0211-034 (AR)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 #: r 7 t74 Licl. Klass Exp. Date 9 tj�7
67401 111 G1ys" ,% 4/ i31Y1e
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:
( ) 1, 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).
() 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 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.
?t() 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 STATRIUND Policy No. %$_0 fCti'' 19
(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 shall not employ any person in any manner so as to become subject to the
workers' compensation laws of California, and agree that if jshtld become
subject to the workers' compensatioq provisnef Sectionf370011of the Labor
Code, I shall forthwith comply wi(h those (ovisions I
,i" Date: as X //r-, `--- Applicant; `'
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes'null and void if
work is not commenced within 180 days from date of issuance of such
permit;,or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all. City, and State laws relating to the building
construction, and hereby authorize representatives OfI 's City to enter upon
the above-mentioned prep rty forriinspection purposes.
t7 i"
Signature (Owner/Agent) Date
-BUILDING PERMIT PERMIT#
�-..
(411 1-034
DATE VALUATION g.� ppyyo� pp LOT TRACT
294,574
JOB SITE
ADDRESS 49-3`51 VIST } t <i�+gCiE.
APN
OWNER
CONTRACTOR // DESIGNER /ENGINEER
I'D AyMIMy, VELqy15W
ETaAK19 6ON i11/IN
�ytC��iX 1 7 7 6
9Ss�-295Tt�RANC.1„ `:0.LA Q" �1J�INT.J1�1i'��3.„L . /
TY?AA(;2
�� eE'�pp a��rf
T:,.e-�,'NNUS 1!'"i. x. A 92253
t7s
i. A t�I IENJA CA 9w,G.J3
(766)771-1941 Muf "96
USE OF PERMIT
110V ADVITi.ON W111J,.1r UN DLI't. C.014S T RUC'!'iON TO 1ZT25 25 P' .
APPROVED RAW&
C 1i#TOM COMI'!`i'UC:TiO}`d' 11i},C3 B
l'MW.!A° fes? < �{ 4` 4� ' 1�CITOfR
13, &
PLYR aI 1r'Ta R grJbfMARY
PLAN (.1}IECiC FEE 141-WO.439.938
Ce'}N^4`l'UC".T%C+14FEE 101-0007418-600 �.1Q1$,ti9
9111FICTRIO&I V�R 10 1; - Omit 20.0-011
R*..9N R • RmID 101-0004141 -000 $.�6
NOV?n 13 7002
CITY OF LA
QUINTq
FINANCE DEPT.
i
8tWA)T,AL r°C)MMUICTIM A 11 RQhN ErMt°3,
$191-06
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
)$. I;-£...1
i"11I
INSPECTION RECORD
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.
1A A
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
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
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 A
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
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)
CERTIFICATE OF COMPLIANCE J FUDR;
Desert Sands Unified School District q�e 77
47950'Dune Palms Road °
Q BERMUDA DUNES r
Date 1.1/7/02 La Quinta CA 92253 rn RANCHO MIRAGE d
f _ INDIAN WELLS ti
PALM DESERT
No. 23834 (760) 771-8515 LA QUINTA
VQ 0
Owner TD Desert Development . ,APN # 649-100-002
Address P.O. Box 1716 Jurisdiction La Quinta
City La Quinta Zip 92253 Permit# 0211-034
Tract # 29457-2 Study Area
Type Residential Addition No. of Units 1
Lot # No. Street: S.F. Lot # No. Street S.F.
Unit 1 25 4935.1VistajMltasol'`' 110 Unit 6
Unit 2 -.� Unit 7
Unit 3 �Y, a. Unit 8
Unit 4 Unit 9 _
Unit 5 Unit 10
Comments 110 SF ADDITION WHILE UNDER CONSTRUCTION TO LOT 25 PER APPROVED PLANS.
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 (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile
homes. It has been determined that the above-named owner is exempt from paying school fees at this time due to the following reason:
Add. of Sq. Ft. to New Construction • `"
EXEMPTION NOT APPLICABLE
'This certifies that school facility fees imposed pursuant to
Education Code Section 17620 and Government Code 65995 Et Seq.
in the amount of $2.14X 110 S.F. or.$235.40 have been paid for the property listed above and that
building permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued.
Fees Paid By CC/PDNB -JUDY-SPARKS CONSTRUCTION,, _Check No.' 084341
Name on the check Telephone 760/771-1941
Funding Residential
By Dr. Doris Wilson -
Superintendent R
Fee collected /exempted by Monica Guillen $235.40 0.00
Payment Recd Over/Under
Signature ✓A
NOTICE: Pursuant to Government Code Section 66020(d)(1), this will serve to notify you that the 90 -day approval period in which you may protest 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 issued, or from the date on which .
those amounts are paid -to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier.
NOTICE: This Document NOT VALID if Duplicated b
Embossed Original - Building Department/Applicant Copy - Applicant/Receipt Copy - Accounting