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9908-151 (AR)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 Prujessionals Code, and my License is in full force and effect. License # Lic. Class Exp. Date 44-197ia' Q�3fl,pt f 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 Uccle). () 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. It MID Z29- (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 eodon 3700 of the Labor Code, I sh I foC�hwith comply with thps visi ns� Date,: _ G4 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 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 this City to enter upon. the above-mentioned property for inspectiolYgu p ses. $Ignature (Owner/Agent)��.� �^l- ^""Datef %w^ BUILDING PERMIT PERMIT#• DATE` VALUATION %17/ d dR LOT V46 TRACT � sI!f 1 JOB Sitt ADDRESS . ! 474540 NIAE1`IONTESSA APN is 4 , .2 i€► OWNER CONTRACTOR/DESIGNER/ENGINEER gC'h7 1�iiTt{.•h'S1A ,LAL.YFY 1,1 X1'1 .14 \J,1Y 1•Af � 1'h�l7F 'S3 Y7�JFAA.at7•ya'1fiTKVtP7. lt`�TtFllr 41L1 dfk sIJ I.iJ:r i,1A.lty Ly .JF X1:1 i.14 47-540 VIA NICYl\d"TOSSLA. 72919� 9KYV4t`A&D WAY LA CatJl1' TAS (A 92;1.5:3 PALM ill SEM' CA 9222.50 i'vo)862-gon C IRIA 4277 USE OF PERMIT i�.ttiS{��iv e:1F�..rtlJl�a".'1`13_af� :31$ .SY. GUTSY HOUSE ADD)"TION ?415 W Me vr�to°�•a'�a M°v°x,.sa r+��dcrr e��° �w+.daj°v e'.��`.'� s*''�il: ."n�.a:`i�.'��"�a' PLAN 0•1Et'::K FEE 122.85 Z%0V'X.141CAi. VEL. f;J.t. =U }()�<`� )�- li !49,00 3aZ'a,;t rtiCAL. f FE, �40.01 Yl,lfN16fNIIOFEEL 1'01 {b O-4,0,. KYJ 3�+.ibis PsR t W V WY117TON 147F - R i^ 11r) il 161 Ktf)_,7 41-_00 e B 101 000j:423.0*0 w � t e A Q_!!,Jf Pf,AA.Id14EC!K Ivp IXIS'11; PRE-111vit) FRIES 114) In r ;> 01 i999 •�-��Q��11:11E.R.Mcr YEIF2:4 DUE NOW I.S. RECEIPT DATE BY DATE FINALED INSPECTOR INSPECTION RECORD r, OPERATION I I DATE I INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings _ Slab Grade �— �d Ducts Return Air Steel Combustion Air Roof Deck 49 ( – Exhaust Fans O.K. to Wrap F.A.U. Framing Compressor Insulation p ( 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 -o 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 I I 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 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 Final Utility Notice (Perm) a. F .......... ...... ........ ......................... ......... .......... ................ in C i la u tors X.- ......... .... ..... .. . . . .. .::: ......... ::X.:.X . .......... .. . ........ . ............ ...... ....... .... . .. .. t Bu [ding. Safety. Pivision -X ...... .... .. P.O. Box 1504 X , I , X Permit 78-495 Calle Tampico' .... X . f La Quinta, CA 922,53 4 :.::::-x.x.x.x.x . ........ .. . ........... .. ............... ............ ............ .... . ......... ... ....... . ........ ........................ Building"PerMitAp*p lic ng,Sheev:. ation and T acki .. . . ........... ............ .......... .. ........... . .......... ... ......... . ........... .......... ............ . .. . .. X ..... . .......... . ......... .............. ......... ......... X, ......... :X ........ ........... W Project Address:, 7 -4 ....... . . .7 "i ,Owier's Name: X.:.X.:.X.: X _4-f; A p N .Pl ji 'Jiii A x x X. X Address: .......... ....... ... . . ..... ..... LegaI'Descriptior�. Z�' CityISTip- _q 2— Oxx, ... ......... Contractor: e Telephone: 3 Cc 2 ......................... x.: ,V. - Address: 4 0. gox -,7_4� .. Proj�cvpescripti6n: .. ....... * ....... ............ ........ ....... . ........................ .. .. ..... ....................... City,§T', Zio:' P t .i,e -2c- _c�., ............. ...... ........ /40 -e— - -X Teleplippe:O8. ............. ............ :X- .. ... .......... .................... .................... ................... .......... .. State Lic. # C? City Lia #: ............. .................. . . .... ............ X ..... i Arch., Eng:; Designer: ... .... ....... ........... ......... "ID. a "A b W Address. P.O. f Ci P* Ci.- A-V . Te I ephone:- -74 ................. ... . ....... . ...... ..... ........... .............. ......... ...... . ............ ................. .............. ................. ............ .......... .... . . . ... .............. C onstruction cy: Type:' Occu'pan' Lic. .................. ....... ......... ...... ....... .................. .-'Project-typ,�-(pircle-one):,, New _Add'n* -Alter'_Re Demo.. Na ;ii of . Contact Person: Sq, Ft.: 3 y f # Stofi.,es: # Units:,, Te e lepl�oft 9 of Contact PersonValueEstimated Value of Project:' d) ................... ... ................ X . . ...... . . ........ ...... a. X X..; "X.... ......... .......... ...... .. ...... ...... .......... ...... ................ X.- .............. ....... .. X ............ ...... ....... .... . .. .. t ................. -X ...... ................ .................... d: Wh ........................ X , I , X ...... ........ X . . ...... :.::::-x.x.x.x.x ............... .................... X: x X ... .. . . ........... ............ .......... .. ........... . .......... ... ......... . ........... .......... ............ . .. . .. X ..... . .......... . ......... .............. ......... ......... X, ......... :X ........ ........... W X.: ....... . . .. . . ......... ............ ............. .......... . ............. X.:.X.:.X.: X ..........t. .Pl ji 'Jiii A x x X. X .......... ....... ... . . ..... ..... x X . ........ ............ . ......... X. Oxx, ... ......... . . .......... ..... ....................... X" ...... ....... ........... ................... ....................... ......... :X- .......... . ........ ..... X X. .. . .. ....... * ....... ............ ........ ....... . ........................ .. .. ..... ....................... ..... ..... X W11 ...... v .... :fl r xxol�� ..... . ................. -X ....... . ....................... ........ ...... ...... .......... .. ................ X% .......... ............. .................. . . .... ............ X ..... i ........... ............ .... X.. .......... ... .... ....... ........... ......... "ID. a "A b W Desert Sands Unified School District 47-950.. Dune Palms Road Notice: 'La Quinta, CA 92253 Document Cannot Be Duplicated 760-771-8515 CERTIFICATE OF COMPLIANCE Date 8/23/99: APN # 643-120-008 No. 19232 Jurisdiction La Quinta Owner NameBob,Byington Permit # No. 47=540 Street Via Montessa Log # City La Quinta zip 92253 Study Area Tract # Lot # 236 Square Footage 315 ,Type of Development New Residential Addition 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 the amount of " 1.93 X 315- or $ 607.95 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' CC/1st. Bank/ Mike Bergin Telephone 862-9058-' f - Name on the check By Dr. Doris Wilson Superintendent' Fee collected /exempted by Sylvia Carrasco Payment Received $607.95. Check No. 51562 Signature F TICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90-0ay approval period in which you may protest the fees or other payment identified ove 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 llect them on the District('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