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0206-211 (AR)t 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 Exp. Date ,©ate • ` Signature of Contractor". 1�4- e:— 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 reasori 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. (In) 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 MrS Fi.yj D Policy No. 14219P1-99 (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 provisions. Date: r 4 .- Applicants' 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, indemnity & 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.)._ �� +' Date BUILDING PERMIT PERMIT# DATE ' r VALUATION *4'134*� LOT � �, TRACT 441,8 JOB SITE ADDRESS �l i -u7 :� n�fi t�:l"+ti9, APN 65R-2 7a°044 OWNER ICONTRACTOR / DESIGNER / M419MORTMOR D.L. FREEMAK, NIC, 77,985 LAGO 1AWW'I:AD S 72Y880 i%RED VJ'c^RI3' G DR.t�JE C-3 3. "L&Q'UDrfA :"A 92233 PALM?y.3 SEM' CA 922,60 (760)773,9024 CBS 5390 USE OF PERMIT tide S.F. 0, PFI IV, A03D11'ION AND INIT9910R ZiTMODfly. CUM TOM 3%VC10 C014VER210N f,00 SF EMMIATEM COST 071 CONISMWC370N CON91.1'lit.3CTION FER, 101 -000418-000 S72 PIA"M chkICK at 101-000-439-318 r� CTRI.C.AI: FE. IaIJUMBNO RE 1 U I MD -419.000 - Si STRM40 MOTICYN ME «RMP 1.01-000-241-000 SUB -TOTAL RECEIPT DATE,. BY `•+ .. DATE FINALED INSPECT n, 3.•l3 1 INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings 7=57: C222 Ducts Slab Grade + Return Air Steel Combustion Air Roof Deck 1 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 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 APPROVALS Gas Test Electric Final Waste Lines Heater Final Water Piping j� _ r Plumbing Final Plumbing Top Out '7 Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test Z Appliances Final Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring -Z Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G. F.I. Smoke Detectors Temp. Use of Power Final _ Utility Notice (Perm) COMMENTS: , At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patiostwalkways, residential additions under 500 square feet, detached accessory structures (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile homes. It has been determined that 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 Education Code Section 17620 and Government Code 65995 Et Seq. in the amount of $0.00 X 64 S.F. or $0.00 have been paid for 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 Exempt - Joe Bierra . Check No. - Name on the check Telephone Funding Exempt By Dr. Doris Wilson Superintendent Fee collected /exempted by Crystal Scott s 50.00 Payment Recd Over/Under Signature NOTICE: Pursuant to Government Code Section 66020(d)(1), 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 issued, or from the date on which those amounts are paid to the District(s) or to another public entity authorized to collect them on. , NOTICE: This Document NOT VALID if Duplicated Embossed Original - Building Department/Applicant Copy - Applicant/Receipt Copy - Accounting 07/30/2002_ 17:05 7607739065 _ DL FREEMAN INC a«�Q PAGE 02 NO 60 WAI JUL--V-'-w "", yp�q�Iltted 1MM C��O" O...w fawty x"640 3A OUiesea,Owlt,ioa CIL f2a s p11'B ►MOIL (b.: 6 aR -A70 -Q4+-1�.� � � ply o0frrsYrd4� ?rf1.6 0 /IDa ALwowOh to ke WOW 41111! 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Atd1I"Wwwww" 07=2002 02.11 PM 10f2 YOUNG ENGINEERING SERVICES Engineering Architecture•Surveying• Building & Safety Services Letter of Transmittal To: City of La Quinta Date: 07/30/02 Project: 77-985 Lago Laquinta Attn: Ed Randall Tel No.: (760) 777-7012 PC #: 0206-211(2 nd Check) Tract No.: We are forwarding: x By Messenger By E -Mail Your Pickup No. of Copies Description: 1 Set of redline Set of corrected plans Set of struct. calcs. Comments: , Plans are acceptable. Thanks This Material Sent for: Your Files Per Your Request Your Review x Approval Checking At the request of: Other By: Eric A. Frenzel Phone # 342-9214 47-159 Youngs Lane Indio, CA 92201 (760) 342-9214 Bronz Young