9906-211 (AR)LICENSED CONTRACTOR DECLARATION
�1hereby .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 66die, and my License is in full force and effect.
License # Lic. Class Exp. Date,
�jz�
Date Signature
of Contractor
DECLARATION '04
I hereby affirm under penalty of perjury that I am exemp!,.fr6m the Contractor's-
. License
ohtract6r'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).
1, as owner of the, property, .am exclusiJely;', contrLtini*q' with licensed
'_contractors to construct
struct the project (Sec. 7644, -(Business & Professionals
Code).
O I am exempt under Section,, B&P.C. f6r'this reason
Date "Signature of Owner
.WORKER'S, COMPENSATION DECLARATION r.
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 3706 of th6 Labor Code, foir the
performance of the work for which this permit is issued.
(1# 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
permk-',• is issued. My workers' compensation insurance carrier & policy no. are:
CaPolicy
rrier No.,'
(This1section 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 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:; Failu re to secure Workers' Compensation coverage is unlawful and
shall suoject-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
PORTANT Application is hereby made to the Direct6r.oi Building and Safety
f6r 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 Quin.ta, its, officers; agents and employees.
1 Any permit issued as a result of this application become ' s 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,su.bject 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.
N
A Date
SignaturC (Owner/Age6t),
. 11j;
PERMIT# X
"--BUILDING PERMIT "06-214'
VALUATION 14) LOT
DATE VAL TRACT,
V
JOB SITE
ADDRESS
APN 7
:OWNER
CO.N,TRACTOR,/ DESIGNER ENGINEER
4
V ON C011TST
ISI WEIST kr.1MQ1)1'"11ANQ
49503,AVENIDA VCS'1'A BONITA,
73-195 CrLTADALUPE AVE
CA W2 Z5
PALM IDESFWr CA, 'W22,61
CKLM
-se
USE OF PERMIT
, f X15, ADD
ke N Y
138 S -P, R,00
PATIO CONVER3101 138.00gn-
VALUA-T1014 4,000.00 LS
'% V
91STINXIr-IMED COS OF CON0111", 1111VCV411 Li
5.6=90
YPIRAIrr ter, FISUMMARY
PLAN 01DCK 401-000-439-318 5116.0
N nmt, jol-0m)-4.1.8-000 $1.17700
NMCHANRCAL FF.8 AM00,4214C
rMa, mm"Fe-, , R , . , )! $.19.8:
ST.F.OX10 Mr -A -10N FtE - ASID 10340M41,W0 9197.
-TQC'.-L QQN- UCTICY-NANDPLIt I W CH50-K
$1 - ,I
IIESIPS PRE4)AIDIF C !3
$0.00
MM
TOTIA 1*, P E IT FE&% 0 LTE NOW
RECEIPT
DATE
D ATE FINALED
INSPECTOR
4 ,
t
INSPECTION RECORD
OPERATION j
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
t
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
l�o
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
'
Underground Electric
-
Underground Pibg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines_
Water Piping
?
� �f
Heater Final
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
4Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
/
G O s--<-
=; Desert Sands Unified School District
47-950 Dune Palms Road
Notice: La Quinta, CA 92253
Document Camtot Be Duplicated 760-771-8515
CERTIFICATE OF COMPLIANCE
Date 6/30/99 APN # . 773-350-045
No. 18964 Jurisdiction La Quinti
Owner NameJeffrey & Jeffrey Pyrmit #
No. 49-503 Street Avenida Vista Bonita Log #
City La Quinta Zip 92253 Study Area
Tract # Lot # Square Footage 138
Type of Development Residential Addition No. of Units 1
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 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
EXEMPT
This certifies that school facility fees imposed pursuant to Government Code 53080 irl the, amount of
0.00 X 138 or $ 0.00 the property listed above and.th t.l;u'z ding":':, .
permits and/or Certificates of Occupancy for this square footage in this proposed project m� r"ow be iss ed
Fees Paid By N/A - Visions West Remodeling & Const. Tele'_ hone 341,
\'0.7,
�i02
t' s� ,0
Name on the check
B Dr. Doris Wilson f2�*
Y v,ti•s, 1'�'�x,
Superintendent
Fee collected /exempted by Juanita Green Exempt $0.00
r Check No. N/A
Signature ,
NOTICE: Pursuant of Asse bly 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
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) orlo another public entity authorized to
collect them on the Dislrict('s)(s') behalf, whichever is earlier.
Collector: Attach a copy of county or city plan check application form to district copy for all waivers.
Embossed Original- Building Dept./Applicant . Copy - Applicant/Receipt Copy - Accounting.
CITY OF LA QUINTA SUB-CONTRACTOR LIST
PERMIT NUMBER OWNER BUILDER
OB ADDRESS
This form shall be posted on the job with the Building Inspection Card at all times in a conspicuous place. Only persons appearing on this list or their employees are authorized to work
nn this iob. Anv chanqes to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result in a stoppage, of work and/or the voidance
n
CARLOS ELIAS�1
Civil Engineer
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i t
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• S i?Et�►�= �(oDS 12) .. °31v.�� �X/dS = X9.91 •
12ao x;251
?A13
T RE4Dlo/24o� =`4s0 �0 9,i5 3_ $3.22 QX'
1, % top, 000 U s s X 10
SOW G,ZS � w= e(7)WAILL 4-z,0 ?(,#��.f
N(= 7�(.�, Z��z�B � 37I $ REa° = :37 ► 12� � 2,.9� 4X L S= 17. �S .
1 Soo
V 13 i 6 /,5)= 3,� x �. ►� 19,tS'
W =
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CIVIL
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No. 16839
CIVIC
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