0006-013 (AR)LICENSED CONTRACTOR DECLARATION
I��ereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 9"(corri'mencing with Section 7000) of Division 3 of the Business and
Professionals Code, and my License is in full force and effect.
License # Lic. Class ri Exp. Date
I31SIC' 11.1'3o/2T
Date -• C�Signature of Contractor . _=t=
OWNER -BUILDER DECL/AR' i4TION
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).
( ) 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.
(l--f,41have 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 STATIZ F1jNL) Policy No. 229196960®
(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 I should become
subject to the workers' compensatJo J provisions of Section 3700 of the Labor
Code, I shall forthwith comply withithose provisionv/
Date: r Ar J✓' Applicant /f // I/
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 City to enter upon
the above-mentioned property for inspection pu^rposes. < r ,
Signature (Owner/Agent) Dates
f
BUILDING PERMIT PERMIT#
DATE VALUATION' LOT TRACT
JOB SITE
APN
ADDRESS 4.9-517.Avx wA..vxmvomu
773-350-044, .
OWNER
CONTRACTOR / DESIGNER / EN (NEER
LOUIS T& MAURA P ROSSO
0. L St,'RNRNS COMS'IRUCITON
49517 f+VEWAiMADOM
61400 YU004AROAD,4260
LA QT.A7WfA CA 922.13
MO1_31`i'f.H.W CF_1rfFR CA 92561
(760)31.7439 CB1A 2481
t
USE OF PERMIT
120 S.F. ROOM ADDITION PER . APPROV ED PLANS ONLY
ADDITION 120.00 OF
WR17M'A'lM COST 01T CO)`T3"TRU(Tl10K
sPIUMIff "E SUMMARY
PLAN CHECK FEE 141.000439.318 859, 11
CONWRUCTION FCL 1101-000=418000 $90.00
MECHANICAL FEE, 101-000-421-000 �aO,QO
ELECTRICAL, FBI, .101--000-420-000
STRO140 MOTION FEE - RIV31D, 101-000.741.000 km
STT.aq0'TAL cow.fRL7mom At>> > PLAN cFwc'fC
$198.65
IZ- 30 PRR-r-AM REFS
$0,00
TOTAL PkRAUr FF"- DM.' NOW
RECEIPT
DATE
BY
DATE F ALED
INSPECTOR
!!�
o
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
Set Backs
Equipment Location
_Forms 8 Footings
Underground Electric
Slab GradP,
Final
Gas Piping
Steel
Gas Test
Electric Final
Waste Lines
Roof Deck
�a9p
Plumbing Final
OX to Wrap
Equipment Enclosure
Shower Pans
Framing
Insulation J
?~
Pool Cover
Fireplace P.L.
Encapsulation
Gas Piping
Fireplace T.O.
Gas Test
Party Wall Insulation
Party Wall Firewall
Exterior LathT-
Drywall - Int. Lath
BLOCKWALL APPROVALS
OPERATION DATE INSPECTOR
MECHANICAL APPROVALS
Underground Ducts
Ducts
Return Air
Combustion Air
Exhaust Fans
Grills
Fans & Controls '
Final
POOLS - SPAS
=0
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground PIN. 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
Final
COMMENTS:
Final
ELECTRICAL APPROVALS
Temp. Power Pole
Underaround Conduit
Low Voltage Wirii
Fixtures
Main Service
Sub Panels
Exterior Receptac
G.F.I.
Smoke Detectors
Temp. Use of Pa
Final
Utility Notice (Per
Desert Sands Unified School District
477950 Dune Palms Road
Notice: La Quinta,.CA 92253
Document Cannot Be Duplicated 760-771-8515
CERTIFICATE OF COMPLIANCE 4 r
Date. 6/2/00 _ f : API #
• No. 20507 Jurisdiction La Quinta
Owner NameLouis T &.Maura Rosso `Permit #,0006-013 -'
No. 49-517 Street Avenida Vista Bonita Log #
`4. City La Quints',- r ' Zip 92253Study Area
• �, r , . " • ,�
Tract # " ` Lot # r Square Footage 120
Type of Development Residential Addition r • - No. of Units 1
' Comments 120 sq ft. room addition. .
- 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 repla:ement 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 facilityfees imposed pursuant to Government Code 53080 in the amount of ♦ , °
0.00 X 120 or $ 0.00' '_ the property listed above and that:building ;
permits and/or Certificates of Occupancy,for thissquare,footage in this proposed project may nowbe issued'- R
``Fees Paid By, N/A --` GL Scrrivens Telephon ° 760-349-3327 .
Name on the checks.' > 1r
'By Dr. -Doris Wilson w'
Superintendent.
Fee collected /exempted by Mary Ann L. Bora Exempt � J �f-so.ov.,r �
Check No. •N/A' r' ,
Signature r
- NOTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 -day approval period in which you may-pntest 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) v to another public entity authorized to -
collect them on the District('s)(s') behalf, whichever is earlier. - t
` Collector: Attach a copyof county or city plan check application form to district copy for'all wai-rers.
` Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting
FROMG.
L.' StRIVENS CO W, 7PHONE NO 760'3451025 w Apr 05 2000 04
N.ttport net_h, Ca► furriia 0260
f.
RC 49-517 Avenida 153ta Runitx
b'Car. Mr. R Mrs. Rosso:
AA
♦
' Your~.amilitectural Variance datad tiiarch 1. -regaldirtc; Wt repL,ccmem of the bacl�uic windotcs and
•
slidin;'eiass ctoorc, extarisior, of [he h ' px►_do W the lot line, remb�'a1 of the fireplace and tllc e?1 rsiun
of the [raster be•droorn has bu%& xppiw d under the following stipulations( I.
�
C
r
.. r ' • A�tus l rasdifi"tioti mus♦ Conform w. the plam; and S}+l'C1�iCxhun6 St11inII ed end app Uv¢d.
F • �- HsrdHsra for the �tlndJws mild aD= m= instch'the a king nardt
;is.
'a • �3ti0'.GY.iCI]S1�It ;t.0'.Ci:rCCiGd'.thz, I'm �IF;,OtIc 1$.i00trta "Ci v.;17.
'.�,
,ntit -ac ,tL';�`C
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uhtt:is c nln-titlti, trwtbllod th-iiithc C'vvit 1 cn3+t�iContractor tntut nottry tit c C,httmlttnG of the cha ege
n,
pncr to the Ivor)•. ) s -,C4 w 4 , " ,}i K A '� .•, Jy h
K
is + ..
-, .., A....,
Stuco Vc:ll[ifiits must rcnwirt uhlriTlti irl vhf} �_ ( nt rQlltid as mdic+atcd itti't11C pl +nc.! " �,. • , c - * '
o he ct rtrute.' Ls to rernain aitaohe•d to the building to "remain unifonmi' Pith t1 eit aoundi�a units
'
• Cnmpetent and licensed professiomlc shall do 211 work.. in x w0d=VwAik` manner.
All work is tobe to ;Ompliance with,beil bullding'codee aiid ordLw'3,C0. a
• � atc� rc:I! utru±�; if appli able. must b_ contained withinconduit pat:fte". to match the
?,
' tSlirhl�c,it .OKt1CtS. ,.
`froth
r.'
• .Any dearaLgi::o the common area.:•csuiting this modification 'and iti _sLm:tion sball he
rpai*cd zt Lhc )wner's exliense.
• If a =nstiuct.iotl bi.,t, ix itrnt,-.d ihrn'uglf WAe Maviagemeut-it must he itciae i I .vie_ ?:nd stln.ed, I=
>
possible. in thr. g:tr:�c:..0 w1ristmaiiin eiebris is. ttt ba rt IX$ c.! Gom iaa site b; Lye � h+�c of arch d:n
to n:;+inl.un ordla uul retain the aesthetics of the Santa Rlw Curr.
t
• Prior tc :h= collvrt><cemert o:nttl w': rk he rortlxactcr,and •aleir sta+crnllactor{s) Idisc. provide the
c
an.ut.,ncurr,: vti G:
�,a;mLfxl proof of uorleComm:litbilird n si
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Gc 'ilt .1 111° (�+ruleCl.
'oI
4{
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PJioi to St'e corttntentement`'cf am. cFcrt. broil ar vtiur contractor ;.rust rtolidl t!t 1iSmC tl1C
s�liecclea >>or;�rlen'tr tht scoiirih gum; 'L at the (.SQ `a'1 tjr Ia
rf t , t ♦�� ~ s ,•
•': -
A• Prior to the COiriltCriCtctl^Tti :o; aIle' aoln Yvur cOttt'Je..�r Ittust r, wand ,L tl'd _S5t7CistiOn a "i•
kr,:
=" : `r
Contractor Rutc6, which have beim fakcd'to Sc.rivzm* atts:tion;.
• ?" -lie'm1I711Cr1CGri1GAt OI aT' will: �'J?tl al'C,t�(ltll't4 to,p ya $560 rGluriliable deposit for tltc
11�-Gir.
4♦roi•-'
room addition,
• - -
tf F�L)r w the culnxiienxtnent. of in-,; ttiozk- vlu 3rr rcquitJ to pa\' a UILc•tiMC iG-v of S: per �.,C1Uare jUr
- -
ihr neiy roof xrca- as Mal; a� pim :dc x livt-.cn: urittcm Emvirlee cavvritig the rew rca+f arca.
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yv:11 7(100 r
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Fsitc'j•wc: rY3 - -
ec
1 is !t*r ;i final .ns livn.
I'1:SSC LUritC�! lll� NiSuzi dcr. UEl Vili v 1'U1I snca_ficxlu+n .uu usr p e p
cop3 vi I.hC s{� +' ca .'ariancr Will be ensiled to you iller the iitspe..t{U" Alnste. u"ith,>tic .rcfund2ble
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Ctrp:fcll. ll•YUe Icall,
Vcr%truly yoto. < _
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