel. �fA1A xi�'Y�Ss 1.�2 3 1777-/,31-/S Contractor n- Addresns ! �/ I/ � o CityZip �� � TTel.„ 101 /W �.Q 1 `� S 6 State Ljc.// f � / City 9 7 & Classif. L-- (D Lic. # Arch., Engr., Designer wnl, Address� Tel :3.QC)^'fd�+l City C ` / C Zip � 2 Staten 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 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). I7 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, 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 ownerof the property, am exclusively contracting with licensed contractors to con- struct the proiect. (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.) 1-1 1 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 0 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 ($100) valuation or less.) I certify that in the performance of thg 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. ' r 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 it work thereunder is suspended for 180 days. I certify that I have read this application and state that the above information is correct. 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 property for inspection purposes. ' Signature of applicant Date - MaYing Address City, State, Zip BUILDING DIVISION BUILDING: TYPE CONST. OCC. GRP. A.P. Number` /-z? a.3!�,( Legal Description f� o j"i� ,c / 7%� /y o U a % i'scl Project Description ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side Setback from Property Line FINAL DATE INSPECTOR Issued by: Date-jj'�-P-ermit rr ��� Sq. Ft. No. Size Stories No. Dw. Units New ❑ Add ❑ Alter :1 Repair ❑ Demolition ❑ Validation: �� t 1 I A I r% 11 vVIV U'r Y`1"IPY II l� Estimated Valuation f 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 Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side Setback from Property Line FINAL DATE INSPECTOR Issued by: Date-jj'�-P-ermit rr ��� Validated by: -I II 111 Validation: �� t 1 I A I r% 11 vVIV U'r Y`1"IPY II l� u By CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES T_ 1ST FL. SO. FT. $ 2ND FL. SO. FT, @ POR. SO. FT. @ GAR. SO. FT. @ CAR P. SO. FT. WALL SO. FT, 0 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 WASHER(AUTO)(DISH) APPLIANCE DRYER GAS (ROUGH) GARBAGE DISPOSAL FURNACE UNIT I WALL FLOOR SUSPENDED OTHER APPJEOUIP. 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 SOWER BOILER B.T.U. SO. FT. @ c BATH TUB SO. FT. Q c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID Q 1'A c SEWAGE DISPOSAL SO.FT.GAR @ 35c 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 & 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 APPJEOUIP. 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 INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL y Desert `Sands Unified School District! - �, <<<t 82 8'79 Highway 111 Indio CA 92201:. w► L i�ment Cannot Be Duplicated ' � • : • X619-775-3500 � '• _ ... - • CERTIFICATE ,OF COMPLIANCE Date 11/1/96 '. APN# 643-120-023 No._ -14976 . Jurisdiction' ' La Quinta ' Owner NameLandua Development Permit # F No. 47=560 Street Via Moritig y Log # '9606-066 ' City La Quint a - Zip 92270 Study Area 123 Tract # 251 1 , Lot # ' 26°152 Square Footage 2794- Type 794-Type ofDevelopmentSingle Family Residen6bNo. of Units 1' Comments +' At the present 'time, 'the" Desert 'Sand Unified School District' does not ''collect fees on . ° garages/carports, covered patios/walkways;residential additions under 500 square feet, detached accessory structures or replacement mobile.mes. It has been determined the above-named owner is exempt from paying school fees -at this time due.to the following reason: z; {, EXEMPTION NOT APPLICABLE -,This certifies that school facilityfees imposed pursuant to Government Code 53080. f ' iii the amount of 1.84 x 2,794 or $ 5,140.96. the property listed -above and that building�permits and/or Certificates of Occupancy for J " this square footage in this proposed project may now be issued'; -Fees Paid By • Landua Development ,' _ Telephone x777-1345 +, Name on the check BDr. Carol McGrew: Administrator.in Charge, o 4 _' `• Y , Fee co` /exempted by "'-Julie,. O'Neil Payment Received t ti ho } ,f �.?.^.ilr 'Check No. 831495357: `.° 'f Signature` Collector: At ;arcopy of county, o� city plan check application form to district copy for all waivers. J y' � Embossed O ginal- Buildi`ng Dept./Applicant CopyY Applicant/Receipt ' ' Copy =Accounting' = �' 'ik t! �+ 4 �..