0005-300 (SFD)t
LICENSED CONTRACTOR DECLARATION
I .`Y 6rebX 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 bode, and my License is in full force and effect.
License-# _.r Lia Class Exp. Date
If
.61
t, "r (01311(
Date Signature of Contractor—IINI'
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).
O I am exempt under Section B&P.C. for this reason
Date Signature of Owner `
WORKER'S COMPENSATION DECLARATION
I .hereby affirm under, penaltyy of perjury one of the following declarations:
O I have and will mainatain certificate of -consent to self -insure for workers'
compensation, as provided for, by Section 3700 of the Labor. Code, for the
pe,qormance of the work ;for which this permit is issued. '
�(( ) I have and will maintaih .workers' compensation insurance, as required by
Section"3700 of the Labor Code;�Jor the performance of. the work for which this
.permit' is issued. My workerscompensation insurance carrier-,& policy no. are:
Carrier. FRIgMoN F COMP INS Policy No. 5'i3d0'i 199€3D>14179
(This section need not be' completed if the permit valuation is for $100.00 or less):
( ) :`I certify thet 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, df S ction 3700 of the Labor
Code, I sh f rthwith comply with those provisio
Date: t?�F t'`'� ' Applicant—
Warning:
pplicant 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 Cdde •,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, iiidemnify
& 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, ente upon
the above-mentioned property for inspect on p !poses.
Signature (Owner/Anent)'µ Date
BUILDING PERMIT PERMIT# `
DATE,� VALUATION LOT '30() TRACT
j ( Cb - J145.146.40 86 26152
JOB SITE
ADDRESS 47-a.7 ,m z+u.Ia
APN
0
OWNER
CONTRACTOR/DESIGNER/EN INEER
CMACAY CUMPAVrf
CAN10AY & COWANY.
17480 N. 17.al 11'!'. 0106
17480Z 17TH 3TC X106
TUMN CA
'T uffl- Ai Chi 92780
(714):508 4"0 :CBT 4485
USE OF PERMIT
L 3G'
S1N'f1LLE FA1dMY T;
SM- LOT 46 PLAN 16Ra!PR .Evf!'t DO -ES -NOT TNCLUnF, SLOCK W.F+►,LLS Oil'.'
Poo °15% PLAN CH 96K RER REDUCTION nOR MULTIPLE 109,"j,CE OF ;
SAIME PL kN TYPE. t
TILAXT CONSTRUCTION 2,422,413 SF
PORCH/PATIO M,60 5F
C1 it GWAR.Pt. WT (M B,t 04,40
USTMA' RID COST U19'.CQNMVM, 10N45%3146';4!0.
p1luarFEE SEJA4MA1:RY
CQN8TXUCT1OA4 FEE" 101.000 418-000 5200;5
RW4Q I;C f £Ir tol,000439-318
I; EE DEPOSIT 1.01 p•000.439.S 18 ' 4250A
A91iiAlldJCAL IRR 101'000-411-00 $9FIr30
�WTIUCAL Fft, . . 101.000.420�000 514105
��: �
PLUM11fli t FE13 '{1f14,.C.Q13 A19 QO!3 I25.75
ew,
SOW, AAovow Fa - RE9.1b 101-000> 14f1W ' -' - S14,1'5
TI�
01t.9DIV. 0 ME 101 -000-423=000 �3Q,t►iJ
y $ � d �`
09OWPER IMPACT FEE
{
fw, n�
OD -B -TOTAL CC?2d0'PL YJMO T .tom]) PL,I R ClINCK
$3,274.29 ,
%.�iM a 'PSP<PA L 1
0t' 0
+� yv;.' i
\ st7J1 3 .•••�•s ail— 1'.YJh,:7 .t/'S/E NOW
�aj$r255�0,
+Da7g9.�.•Lf`Sr6r/ i
[RECEIPT
+BY.+
D T [INID
INSPECTOR • '
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
s BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Fornis & Footings
�.9
`i
Ducts
Slab Grade
,W le--
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
Drywall - Int. Lath
12 7 -7�
Final
Final
POO - PAS
BLOCKW
- AP' ROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location _
Underground Electric
Underground Plbg. Test
Final
I
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
COMMENTS:
Final
Utility Notice (Gas)
7,(is d
ELECTRICAL AP ROVALS
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
6
Utility Notice (Perm)
va+t ,y -r -e -,+.a .-�r;�"Ca�.,'.yrT ;w:.Fe7aZf'9'�v�ru uw; y^,':il'.y; ^4"T+:�e-' "�C:.,,F%rx"t�n Gs !m:. . i-°'": sn.v' � t � x+i: S.trsr:r 9:^•..,,c!^w�1C +a. -t: :. -•_-
BOX 1504 APPLICATION ONLY
Building - 78-495 CALLE TAMPICO
Address I� �! '� �t k`� e� LA QUINTA, CALIFORNIA 92253
Owner � �
G p � `� \_ "'G `'�� �(� �CC. BUILDING: TYPE'CONST. OCC. GRP.
AddMailing
s -T-1 ^
1 � /-
res I l A.P. Number,
City� I Zip Tel. .s
•i L'7� �l 4 ) QO �{ � Legal Description
Contractor w Project Description"
Address
City
State Lic. r 9
&Classif. ..,�J�'
Arch., Engr., i
Designer { / (
Address PQ i3a� t bbi�� �I�-f T
City ---r- JZip r State
�T 1' �--Q f`'Z !OTC 3 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 1 am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,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).
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, 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
orr 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.)
Il I, asowner 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
doesnot 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.)
r
City
Lic. # `� Sq. Ft.
Size
New Add ❑
17 1 am exempt under Sec. _-B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I herebyaffirm 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. O 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 lhF 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.
Date Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become
subject to 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.
1 certify that I have read this application and state 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.
'r Signature of applicant Date .
Mailing Address
City, State, Zip
No. ` No.zDw. 4w1 >a
Stories Units
Alter ❑ Repair ❑ Demolition ❑
PERMIT AMOUNT
Plan Chk. Dep. G IV V'
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
A
PERMIT AMOUNT
Plan Chk. Dep. G IV V'
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
- 47-950 Dune Palms Road
T Notice: .. La Quinta, CA 92253 ^' w
Document Cannot Be Duplicated 760-771-8515 '
CERTIFICATE OF COMPLIANCE
Date 5/31/00 ; ' , APN #' 643-140-030 `
No. 20498 �• '� .° "Jurisdiction La Quints
Owner NamXanaday & Company , Mr , Permit'# 0005-300. '
No: 47-875 Street Via Zurich Log # €
City La Quints _ Zip 92253 n `° , Study Area'
Tract # 26152 Lot # Square IFootage 2422
Type of Development Single Family Residence, " v No. of Units 1
SAI L
Comments
yr 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:
[ eo t
•k '
� t
' EXEMPTION NOT APPLICABLE-
This
PPLICABLEThis certifies that school facility nfees imposed pursuant to ,' Government Code 53080 t. �I in the amount of,
4
2.05= •X; 2,422 r or $ 4,965.10 .the property listed above and that building
permits and/or Certificates of Occupancy for this square footage in this proposedprojec4 may now
be,issued
Fees Paid By CC/Bank of Am'erica/Sue Pelletier Telephone-'760-,77 1-9636
Name on the check
44
By Dr. Dons Wilson 3 ;
-Superintendent y
Fee couected /exempted by Mary Ann L. Borja t'.• Payment •Received
-' Check No. 2004888073,'-
Signature :t
NOTICE: Pursuant of'Assembly Bill 3081 (CHAP 549, STATS. 1996) this will servetonotify you that the 90-day approval period in which you may protest the or other payment identified
above will begin to run from the date on which the building or installation permit for thisproject'is sssued or on which they are paid to the District(s).or to another public entity authorized to
collect them on the District('s)(s') behalf, whichever is earlier. '�• - - • -
Collector: Attach a copy of county or city plan check application form toidistrict copy for all waivers..
Embossed Original- Building Dept./Applicant, Copy- Applicantfkeceipt Copy'- Accounting -