0306-477 (SFD)LICENSED CONTRACTOR DECLARATION-, .;
I hereby affirm under penalty of perjury. that lam licensed ;under'provi'sioris 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. `
E License # Lic. Class Exp. Date
Date �1 t Signature of Contractor r aX
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). t
() I am exempt under Section B&P.C. for this reason
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION d
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.
( ) I have and will maintairi 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 0T Policy No. t
(This section need not be completed if.the permit valuation is for $100.00 or less);
O I certify that in the'perform_ ance of the work for which this permit is issued,.
'I shall not employ any person in any manner s0 as to become;subjectto the
workers' compensation laws of California, 'and agree that*if I'should become, .
subject to the workers' compensation provisions of..Section 3700 of. the Labor
Code, I shall iorthwith comply with those'"provisions.
ate: 'Applicant
'Applicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000;' in
addition to the cost of compensation, damages as provided for in Section 3.706
of the Labor Code, interest and attorney's fees.,
IMPORTANT Application is hereby made to'the Director.of Building and Safety
for a permit. subject to 'the conditions and restrictions set forth on his .
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify ..
& hold harmless the City of La Ouinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date. of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I 'agree to comply with all City, and State laws relating to the,building
Construction, and hereby authorize representatives of this City to enter upon
the above mentioned property for, inspection purposes
•y..c.i ni _ U'.YI�. • T (:-` _ .� F h i'4R•^.
'blgnatur'e `(UwnedAgent) �' "1 r= t Date
K
' PERMITS
PERMIT
_"BUILDING
0477
_
DATE ¢ "" ^VALUATION LOT TRACT
, 3- .: • �k4X,3 'wI0 fir.. 13640.
JOB SITE _ 1
ADDRESS 48•'1M Wi STA IYE .�I�C�].' AL. r64&1.104)9
i -
t
OWNER t" - ?
CONTRACTOR / DESIGNER / EN (NEER
1 -JURY C901A
7 C'a CO%TMRUC.',3IOF3 IMMTEMANCE
53:345 AWN -110A: C.A.RRANZA
334$ AVENirA,C_ARVANV, -
LAQPZrI , CA 92253
LAQURJTA CA -02253
{76P)5G4.4864 cmW, 2093
USE OF PERMIT
113W012FA$ei�'1'Y DWMAJ "
5PID - 2:362-3Q.f?T-- 1 fit.DEUCK 1'�3 Ut TYPOV14 CONSTR. PERMIT
DO S NOT ndCLUDE FILWK WALLS, POOL OR GPA 39PAWE P1;RIMIT &
144s:pscTIQ14:PLeQUIML) FROM PaTILIC'tld'C+FKS DEPT.
TRAdT CONSTRUC MON SF
PORrHIP.ATIO ~ .. 133.0Q 97 .
0A:IZWEJCKRPOI*``t` ' 565.00 3.r
17J COST OF 4:40XS1rX1 ' lf:4iX
E S. WOW
141, >;$M '
CONSTRUCTION FEE- 101.-000-41€ i-000
PLAN CHIMIC "IF. 01 X000-.135'..31:195665. 0
FSPR UOSI'f' kOi�G�If1e43 W31 �. Sfl,iYt ::
Iv1PCHANICA:1.,FM $131.00
s
FTrC�T t;r1Y.1+0'is 101.000.4.201,000 $142,47
1r3.11WIINQ FES 101-000-4.19.000. • 3140.75
STRO140 140TIa l?EE - RW'�.,;1IIJ 1.01i-000-241 -000 114,14
•'
t'?itA??1:�0 �?��>�� • - .2 D'1-4630=A��-000. �15.at�
DEVEWPER IM§'.,gCTFU. ..•
• �3,40S.�i0
WBS TtJTA1,P_OA1:l'�';id<i.�'CTZ(:►AF AND 1�1.�t4' CSFE� K
$4,340."16
PRE -PAM :PE0
-$250.00
pux Now
NOV 0.4 2003..
CITY OF I A Q1 e
RECEIPTFINANCE DTP ,' p
BY _
DATE FINALED
INSPECT
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
-
Ducts
Slab Grade
col Qt7
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
. /s _5
F.A.U.
Framing
_,:?-
Compressor
Insulation
. 38 _
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath .17
Drywall - Int. Lath
—
Final
Final — .5
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 APPROVALSGas
Test
Electric Final
Waste Lines
Heater Final
Water Piping
7
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
'Pool Cover
Sewer Connection
Z
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:
'Comments
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:
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to
Education Code Section 17620 and Government Code 65995 Et Seq..
1i n the amount of $2.14 X 2,362 S.F. or $5,054.68 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 CCNalley Independent Bank - Susan Coia check No. 297850,
Name on the check Telephone 760/564-2594
Funding Residential
By Dr. Doris Wilson
Superintendent
!Fee collected /exempte by ro M Gilvrey Payment Recd 1$0.00
!
$5,054.68 Over/Under
Signature
i
: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
Embossed Original - Building Department/Applicant Copy-- Applicant/Receipt Copy -'Accounting
it .
f
.
CERTIFICATE OF COMPLIANCE
Desert Sands Unified School District
X�",fro
47950 Dune Palms Road��-
-` O
Date
11/4/03
q -
La Quinta, CA 92253
� RANCHO MIRAGE d
INDIAN WELLS
No.
25164
(760) 771-8515
�,� AQUI TA �y
INDIO
!Owner
Larry
APN #
646-110-009
iAddress
533 4;5�A7-
Jurisdiction
�.SCity
La Quinta
La ta
Zip 92253 _ Permit #
!Tract #
1 640,
Study Area
'Type
Single Family Residence No. of Units
1
Lot
# o.
Street S.F. Lot # No.
Street S.F.
Unit 1 9
48236
Vista de Nopal 2362 Unit 6
Unit 2
Unit 7
Unit 3
Unit 8
Unit 4 .
Unit 9
!Unit 5
Unit 10
'Comments
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:
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to
Education Code Section 17620 and Government Code 65995 Et Seq..
1i n the amount of $2.14 X 2,362 S.F. or $5,054.68 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 CCNalley Independent Bank - Susan Coia check No. 297850,
Name on the check Telephone 760/564-2594
Funding Residential
By Dr. Doris Wilson
Superintendent
!Fee collected /exempte by ro M Gilvrey Payment Recd 1$0.00
!
$5,054.68 Over/Under
Signature
i
: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
Embossed Original - Building Department/Applicant Copy-- Applicant/Receipt Copy -'Accounting
it .
Certificate of Occupancy.
`,ti Ivoo�oanTm� -
,/� wax
ofBuildin .& Saf Department,
g ety
This Certificate is issued pursuant to the requirements of Section 109 of the California Building' -
Code, certifying that, at the 'time of issuance, this structure -was in. compliance with the
provisions. -of the Building Code and the various. ordinances of the City regulating building
• construction and/or use.
r ; BUILDING ADDRESS: ,48-236 VISTA -DE NOPAL
Use classification: S:F.D.
Building Permit No.: 0306-477
Occupancy Group: R-3' Type of'Const'ruction:' V -N Land Use Zone: RL
+ • ' 1. . S • ♦ • '+ �' _ .. , - *n � J a ♦ ,.J i _ ' •
Owner of Building: LARRY COIA. ` Address: 53345 AVENIDA CARRANZA
City, ST, ZIP: LA QUINTA CA 92253
By: G. SHOWALTER
Date: 06/25/04
Building Official t
POST IN A CONSPICUOUS PLACE
1 1 M