0005-279 (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 # Lic. Class Exp. Date
,; ,e
.,451 �35:80 1
to e"ll 'Signature of Contractor,° - ^
OWNER -BUILDER DECLARATION t
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, Buslness..8? Professionals
Code).
am exempt u der Section B&P.Cflo ,t is edason
Date . A Signature of
`WORKER'S COMPENSATION DECLARATION
1•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 .NIA 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,
I shall not employ any person in any manner so as to become subject to the
workers' compensation Iaws.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
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 Cityfto enter upon
the above-mentioned properrtyr inspection,purposes
15
Signature (Owner/Agent) r '%�% 1'J'%ato�'d
BUILDING PERMIT PERMIT#
DATE VALUATION LOT Q 00!5- 179 TRACT
JOB SITE
APN
ADDRESS1�. ±nk Diaw
; 604-153-M
OWNER
CONTRACTOR / DESIGNER / EN (NEER
130.W t VAMSA BRAD Y
Ai.. DURR.'"'TT OONSTRW%i W
78.795 VILLE'TADI2.TVE
.51-538AVMMDAA8 11t .
LA QUMTA CA 92253
LA QC.?UrA CA 92253.
7 60)?' 1 ^31336. C)3 1463
USE OF PERMIT
1 U-81133a3`i"M AMMON
�
BEDROOM AI)DI ION TO 9XI.STINO 3 -CAR C.e' RAOE ARY-A 214 SQ. F7,
BONUS ROOM 219.00 3T'
73�+T1!'�r�:dlMD C*0S T' ®•A•vG"oxmuC'-'.T.2.0•IiT
`71MR 30
�py y �y�.
JI"l�.glil.V i FEF. L7if.FM I&AR .. •
.
PLAN CHECK RE 101-000-439-,�3"1'8'-.4kN,�F $64.33
CONSTRUCTION F713, 1011000-418-000 �*• ��.UR
ELECTRICAL NEE 101.000.420.000 522,50
STRONO MOTION Mr+% a "MID . 101-e000-241-000
ffM-TOTAL COX& R.UMON ASD PLAN CIMCK
5186.61
LMPRE,-PAID S
40.00
TOTAL PRM' FFES D&i'• NOW
RECEIPT
DA4TE�
BY
/
DATE
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Baskti
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
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
7 r3
Drywall - Int. Lath
E. - LZ -�
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
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
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
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)
COMMENTS:
Desert Sands Unified School District w -
' 47-950 Dune Palms Road f ;
Notice: La Quinta, CA 92253
Document Cannot Be Duplicated 760-771-8515
CERTIFICATE- OF COMPLIANCE
Date 5/25/00. APN # 604=153-008 '
No.. 20469" Jurisdiciion La Ouinta V'
Owner NameDon & Vanessa Brady Permit #•,
0005-279
J
No. 78-795 'Street . Villeta Drive _ . Log #
I,
City La Quinta k - Zip 92253 Study Area
Tract #, Lot # ' Square Footage `219
Type of Development Residential Addition t +' No. of Units 1
Comments 219 sq: ft. bonus room addition. 4.w
S A
'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:
Residential Addition 500 Sq Feet or Less y
EXEMPT t
This certifies that school facility fees imposed pursuant to, , Government Code 53080 in the amount of
0.00. X "219 or $ 0.00. t- the property listed above and that building
permits and/or Certificates of Occupancy-forthis square footage in this proposed project may now be issued
7.
Fees Paid By N/A - Vickie Durrett " . - - Telephone ,+76.0-,771-3836 �•
Name on the check
* By Dr. Doris Wilson s '
Superintendent r k u
Fee collected /exempted b i �•� � G � ` � s '
P y Mary Ann L. Boda Exempt
Check No. N/A �' a
Signature - x
QJ
NOTICE:Pursuant of Assembly 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 -day approval period in which you -may protesf)<he fees or otherpaymeni Identified ,
above 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) of 4iinother public entity authorized to
• tolled them on the District('s)(s') behalf, whichever is earlier.
Collector: Attach a copy of county or city plan check application form to district.eopy for all, waivers.
4 r '
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting. '