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0005-297 (SFD)U) C W o�cV. r; CY �. rW r`tr� C:) Z r` CD�' O H W w I hereby affirm under penalty of perjury that I .am exempt from the Contractor's ~ d License Law for the following reason: Z ( ) 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). }' O I am exempt under Section B&P.C. for this reason Date Signature of Owner , • j WORKER'S COMPENSATION DECLARATION . A. , I hereby affirm under penalty of perjury one of. the following declarations: ` O 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 tion 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: Cartier ..PFit�M AiT Ci3A F INS Policy No. a,PS0-�1Q99A-14119 (This section need not be completed'if the permit valuation is for $100.00 or'less). O 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 provislo s of .Section 3700 of the Labor. Code, I sfi l f �rthwith comply with those< rravi `o Date:! `' r Applicant �• - ' 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 the above-mentioned property for'ns�ctio� purposes. Signature (Owner/Agent) '� '` Date! LICENSED CONTRACTOR DECLARATION. I %ereby affirm under penalty of perjury that I am licensed under, provisions of �&6pter 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 SignatureofConractorDatt&IF, OWNER-BUILDER DECLARATION - ;,' BUILDING- PERMIT _PERMITH • '• DATE VALUATION LOT 4� 1 TRACT �- JOB SITE A_ PN f ADDRESS 417-M VIA CH 643-140-027 j OWNER CONTRACTOR/DESIGNER/EN (NEER CMADAY �& CONWANY CAMADAY & COMPANY 17410 1 [ #'• 0a 06 174661 17123 M 0106 TUMN C.R 92780. Tum ; CA. 92780 (714>508-4440 C'`BL4' 44$5 USE OF PERMIT it�l�l1 1'1J hNMYDWWi -Md' - 9?0i. 6T'93 PLAN 3013 P&RA,I'.^ D09S NOT IN-CLUDE I33.UCK W -A 1.� 09 POOL, 75% PLAN f~lik * 0E9 REDUCTION I"r'OfZ MULTIPLF ISRANCR OF+ ,• SAW PLAN TYPI MACI CONSTRUCTION 1034,00 O I'OPICHIPA't`Io °13.00 s1� • r 0ARA,MWARP'OR! C, 12, A00 RS'fii3xr'x D COST OF COW17 e7cTION 1806751.70 COW-1RUCTION FEZ 141.400-189000 ' PLAN CHECK FEE $104.04 't DEPOSSIT 101 -000 -43? -318 =$2SDA M ECH,A.NIGA'Id F&F 101.000-429. • 000 $105.00 ELROTI�3CAI. TT?F;' 10! 4)60.420.000 1167,29 PLUMBING FEL: 101=QGQ- 19.000 -9 Si1RONO MOTION FOR R&SID ' 101?000-7AJ-000 QRADI IN01rI?M 101-004-423-000 DEVE14PER JMP,&CT FEE 81,!10`160..: ^ _ s-' s t 1 41— fit ,. StJ�3-` t�` Ad: C x 'T`PLLP `J`09 MD PLAU CTWCK 10 ! *-tf: $3,526.'91 LM P12 -PAID -$250.00 'E NOW PERM M. IS DU ?: e RECEIPT ' DATE kr BY d'` 7�- D qTLI ALEO INSPECTOR INSPECTION RECORD r OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts ?� Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck Exhaust Fans O.K to Wrap _ _ F.A.U. Framing Compressor Insulation —/D _tea���:�,,� �y 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 Steel POOLV-PAS 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 da �r Neater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral �`/� Sewer Connection Pool Cover Encapsulation Gas Piping Gas Test Appliances Final Final Utility Notice (Gas) ELECTRICAL PPROVALS 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 Finale Utility Notice (Perm) COMMENTS: 11) ,c�. i'"+'-v�:rr«'q*,�r .aj.�;1:�.:,: ,:y.s' 1i"''i.`.•'. ...: <� . 1 ti._ril}.tw';,:..t,,:"+.•�r�..�t3�-.-� i .. �c tiw:�...� a.,. �Y.X.r� x;:,'ka.�,kCi":.':�,.� 4 -^ 7 O P.O. BOX 1504 Buildingq-7 of �j�� ! C`_78-495 CALLE TAMPICO Address "� 1 V ! i` LA QUINTA, CALIFORNIA 92253 Owner C -1 i r -r �- Q 0%AAl ( v -,^,`i v,.v ; LLC. Mailin '• Address � �� ^�✓ t ( / oto CityZip Tel. I\) 41� 9 ��b 7fy 50?qt/qct Contractor , �` l a C S c4 ' Address I City lZip JTel.. State Lic. City & Classif. # t Lic. # C 05 Arch., Engr., Designer Q �, Address 0 `OL/�7 T1 �1 T SS 1 q'91K City Zip State � 1? b T3 Lic. # "LICENSED CONTRACTOR'S DECLARATION , I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. SIGNATURE DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031. S,Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to *Its issuance also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code. or that. he is exempt therefrom, and the basis for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). 1] 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, Buisness and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder, will have the burden of proving that he did not build or improve for the purpose of sale.) I'I I, as owner of the property, am exclusively contracting with licensed contractors to con- struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) I) I am exempt under Sec. B. & P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure, or a certificate of Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No. Company n Copy is filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) valuation or less.) I certify that in the performance of the work -for which this permit is issued, 1 shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Owner NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become subjectto the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY Ihereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code.) Lender's Name Lender's Address This is a building permit when properly filled out, signed and validated, and is subject to expiration if work thereunder is suspended for 180 days. . I certify that I have read this application and stale that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives sof this city to enter the above. mentioned property for inspection purposes. Signature of applicant Date - Mailing Address City, State, Zip u APPLICATION ONLY BUILDING: T.. E'CONST. OCC. GRP. BY: Minimum Setback Distances: xw r Front Setback from Center Line A.P. Number Rear Setback from Rear Prop. Line l I p t✓" 3 Legal Description 1 FINAL DATE INSPECTOR Issued by: Date Permit Validated by: Project Descriptionr"^=_ Validation: Sq.Ft. 2 Cf No. + No. Dw. iz Size 7jj Stories Units New Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. cl:�50 - Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side Setback from Property Line FINAL DATE INSPECTOR Issued by: Date Permit Validated by: Validation: WHITE'=FINANCE YELLOW =APPLICANT PINK = BUILDING DIVISION ...Desert Sands' -Unified School District 47'7 950 Dune PaIm s Road' !N,qtice: La Quinta;'CA 92253 Document i' ajm6t Be Duplicated ...760-771-8515 - CERTIFICATE OF COMPLIANCE. Date 5/31/00 APN#.'643-140-027 ., ti No. 20495-,.. Jurisdiction La"Quirita anaday & COffipany -297. , qwner.Nam,eC. Permit # 0005 No..47-850 Ste*e'et Via Aifich Log # --------------- Zip ., City La Quints 92253 , *StudyArea ��Sq'u 'are Footage e raci # 26152 Lot # 83 ' 3034" Type of Development'Single Family Residence: -L No. of Units At the present time, the Desert Sands. Unified School" District does not collect fees on garages/6arports, covered patios/walkways,residentia�l additions tinder 500 square feet, detached accessory structures' -or replacement mobilehomes. It has been determined the above-named owner is exempt from paying school feesat this time due to the following reason: EXEMPTION NOTTAPPLICABLE This certifies that school fkility fees mpo'sed pursuant to Government Code 53080z -in the amount of 2'05that building' ing' X 3,034 or$ 6,219.70 the property, listed above and is now be issued permits and/or Ceirtificates-of Occuoancy for th 's'quare2'-footagein this propbse'd project may, 'Fees Paid By CC/Bahk 'AjmericE��ue Pelletiiier i _i�, eleph ne' 760-771-9636 of 0 it Name on the check i 7K By ­-Dr.,DorisWilson' Superintendent i 11t -p L. Borja�;$'6;219:70 Fee collected /exempted by Mary Payment Received ,Check No. 2004888073 Sigiiiture- 1 t% • 'NOTICE: -Tn Pursuant E: Puuant ot Assembly Bill 3081 (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 payment identified above0Ic 0 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 coil ci Ct them on the Distdct('s)(s') behalf, whichever is earlier. Collector: Attach a copy of county .or city plan'check appl�ication, fo I rM to, district copy for ati.waivers. , Embossed Original- Building D ept./Applicant Copy-'ApplicAnt/Re6eipt'1 -:Copy Ac&ountin' 9- 4 j.