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0102-027 (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 'Professionals Code, and my License is in full force and effect. License # Lic. Class r Exp. Date r 3117A 'Xwl.MIC fl Date - f''"°�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. (L#1 I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the wnrk.for which thio permit is issued. My workers' compensation insurance carrier & policy no. are: Carrier Policy No. lApof (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 with those provlsions� Date%/? t Applicant :.Warning.. Failure to secure Workers' Compensatiof Coverage is unlawful and shall subject an employes to criminal penalties and civil ines`up to $100,000, in "additionto 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. PI 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, & shalllindemnify & hold harmless the City of La Quinta, its officers 4'ageAts 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 ACity, and State laws relating to the building construction, and hereby authorise representatives of this City to enter upon the above-mentioned property/for,inspection purposes. Signature (Owner/Agent) J Aw ll/,!'�'� 0 Date— ,P a&' BUILDING PERMIT PERMIT# DATE"" w VALUATION LOT l�i [-�A'E TRACT JOB SITE ADDRESS APN _0 n. �.A DY� 7-98511A ,..w.s XU OWNER �7 CONTRACTOR / DESIGNER / EN INFER ��kk�y AAqqpp� DON GRAY 7795'5 1c+4-00 LA QUkT,1-+°iDR 82-365 FUGHWAY 313 1A QUIDUA C:A. 9-2253 71iD10 CA 5122:01 X/60)831.6734 G°1JA41 USE OF P((yyE''yyRMIII�T 1} yy �si,,y'� py+� r('�p� l4RrL'1.7.S.A.G3li°J.�),I L w' aS,i�0¢3'4:1C 5 .I.? RW?d ADDITION CUSTOM CONSTRUCTION a? NOWA°13M f OWT OJP colvf2rMUMC9N �7�YRWi FEE suladtL Zy lxJ,, N CF's.%` I '1ME 1011000,43p-318 $225,70 C '#I STKL`,t.ki$i'. N IFES 1-01,-000-4ie; 0000 50 MRCTU>;;4!331Crvm, FEE -3 1:01-000-421-000 $40.su 101-010-420.000 �S,slr PL 0 k1ri<' 101.OW- 1.19.1000 $24.00 IESID STRONG MOT16N na, '101 -OW -241-000 I ITD 23VB-7VIVA3..(C 0 X'-4 UC -1 10 Y� NDP 11 C°W_X a -02 TMAL 1XVia' 1-Ims DrJk"FTOW RECEIPT D/A'T,r/) �f / 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 _ _ _ Roof Deck 3 _� a „/ O.K. to Wrap Combustion Air Exhaust Fans F.A.U. Framing Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Will Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath Final �mt 77�1,4 BLOCKWAL• I / APROVALS Final 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: l r� li/ Notice: Document Cannot Be Duplicated Desert Sands Unified School District 47-950 Dune Palms Road La Quinta, CA 92253 760-771-8515 CERTIFICATE OF COMPLIANCE Date 2/2/01 APN # 658-270-047 No. 21617 Jurisdiction La Quinta Owner NameTimothy Flynn Permit # 0102-027 No. 77-985 Street Lago La Quinta Drive Log # City La Quinta Zip 92253 Study Area Tract # Lot # Square Footage 375 Type of Development Residential Addition No. of Units 1 Comments Addition is an atrium enclosure. 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: Residential Addition 500 Sq Feet or Less EXEMPT This certifies that school facility fees imposed pursuant to Government Code $3080 in the amount of 0.00 X 375 or $ 0.00 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 2•' r Fees Paid By N/A - Don Gray Telephone Name on the check ; w a j �• e By Dr. Doris Wilson - Superintendent Fee collected /exempted by Annette Barlow Signature Exempt Check No. $0.00 NOTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1998) 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 for this project is sssued or on which they are paid to the District(s) or to another public entity authorized to collect 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 5 NEW O m m o -i 0 O N -N CD 3 w cn ¢ m T_ H O H z z J LL - CD L -O H rT / J 0 H z 0 H z / U allillomi NEW ROOF PLAN SCALE 1/8"=1'-0" NEW F ;:6mmjmm NEW GLS. BLOCK NEW PLASTERED PARAPET WALL WINQOW COLOR & TEXTURE TO MP�TCH EXISTING e FIXED TRANSOM PANEL I I -- -- ' AN IIS WEST ELEVATION SCALE 3/16"=1'-0" �C i rU 11Y U DATE: OCT. 2000 I I I II i I I I DRAWN BY : A. REYNA � 1 ILo20 $GALE: A� NOTED z D � J G 0 V ,c N � a � C N z N n� 0)Q W �+ '0 N C a > 0 co (E) COVERED PATIO J (D N U 4 Ij V J \ 4"O M 0 N 0,0E 6 '�'-"4aM N °° El 0 ULq II I ' Q 0 I _ I I -- -- ' AN IIS WEST ELEVATION SCALE 3/16"=1'-0" �C i rU 11Y U DATE: OCT. 2000 DRAWN BY : A. REYNA $GALE: A� NOTED I � $HET: 1 OF: a a DATE: OCT. 2000 DRAWN BY : A. REYNA $GALE: A� NOTED I � $HET: 1 OF: