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9605-050 (SFD)LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of F_ U) 9 (commencing with Section 7000) of Division 3 of the Business and fV W Professionals Code, and my License is in full force and effect. o M License # Lic. Class Exp. Date LO ZO r Date Signature of Contractor _ T 1 OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from thentractoes J ~ co License Law for the following reason: Z_ ( ) 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 L N Date Signature of Owner ON O) Z WORKER'S COMPENSATION DECLARATION p C1 I hereby affirm under penalty of perjury one of the following declarations: F2 p () 1 have and will maintain a certificate of consent to self -insure for workers' X w compensation, as provided for by Section 3700 of the Labor Code, for the O _ Q performance of the work for which this permit is issued. C0 Q C) ( ) I have and will maintain workers' compensation insurance, as required by OU Q Section 3700 of the Labor Code, for the performance of the work for which this CL:LO H permit is,,0!sug1Myjworkers' compensation insurance carr�er�&�poliey no. are: 1�t Z Carrier Policy No. obn r-0 J (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 3 subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. �- Date: % ^ 1 ,7~ � C Applicant 1��_ ,,_� (l>oy " ;F` i fid r' a�LcG'1 Warning: Failure to secure Workers' Compensation coverage is un llawful 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 pormit cuhject to tha renditions and restrictions 58t forth on his application. .4 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 applicator 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.? iy Signature (Owner/Agent)/yl I! f'"�� Date BUILDINGPERMIT PERMIT# CONTROL# 3671 DATE VALUATION LOT . TRACT 7/ 9"6 srs4,347.30 JOB SITE APN ADDRESS 47-1.50 VIA LOR.CA "3460-028 OWNER CONTRACTOR/DESIGNER/ENGINEER LANDAU AU UC>tTt,,t)i9N3ENT C'()e INC.. !Niel RUAL SUN L;ONS tW(`,'l"ii;).N V0. (SOX 1125 28251'ARQ1.1MLC:EIhiYON HDI PALM SPRINGS, r•j VALM. SIRRMOS CA 92?,6'i (t�19)328.22.77 C` -RL# 3791 USE OF PERMIT S!1`lttL� 1~'1�.h1ii,Y lfl�Fj{i.,1.tlVt,i `+t )=:NIi12Mt C{ OEPt NOT Ii�fCIArDE RIL01`iti WXM, ("I.tI>l)OL 1'KA.04 CO.N61KLIC; IOIN 1,S4.mif) 'kw t>t R(,:W13A'f1 s 120).(w W. GARAG ICARK)RT Il &-rIMtATEDi FOND' OF i.0NS.D"RD1CMOIN 154,347,30 Cf>NS•t•R fCMON F PF. 101 -000 -418 -OW l� i2.0i1 PLAN CMLI. V. FEF S"05.1 ` r EF1?fsl110trr •.Wo..i10 MEC"AN{C<'AL FEE 101-000-.421-000 X9.5 VLE.CrRICAr. FE7 101-000-420-000 57.74.1y M13ING F: � s 101-000-4,1.9-000 5167 w'S 1� ri)N(; WTION �U - iZ1;SW 101.000-241.-000 QRAW 1VO FfiXt1131.�?ti0-4 � 3-ttOt) S2©.ti0 MF11-ASTR.'ITMIRR fVT1 S.1 412.96 A i"1. PU131AC1tAC'hS =- PL-;siC 701-000-255M0 .. Will SUP -Ir AL f"OINSTRUC; -ION AND PLAN CHECK 55,52.57 LESS 1' KE -PAID FLIES -$250.00 RE[EIP'T� DAT7 y J�% BY y�yif J. 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 Exhaust Fans O.K to Wrap F.A.U. Framing 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- Al POOLS -SPAS BLOCKWAL A PROVALS 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 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) Lj V V t Building'/© Address Owne������ Mailing Address Zip Tel Contractor or V o�f/,/ Address City Zip Tel.. 3-2 `State Lia 61 City �� S / & Classif. / Lic. # Arch., Engr.,rw `A Designer Address Tel. 3a 0- /A 1 / Crit -y Zip State , , / i f Lic. # LIC NSED 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 or not more than five hundred dollars ($500). 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 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 1 am exempt under Sec. S. & P.C. for this reason Date Owner v 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 ❑.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. 4,4 Q�OAI'� P.O. BOX 1504 i&105 CALLS ESTADo APPL CATION ONLY LA QUINTA, CALIFORNIA 92253 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 correcE 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 bovementioned property for inspection purposes. Signature of applicant Date Mailing Address City, State, Zip BUILDING DIVISION BUILDING: TYPE CONST. OCC. GRP. /n A.P. Number �`� / / 0- Legal Description , -/a 71-P A 11% 69 i 5l.� Project Description ZONE: BY: Sq. Ft. Size No. No. Dw. Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Rear Setback frorr Rear Prop. Line Side Street Setbadk from Center Line Side Setback from, Property Line FINAL DATE INSPECTOR Issued by: Estimated Valuation Validated by: PERMIT AMOUNT Plan Chk. Dep. ZCjQI Validation: Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure n TOTAL r\I (A \!--J REMARKS v I /I 7� (l, l / / , v K J { ZONE: BY: Minimum Setback Distances: Front Setback fron Center Line Rear Setback frorr Rear Prop. Line Side Street Setbadk from Center Line Side Setback from, Property Line FINAL DATE INSPECTOR Issued by: Date Permit Validated by: Validation: CONSTRUCTION ESTIMATE 1ST FL. SO. FT. @ $ 2ND FL. SQ. FT. @ POR. SO. FT. C GAR. SQ, FT, (d. CAR P. I SQ. FT. WALL SO. FT. ® SO. FT. @ ESTIMATED CONSTRUCTION VALUATION $ NO. ELECTRICAL FEES UNITS MOSILEHOME SVC. POWER OUTLET NO. PLUMBING FEES YARD SPKLR SYSTEM BAR SINK ROOF DRAINS DRAINAGE PIPING DRINKING FOUNTAIN URINAL WATER PIPING NOTE: Not to be used as property tax valuation COLL. AREA FLOOR DRAIN MECHANICAL FEES BONDING WATER SOFTENER VENT SYSTEM FAN EVAP.000L HOOD SIGN WASH ER(AUTO)(DISH) APPLIANCE DRYER DUCT WORK GARBAGE DISPOSAL FURNACE UNIT . WALL FLOOR SUSPENDED GAS (ROUGH) LAUNDRYTRAY AIR HANDLING UNIT CFM OTHER APP./EQUIP. 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 GRADING cu. yd. $ plus x$ SQ. FT. @c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID @ 1+/. c SEWAGE DISPOSAL FINAL INSP. SQ.FT.GAR @ 3/.c HOUSE SEWER GAS PIPING PERMIT FEE VENTILATION 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 APP./EQUIP. 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 Desert Sands Unified School District Notice: 82-879 Highway 111 Indio, CA 92201 Document Cannot Be Duplicated 619-775-3500 CERTIFICATE OF COMPLIANCE Date 5/2/96 APN # 543-160-028 No. 14426 Jurisdiction La Quinta Owner Name Landau Development Per, -nit # No. 47150` Street Via Lorca '' L,,g # La Quinta zip 9225.3 Study Area 123 . city , Tract# 26152, Lot # 154 Square Footage ° 2543 Type of Development Single Family Residence No. of Units 1 Comments At 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 amessory 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 1.72 x 2,543 or $ 4,373.96 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 Imperial Sun Construction, Inc.Telepnone :;777-134'5 Name on the check " By Dolores A. Ballesteros Superintendent Fee collected /exempted by Pauline Pearson `Payment Received $4,3.73.96 Check No. 15318 Signature PPA A j A &LIA— 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