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9605-095 (SFD)'A. LICENSED CONTRACTOR DECLARATION I hefpby affirm under penalty of perjur '. y :. :that lam lic'ensed'undeir provisions of Cffdpter 9 (commencing with S'eciion.,7000')' of Division -3 of the Business and Prof6spionAls Code, and my Lic§6_ie is,in full force and effect Uceirise # i Lic. Class Exp. bate 4 Date Signature of C6ntractor 9 4 OWNER -BUILDER DECLARATION, I hereby affirm under penalty of.perjury that I am exempt .from.the C6ntractors Licensel.Law for the following reason: 1, as owner of the property, or mV employees. with'wages as their sole compensation, will do the work, and . nd the structure is not intended, or offered for Sale ($iec, 704, Bvsiness &-Professionals Code). ( ) l! -.as owner of the-Oroperty, am. -exclusively contracting with.-lice'riise'd contractors to ccinstru6t'4ke project (Sec. 7044, Business & •Pr6.iessionals Code). Ci O wt I am exempt under Section B&P.0for 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,r C , " : is provided fo :,by Section 3700 of the Labor ode, for the performance of the work for which this permit is issued. have and will maintain workers' compensation in6urance,.,as required by Section 3700 of the Labor Code, for the performance of the Work for- which this peirnit is issued. my workers' compensation insurance carrier & policy no; are: Carrier Policy No. (This section need not be complet6d if the permit valuation is for $100.00 or less). fce'iriify'iliat in the performance of the work for which this permit is issued, shall not enipioy.any person in any manner so as to become subject to the Worikers'. I comp . ensa , flon laws of'Californi' d'agree that t anif I should become subject to"the workers. compensation provisions of Section 3700 of the Labor Code, 1, shall forthwith comply with..those prbvision s Date: Applicant , `2 ' Warning: Failure to secure Workers" Compensation coverage is: unlawful and shall s6bWCt an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of comoe6sation,.d6mages as provided for.in Section,3706 of the Labor Code, interest,and attorney's fees. IMPORTANT Applidation'is hereby made to the Director of Buildin . g 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 mad6& each pers6n-ai whos.e,re,quest and for whose benefit work is performed underor pursuant to any permit issued as a result ofithis applicaton agrees to, .&,§h.all, indemnify & hold harmless the City of La, Quinta, its officers, agents and 'employees. 2. Any, permit issued as a result of this application becomes. hull and. Void• if work is not commenced' within: 180, days from date of, issuance.9f such permit, or cessation of work ork� for 180 days will subject I p . ermit to . caricellatiom. 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.felating to ..the building uildin6 construction,,, and hereby authorize representatives.of this City to enter upon the above-mentioned propertyfor,inspecticin purposds.., & ' Signature (Owner/Agent) D6'te PERMIT* -coNTROL# BUILDING PERMIT -3.6 8 5 DATE VALUATION .- -T,4,(T L6152 454' - JOB SITEPN ADDRESS. _47420Y . IA-LOWA -.:643-1"029 OWNER CONTRACTOR DESIGNER ENGINEER UNDAU 1.) E . VE 1. , X). .1%4 E�N T. iAwwj Orwt-.14)PIKENT P-0. Box J. -W. PXLM SPIUNGS CA. 9216.3 - RAIM SPRINGS CA92263 (6 10)?77-1.145 31 M CaL4 0 . 91) 1345 . ­�L V .0- 74.11M RITH. USE OF PERMIT. L P.6 Bax .1950 P ALN4 SPKI(NOS, CA •M.63 0524117 swD-mRmrr 60L�s, NoT mcLUDE, BLOCK WALL OR POOL. TRACI CY)XV1 RUCriON 2.4A A) SOP ti 2-52 00 S;F- OfYCARPORT S9 Y. 11.,3'rf JAIXAM CaST.OF CONSTRUCTION .136,091.70 Pr CON.TMUMONFIX" 'I014004113.000 $769,0O PLAN CRUX F 1,01 -00039»3I S. • 17 ,\4RCHANICAL. V09 .10t-OW421-000. $73.00 101-0f*420-0005162 73 INO FM . 1166 (10 1111-000-4 19-000 -'a maeloiq IL --t, 'RE tf o 1,61-00'241-000 `QTRAJXFNG, FE 1014WO-4.23-M), fNrRMJ.RVP=�_F, ITTE, 22.541(4 443-342 ART IN PUBLIC PLAa- S RESIC701,00045 .400 SUB4MAL MNURUCIION A.N.D.PLAN CMItC.q. 1031 M TWA 'I, 'MIT FK*FS-D'Qh'N0*%V' N 'RE .)EIPT I DATE. 6/,' raj L41) /'I,BY DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Sgt Backs Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air a Roof Deck / Exhaust Fans 0 F.A.U. Framing Compressor sulation Vents Firep Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Exterior Lath Drywall - Int. Lath V Final Final 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 APPROVA S/7 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 12 -1 74k 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: / TA"tyl o-��s P.O. BOX 1504 APPLICATION ONLY Buildingj�C tt�- 7&105 CALLE ESTADO Address LA QUIN IA, CALIFORNIA 92253 Owner �=lJ BUILDING: TYPE CONST. A.P. Number Legal Description Project Description OCC. GRP. —� /� 9 Mailing Address ©x 1 2-S-7 city Zip qj�t, -Q Tel. 177 3.,� Contractor � `�o Address U 606/�dZ-0 x6 G r City 42 Zip Tel. State Lic. W City & Classif.' f p G l{ Lic. # Sq. Ft. No. No. Dw. r Size Stories . Units Arch., Engr., �� j � � 7� Designer '�✓� G��'¢"P �"'-�/j'V New ❑ Add ❑ Alter ❑ Repair. ❑ Demolition ❑ AddressA IJJA pQ rr� l Tel. , city/ pp ct.fi4cq.-�- Zip State Lic.' # f, , 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 K DATE OWNER -BUILDER DECLARATION t 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,,fhe' basis11 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, 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.) Estimated Valuation --^ PERMIT AMOUNT Plan Chk. Dep. sr' .,� `i Q Plan Chk. Bal. Const. Mech, Electrical Plumbing [II'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 owneriof 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. 8 P.C. for this reason S.M•1- Grading Driveway Enc. Date Owner Infrastructure • r WORKERS' COMPENSATION DECLARATION r j 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.) r ae T - Policy No. Company Copy is filed with the city. O Certified copy is hereby furnished. 1 [3_T - t r. , ' — OTAL vi CJ REMARKS CERTIFICATE OF EXEMPTION FROM I ' WORKERS' COMPENSATION INSURANCE 4, - (This section need not be completed if the permit is for one hundred dollars ($100) valuation t' or less.) ' I certify that in the performance of thg work for which this permit is issued, I shall not f employ any person in any manner so as to become subject torthe Worker's' Compensation Laws of California. Date Owner 7 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 p"erfnit shall be deemed revoked. ZONE: BY: Minimum Setback Distances: Front Setback from Center Line 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 io 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 Mailing Address City, State, Zip BUILDING DIVISION Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side Setback from Property Line fi FINAL DATE IVSPECTOR Issued t Validate Validati CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEEL 1ST FL. - SO. FT. @ $ 2ND FL, SO. FT, POR. SO. FT. @ GAR. SO. FT. @ CAR P. I 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 WASHER(AUTO)(DISH) APPLIANCE DRYER GAS (ROUGH) GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED OTHER APPJEGUIP. LAUNDRY TRAY AIR HANDLING UNIT CFM TEMP. POLE KITCHEN SINK ABSORPTION SYSTEM. B.T.U. TEMP USE PERMIT SVC WATER CLOSET COMPRESSOR HP POLE, TEM/PERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SO. FT. @ c BATH TUB SO. FT. @ c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID @ 11A 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 & 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 APPJEGUIP. 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 Desert Sands.Unified School District Notice: 822879 Highway 111 • Indio, CA 92201 " Document Cannot Be Duplicated 619-775-3500 CERTIFICATE OF COMPLIANCE Date 10/25/96 APN # 543-160-029 No. 14947 Jurisdiction La Quinta. Owner Name Landau,-Development Permit # No. 47120 Street' Via Lorca Log # City La Quinta zip 92253. Study Area 123 Tract # 26152 Lot # 155 Square Footage 33 Type of Development New Residential Addition No. of Units 1 Comments bathroom addition 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: ' Add. of Sq. Ft. to New `Construction EXEMPTION NOT APPLICABLE This certifies that school facility fees imposed pursuant to Government Code 53,080 in the amount of 1.84 X 33 or $ 60.72 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 Landau Development `� p 3281=2277 Tele hone Name on the check By Dr. Carol McGrew _} Administrator in Charge yr Fee'couected /exempted by Pauline Pearson Payment Received r .$E0.72 Check No. cash Signature 1 Collector: Attach a copy of county or city plan check application form to district copy for all wavers. Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy Accounting