9803-127 (AR)LICENSED CONTRACTOR DECLARATION
I; iereby affirm under penalty of perjury that I am licensed under provisions of
�dhapter 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
D/B
Date 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:
;(.L) 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
S/) I am exempt under Section , B&P.C. for this reason
(Date Signature of Owner i
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.
( ) 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 . Policy No.
(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,
(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: ^ < Applicant e f
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, 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
thAbove-mentioned property for inspection purposes.
Signature (Owner/Agent) _ �� .1 ! . •y} Date
BUILDINGPERMIT PERMIT# CONTROL'# '
DATE VALUATION LOT TRACT
G96G
'7Z1 Cfr -
JOB SITE p/� �. APN
ADDRESU r Tf3^��70 VIA &EV ii( LA
OWNER CONTRACTOR/DESIGNER/ENGINEER
782.70 Vita. SI~V LLA
LA Qf..X1b7rA CA 92251
C1 .110.
USE OF PERMIT
A DDIN
ADDIT10 OR . 433.00 SF
23 1998
LE SS PRE
-S'.M%) FEES
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RECEIPT DATE BY / DATE FINALED . INSPECTOR
i
C1TY
FLAQUINTI A,
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1011 -000 -418 -ON)
554.00
11,21+alANICAL VM
500
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F
LE SS PRE
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RECEIPT DATE BY / DATE FINALED . INSPECTOR
INSPECTION RECORD
' OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings i
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 2
Drywall - Int. Lath 6N0l"f j**4
Final
Final —/ —
BLOCKWALL APPROVALS
Steel
POOLS - SPAS
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 �1- 30 -es
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Law Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
r
Final
Utility Notice (Perm)
COMMENTS:
4IESZ> 6 -FI
P/Jg rN 3gT/I �cbai+'�
Desert Sands Unified School'District
Notice: 82-879 Highway 111
y Indio, CA'92201 . ' ...
Document Cannot Be Duplicated 619-775-3500
• - CERTIFICATE OF, COMPLIANCE
'Date 3/23,/98 APN # , 604-201-009 ,
16774. Jurisdiction La Quints
'Owner NameGovind H. Lalani •Permit #
' No., 78-270 Street Via Sevilla Log #
City La Qunita Zip" 99253. StudyArea - -
Tract # Lot # Square Footage 43
Type of Development Residential Addition No. of Units 1'
Ate the., present time, the Desert Sands Unified School District. does, not collect fees, on garages/carports, 'covered
- Tatios/walkways, residentialadditions 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: t
Residential Addition 500 Sq Feet or Less
- - EXEMPT
This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of .
3 0.00,. X • 43 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 npw,be issued '
Fees PaidByN/A Teleprione 60 444' -
'- Name on the check
.. - ' r '� ' �.1 ,t• �.�."r � ate, t J -
By Dr. Doris Wilson ' -
M,
Superintendent.
Fee collected' /exempted by Juanita Green Exempt ' so do -
• Check No. N/A
Signature
NOTICE: Pursuant of Assem� y Bill 3061 (CHAP 549, STATS' 1996) this will serve to notify you that the 90 -day approval period in which you may protest the fees or other pay mant identified
- above "ill begin to run from h e 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 -
colled them on the Distrid('s)(s'),behalf, whichever is earlier.
Collector:' Attach, a_ copy'of county,or city plan clieck application form to district copy for all waivers.
Embossed Original -.; Building Dept./Applicant, Copy ' Applicant/Receipt Copy - Accounting