0003-010 (BLCK)^� .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
�6�.4
) Signature of Contrac/toyr I
OWNER-BUILDER•DECL RATION
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). t I ..' .
() 1' am'exempt under Section'. B&P.C. for this reason
Date f Signature of Owner
r
WORKER'S COMPENSATION DECLARATION
1, 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 3700aof the Labor'Code, for the
performance of the work'for which this permit is issued.
-,(¢PI.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 STATE MID Policy No. 046.00-00065r`i9
(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 hall not employ any person in any manner so as to become subject to the
orkers' 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 all forthwith comply with those provisions. -e?
Date: —' � Applicant,,—'—/ e. - /��
Warning: Failure to secure Wor ers' 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 of this City to enter upon
the above-mentioned property for•inspectio pur o es.
i nature (Owner/Agent) �� `orf�eate
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 0003-010 TRACT
$7,902.10
JOB SITE
ADDRESS 035 VIA tRAKCLArxA
APN
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OWNER
CONTRACTOR DESIGNER //ENGINEER
��rr `•
CiA SYTC BVtILDLRSWC '
7 9.03 5 VI E1,I C'-IA&k
45.270 C•L.UD DRINK'
I.A QUINTA • CA 92253
71,M. IM I,4rE.= CA 92210
(760)722-1011 CRt# 4999
USE OF PERMIT `
emin AL Am -DI o
CLOS61' .t DDIT014 97 SF(B.EDI`C7OM) & 26 SF (PA. 10)
CUSTOM C014STRUCTION 97.00 SF
PORCH/PATIO 26.00 Sk'
i
v
EMHK): &D COST ore CON •s1t?CP 77ON
7X2.10
FERKW FEE Sb-MWIARY
PIAN CHECK FEE 101.000.439.318 $64.33
ELECTRICAL FEE 101-000.420-000 $18.+10
STRONG MOT1014 FEE - AE:SID 101.000-741-000 $179
OR"INO FFIE 101-000-423-000 $20.00
SUB -TOTAL CON e"t' LUCK 30M AND PLAN C RCX
.$103.51
'i OITA-1 PMROMI�'�+VE-S DUE ROW
S � C�t54 .
RECEIPT
DATEY
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DATE F ALED
INSPECTOR
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INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
, G,J
Underground Ducts
Forms & Footings
cel
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
�f
Exhaust Fans
O.K. to Wrap
—Gt/
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
-7 CAU
Drywall - Int. Lath
Final
Final 3 E70 -
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
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:
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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 r
Date 4/4/00 APN # 604400-004
_ No. 20250 Jurisdiction La Quinta
OwnerNameD.X. Friend Permit#
No. 79-035 Street Via San Clara L -)g
City La Quinta Zip 92253 Study Area' ,
Tract # Lot # Square Footage 97.
Type of Development Single Family Residence: No. of Units 1
Comments Closet Addition • bedroom and patio
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 53050 in the amount of
0.00 X 97 or $ 0.00 the property listed above and that building r
permits and/or,Certificates of Occupancy for this square footage in this proposed project may now >be issued • '
" •
Fees Paid By exempt Telephone 760 333-1935
Name on the check
By Dr. Doris Wilson
Superintendent
• Fee collected /exempted by Olivia Aguirre ' Exempt - $0.00
Check No. N/A
Signature
NOTICE: Pursuant of Assembly BIII 3081 (CHAP 549, STATS. 1998) this will serve to notify you that the 90 -day approval period in which you may pro*st 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 Distrlct('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 DeptJApplicant Copy - Applicant/Receipt Copy - Accounting F
Mar-i8-ofd 16:28 Andrzej Weber Architect 760 340 .9502 P-021
JA14.
al�l!Illl'ilf'
February 1.7, 2000
t
Mr. O. A. Friend
79-035 Via San Clara
La Quinta, CA 92253.
Dear Mr. Friend,:
The Rancho La Quinta Architectural Committee has reviewed your submittal o= remodel plans
for your home. The plans included the roof and elevations as requested.
The committee has given-an aesthetic approval for this remodel. The colors and finishes_must
match the existing home. We cannot give structural or engineering approval, tris is not in the
scope of this committee's review process.
Attached is a copy of the Association's .Architectural Improvement Agreement. This form will -
need to be signed by you and notorized before construction can begin. We are :n receipt of the
sign' ed and Drainage form,, the construction deposit and review fees. The Construction
Regulations have been signed by you but will also need to-be signed by your contractor before
construction can begin.
Thank you for your patience in our review of the plans. I hope you have a great trip to Australia
} and I took forward to `working with you further on this remodel.
Sincerely,
TTOR
Mindy Gutierrez, Property Manager,
The Master. Association for Rancho La Quinta
Professional Community Management/ Desert Resort Management
Post Office Boz 4772 * Palm Desert,'CA 92261-4772
73-550 Alessandro, Suite 5 • Palm Desert, California • (760) 346-1161 FAX (760) 346-9918 .
:Mar -20-00 10:59 Andrzej Weber Architect 760 340 9502
10
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GUEST SUI E 3
P.03
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