0403-209 (SFD){ LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions
Chapter 9 (commencing With Section 7000) of Division 3 of the Business a
Profes&ionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
✓✓Dated Signature of Contractor
OWNER -BUILDER DECLARATION '
I hereby affirm under penalty of perjury that I am exempt from the Contracto
License Law for the following reason:
( ) I, as owner of the property, or my employees with wages as•their si
compensation, will do the work, and the structure is not intended or offered 1
sale (Sec. 7044, Business & Professionals Code).
( ) I, as owner of .the property, am exclusively contracting with licens
contractors to construct the project (Sec. 7044, Business & Profession
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 declaratior
() I have and will maintain a certificate of consent to self -insure for worke
compensation,• as provided for by Section 3700 of the Labor Code, for •tl
performance of the work for which this permit is issued.
( ) I have and will maintain workers' compensation insurance, as required
Section 3700 of the Labor Code, for the performance of the work for which tt
permit is issued. My workers' compensation insurance carrier & policy no. ai
CarrierPolicy No.
LIBERTY MUTUAL X WV62DD04723012'
(This. section need not be completed if. the permit valuation is for $100.00 or les
( )
'I certify that in the performance of the work for which this permit is issue
I shall not employ any person in any manner so as to become subject to tl
workers' compensation laws of California, and agree that if I should becon
subject`to the workers' compensation provisions of Section 3700 of the Lab
Code, I shall forthwith comply with those provisiQn�s ,
'bate: L"f7-r'stfApplicant /�l'I�% j` �-�"4�
Warning:'Failure to secure Workers' Compensation coverage is unlawful ai
shall subject an employer to criminal penalties and civil fines up to $100,000,
addition to the cost of compensation, damages as provided for in Section -371
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safe
for a permit subject to the conditions and restrictions set forth on t
application.
1. Each person upon whose behalf this application is made & each person
whose request and for whose benefit work is performed under or pursuant
any permit issued as a result of this applicaton agrees to, & shall, indemn
& hold harmless the City of La Quinta, its officers, agents and employeE
2. Any permit issued as a result of this application becomes null and voie'
work is not commenced within 180 days from date of issuance of su,
permit, or cessation of work for 180 days will subject permit Eo cancellatic
I certify that I have read,this application and state that the above information
correct. I agree to comply with all City, and State laws relating to the buildil
construction, and hereby authorize representatives of this City to enter ;6p,
the�,/a bove-mentioned property for inspection purposes.
Signature (Owner/Agent) J�L° ' Date =rf
of BUILDING PERMIT PERMIT#
rid BATE f_.c,J,;vALUATION LOT. TRACT
!1 a7s.oI 9.--A 129
JOB SITE APN
ADDRESS
80-5, 70 VIA, TAL.AVFRA 772-2504102
OWNER CONTRACTOR / DESIGNER % EN INFER
is 71-121 '. 'WA^,1UTG A] 00 73.121 147M I PARING 0100
le 't: C A 92260 1;A'Q_iA DESERT CA 92260
or (760)V4-9699 CB14 3832
USE OF PERMIT '
�d
SC Q, LOT 129, I+ O'L114A. 4.Z. PERMIT DOL -.9 'tit',)'f fNC .L11FJ.}.° I%LOCK WF L4,,
POOL, 93>,A. OR DR1VWAVAPPlii7AXH.
i
s:
rs' CUSTOM (:fJNXPt1,W:`1014 ?x,269100 SF
ie P6,kC:Z•[fwrio SP
by CAItAGWCA;R1°ORT •9011.00 87F
lis
ID CIVT 10 IV
d, wONJeTaRUCTIU1zi1;'1 1Oi�(f00�418�00 1, ss;�n
ie PLAN CHECK }"2Z $1,02x9.7
ie PfPCI.3Ai4tC AL 1� L 101-000421-000 6124,311
or )?IJeC'TRJf AL P&E. 101-000-42.0-000 $Imu
_ PLL1M'81W0 VU 101.000.419.000 1100:00
S:nRONO Ml. INCYPD FEE a USI,O 101-000-24-1-000 $27.iD
'd a3I'dADIN04titE 901-'.000.423.000
in
)6 37L?1LI, d)P°.YisAilfir�.S:3'I w2o463a.0t1
ART IN POWC PLAC`W-' - WE' 27f) -000-4,45-C. K, 518735
,ty
its
at
to 8UB-.iC?'fAL'C'CWKWYC'd'T09 ACID PLAN (111 r_K' $5,414.6E
S./A\ ,�
;h ,a..�+L' :PKEsi1W.F1MS DUE' NOW fL,414.ff
n. MAR 3 0 2004 U
is
Ig CITY OF LA Qt3IN1TA
m HNANCE DEPT.
RECEIPT DATE BY` DATE FINALED INSPECTOR
- ,_ / y 3d OV �-
INSPECTION RECORD
OPERATION
1 DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROV LS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
_
Return Air
Steel
_
Combustion Air
Roof Deck
Exhaust Fan
_
O.K. to Wrap
Framing
mpressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wali 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 Pibg. Test
Final
Gas Piping
PLUMBING APP OVA,!Gas
Gas Test
Final -
Waste Lines
Water Piping
Heater Final
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 , , O 7
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
Coachella Valley Unified School District This Box For District use only
4 " C` CA 92274 DEVELOPER FEES PAID
P.O.- -503; 7, Thermal,
,760) 398-5909 — Fax (760) 398-1224
AREA:
AMOUNT ----
LEVEL ONE AMOUNT:
LEVEL TWO AMOUNT:.
MITIGATION AMOUNT:
COMM/IND. AMOUNT:
DATE:
RECEEPT:
CHECK N:
fNIT1ALS:
CERTIFICATE OF COMPLIANCE
(California Education Code 17620)
Project Name: Reserves, 60's " Date March 29, 2004 .
Owner's Name: Toll gortheIrs ine Phone No.
Project Address: —
/14
Project Description: • F
APN: 772-250-002 Tract #: 30357 Lot #'s: 129 _>
XXX Commercial Industrial
Type of Development: Residential
Total Square Feet of Building Area: 37;269 sq. ft.
Certification of Applicant/Owners: The person signing certifies that the above information is correct and snakes this statement
f 'under penalty of perjury and further represents that he/she is authorized to sign on behalf of the owner/developer.
^
Dated: Signature:
SCHOOL DISTRICT'S REQUIREMENTS FOR THE ABOVE PROJECT HAVE BEEN OR WILL BE SATISFIED IN
ACCORDANCE WITH ONE OF THE FOLLOWING: (CIRCLE ONE)
Education Code Gov. Code Project Agreement Existing a Not Subject to Fee
17620 65995 Approval Prior to 1/1/87 Requirement
Note:
Number of Sq.Ft.
3,269
Amount per Sq.Ft. $ 9 74
Amount Collected $7.197-S6-
Building
,397S6Building Permit Application Completed: Yes/No
By: Carey M Carlson ;
Asst. Supt., Business Serv.
Certificate issued by: El vi ra- Mattson Signature:
Office Technician
NOTICE OF 90 DAY PERIOD FOR PROTEST OF FEES AND STATEMENT OF FEES
Section 66020 of the Government Code asserted by Assembly Bill 3081, effective January 1, 1997, requires that this District provide (1) a written notice to
the project appellant, at the time of payment of school fees, mitigation payment or other exactions ("Fees"), of the 90 -day period to protest the imposition of
these Fees and (2) the amount of the fees. Therefore, in accordance with section 66020 of the Government code and other applicable law, this Notice shall
serve to advise you that the 90 -day protest period in regard to such Fees or the validity thereof, commences with the payment of the fees or performance of
any other requirements as described in section 66020 of the Government code. Additionally, the amount of the fees imposed is as herein set forth, whether
payable at this time or in whole or in part prior to issuance of a Certificate of Occupancy. As in the latter, the 90 days starts on the date hereof. This
Certificate of Compliance is valid for thirty (30) days from the date of issuance. Extension will be granted only for good cause, as determined by the School
District, and up to three (3) such extensions may be granted. At such time as this Certificate expires, if a building permit has not been issued for the project
that is the subject of this Certificate, the owner will be reimbursed all fees that were paid to obtain this Certificate of Compliance.
MV:c/mydocs/devfees/certificate of compliance 09/30/02
F ,
. ' Ia-'�,
V
P.O. Box 1504
BUILDING.& SAFETY DEPARTMENT
�4o`S78-495 CALLE TAMPICO } 760
OF rim ( ) 777=7012
LA QUINTA, CALIFORNIA 92253FAX'(760)- 777 701
-1
To: Greg Butler, Building &.Safety Manager To CDD:
From: Oscar Orci, Planning Manager
Building Permit Release
u
The Community Development Department has reviewed the Building Plans for the
following project: '
Description: 2 SFD MOUNTAIN VIEW BY TOLL BROTHERS 6&y�,— /a' q-
Address or general location: T30357.
APN and/or legal-description APN 772-250-002
Applicant Contact: KELLY (760) 275-7732
The Community Development Department finds that:
❑ ....these Building Plans do not require Community Development Department
approval...
...these Building Plans are approved by the Community Development =
Department. .
r Oscar Orci, Planning Manager _ Date
,.