9804-186 (MECH)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
:.;
5.3 � iii �°; O I1/30 X)
Date" v� S gnature 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:
( ) 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.
( ) 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 Policy No.
A112 FUIND 2 - r if)13v95�
(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' compensation provisions of Section '/00 of the Labor
Code, I shall forthwith comply with.those'p�.ovisions. %�
vDate: *j Applicant—
Warning:
pplicant Warning: Failure to secure Workers' Compensation c verage 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
thheCabove-mentioned property for inspection purposes.
vSignature (Owner/Agent)ft Date
r,
PERMIT# CONTROL# -
BUILDING PERMIT
11804-M
DATE �Ar, VALUATION p3i LOT TRACT7703
d
JOB SITE
+49-545
ADDRESS 49—�A 'tNID'�.��IST 1' BOITA
APN
773-330-043
OWNER
CONTRACTOR/DESIGNER/ENGINEER
RAY ti'4"W'Ri.LIA.&IS
Q. L. SCHI1JEWS C'ONS!'RUC"i:l�` N
1.067.1 OS JAIMINES C19
260 PIKY EN CfWSS'
a
EL PAIS TX 79912
Mi)'f..WfAIN CENT Lk ('A 92: (11
USE OF PERMIT
:kI)!v
A.lRIUM i�] NCL080RE, ADO 4a:,A+1 ' its LII iko, Nj w WAT— �:
Fi'ksA'i'��:ft
VALUA'i' ON 1I.r.12.00 La
d� S "IMA P. O.ial� COSPT �.i.Kt, \, 611Yf.1•} ii�e�!`.: .k �.t�fi ix
.S X.y�J6^r.Vu�
�si�gp��v�/�6gss��CC .�a
tlY pps� ii;; ,+�,,@@ 11 FEE
f"EI �Ei).i"IY1, F� EE �7lfAIMARN.
PLAN 0*,i.,K H b t? l p 1 f�(!»y►3�)-.� 1.1t U7.75
.E.°.W rIP"rRICAL FEE 101-000-420000 531111w
Idi.i1MRING I'M lA1.000-4 19-000 X27 a3U
S rRONO lLT(7Tic; N PEE, REM 10!-t't00-241-000
�' '. �' lll► iM,T . �� ON , f ISE `C"I ICS fLVvi I�1. r tV i'I1I i.'
ESS .i 1,10 AW) .i ES
$090
0199 Ta3TAT, PERIM>sT FEr,N DUE NOW
$293.67
,�
R CEIPT i
DATE
BY
a
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
0
,.BUILDING APPROVALS
MECHANICAL APPROVALS
Set Ba?as
Underground Ducts
Forms 8 Footings
Ducts
Slab Grade
Return Air
Steel _
Combustion Air
Roof Deck
Exhaust Fans
O. K. to Wrap / `/
F.A.U.
Framing Q ���ti
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath 5 a
Drywall - Int. Lath S
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 I
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 Sendce
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
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City of La Quanta
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Building Safety Division -
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�?.O. Box 1504
78-495 Calle Tampico
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La,uInta 'CA 92253
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licatio n
Building, Permit Ap n a 'd Tracking �he'et,
Project Address:,"
Owner's Name:
A. P.,,Number. '' r
Address: W51y5 4
Legal �Description:
City,ST Zip:
Contractoi: -
Teleplione:,
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IrAddress:
Project Description:
City'ST, Zip:,
..
Telephone:
........
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e -
State Li'C.'
City Lic. #:
A cli. Engr.' Designer:,
Arch
t.
1.4. 1.
Address:
City. ST. Zip: 41
Telephone:
...........
Consituclion Type:, ccupancy:
State Lic.' #: -
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d'n ter Rep
Project iype (circle one New Ad Alt air Demo
Name ofco'ntact'P6'rsoin:
Sq. Ft':' 90
# Stories::
#Units.
Telephone # of ContactPerson:
Estimated Value of Project:' i
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Notice:
Document Cannot Be Duplicated
r r
Desert Sands Unified School District
82-879 Highway 111
Indio, CA 92201
619-775-3500 "
CERTIFICATE OF COMPLIANCE
Date 4/30/98 APN # 773-350-048
No. 16967 Jurisdiction La Quinta
Owner NameRay W. Williams Permit #
No. 49-545 Street Avenida Vista Bonita Log #
City La Quinta Zip 92253 Study Area
Tract # Lot # Square Footage 80
Type of Development Single Family Residence No. of Units 1
Comments
trium enclosure, add so rt in living, new water heater
r�
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�th6 following �, f
A
reason:
"M
Residential Addition 500 Sq Feet or Less t`
r� . r
` EXEMPT
in the amount f
'
This certifies that school facility fees imposed pursuant to Government Code 53080
0.00 X 80 or $ 0.00 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 exempt Telephone 760 775-8618
Name on the check
By Dr.- Doris Wilson
Superintendent
Fee collected /exempted by Olivia Aguirre Exempt $0.00
Check No. N/A
Signature zwjr
NOTICE: Pursuant of sembly 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) or to another 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 copy for all waivers.
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting
Apr-03-98.02:56P santa rola cove. assn 619 777-7622 P.Ol. }'
April 3, 1998
Ray Williams
49545 Avenida Vista Bonita.
La Quint's,.California 92253'
Re: 49-545 Avenida Vists Bonita d'
Dear Mr. & Mrs. Williams:
Your Architectural Variance dated Mah 24, 1998.has been approved under the following
stipulation(s):,
• All work shill be done in a workmsalikc manner by competent and licensed professionals.
Actual modification must conform;to the plans and specifications submitted and approved.
All Rork is to be in compliance; with local building codes and ordinances.
• Any damage to the common areas nmulting fmm.this modification and its constriction will be
re pairod at the Owner's cxpcnsc.
• All construction debris is to be removed from the site by the close of each day to -maintain
order and retain the aesthetics of the Santa Rosa Cove.
+ All electrical wiring, if applicable, must be contained within approved condrdt pa:.nted.to match
the surface. it contacts.
•' Any alterations to the common arca landscaping, if apphcabk, must be presented to the
Association's landscape contractor. Omar Oarza of Shadow Palms Gardening.
Ptior to the oornmencemcnt of ant° work the Owncr must provide the'Association with a
refiuxkble deposit of $500.
Pwor to the commencement of any work the Owner must provide the Association with a one-
time fx of for the roof mcnsion and the exterior wall paint.
PHw to the commencement of any work the contractor and their subcontractor(s:. must provide
the Association proof of workers comp., liability and auto insurance'
• Pi►iw to the commencement of any work you or your contractor are to.provide a _ist of tures
of the scheduled worlanen'to the security guards at the Ma,zoan gate.
Please contact the Association Office once your modifications are complete bra final
inspection. A copy of the approved variance will be n=W to you after the insPectior if you have
MY questions, please call.
Very truly yours,
ameba S. Salinas
Association Manager
On Behalf of the Architectural Committee q4e 991 h;isentiuwer
THE SANTA ROSA COVE ASSUCIATIQNIUhAn. Callfurnia
G. L, Scrivans Construction (760) 77.7-7fi'�t
F'ax: (700) 777-7d2'T,
Wiling Address:
SANTA ROSA COVE ASSOCIAT* IONPtN,�! omrt pox 12710
'aim Deserl, Califurni,i 4:355
. Y