9708-117 (AR)LICENSED CONTRACTOR DECLARATION
I 4areby 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 Ezp. Date
Date Signature of Contractor y
OWNER -BUILDER DECLARATION '
I•hereby affirm under penalty of perjury that I am exempt from-tFie 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,;Business & Professionals
Code). ,
O 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 mintain a certificate of'consent to self -insure for workers'
.compensation, .as provided for by Section 3700 of the Labor Code, for the
Zeclormance of the work for which this permit is issued.
I have and will maintain workers' compensation insurance, as required by
ion 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.'.WQ.l.`7W10,
(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
wo ers' compensation laws of California, and agree that if I should become
s,Object to the workers' compensation provisions of Section 3700 of the Labor
ode, l sshall'forthwith comply with those provisions,
Date:. t t " Abplicantf' .�. a------ `-
i f, _
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
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 represeantatives of this City to enter upon
the above-mentioned property for inspection purposes. `
Signature (Owner/Agent) '''� ^ }-'" date
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BUILDING PERMIT PERMIT #
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DATE. I! ( VALUATION :5,430 Q - LOT TRACTqT
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APN
ADDRESS
OWNER
CONTRACTOR/DESIGNER/ENGINEER
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I RECEIPT
DATE
BY
DATE FINALE
INSPECTOR
OPERATION
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 Az 7
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
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
f Desert Sands Unified School District
Notice: '82-879 Highway 111
Document Cannot Be Duplicated
Indio, CA 92201
619-775-3500
CERTIFICATE OF COMPLIANCE•
Date 9/10/97 APN # 773-350-050
No. 16068 - Jurisdiction La Quinta
.Owner NameMr. & Mrs. Cabreia Permit #
No, 49-573' Street Avenida Vista Bonita t Log #
City La Quinta Zip 92253 Study Area,
Tract # Lot # Square Footage 100
Type of Development Residential Addition No: of Units 1
Y -
t ,
At the present time, the Desert Sands Unified School District does -not collect'fees 'ori ga-ages/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 tirre 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 in the amount of
0.00 r X 100 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 new be issued
. 2
' . Fees Paid By N/A� ' Y
Telephon `"349-3327 {
Name on the check'
By, Dr. Doris Wilson
Superintendent
Fee collected /exempted by Ellen Patino Exempt $J OGS
0 G. � ; ►�
Signature �U GJ _ .
Check No. N/A ' r�
Collector: Attach a'copy of county or city plan check application form to district copy for all -aivers.
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy -Accounting - ' {
<� N rZ, � 7'5)
March 14, 1941
VIA
VA
CkMX (41319044596) AND M31 CLASS MAS
ChucklandLinda Cebrera
' 330Be�evita8•Avenue- .
Belvedere, California 94910
R0; 44-473 Ave*Ada. Vista. Bom(ta
fear Mr.. 8t Mis. Cabrera; • . .
Your Architectural 24; 2997' has'been apprgved und& the fb4o*iog
stipulation(s):
•
All work sball be doneAn a workmanlike manner'by contpatent rad licsns®d Professionals,
•' Actual'.mo&firation must oodorm to the plans and'spocifications submitted and apobvld:
• All cuotk is to be in compliance with local building codes and ordinances.
Any dung to the common areas resulting Som this modification and its construction will be
repaired at the Ownex's exyeaee•
• Contractor most provide the Association proof of worker's pomp, liability and auto insvauce prior to
the comiaendement of any work.
0 . You or your contractor sre to proOde a list of nil es,of the,scheduled workmen to the Wcurity guards
at *9 uWadan Geos yrlor to•the oominonceatent off anywork•
• , All constraotio udebris is to be removed frwtthe site by the close of•each day to maintain order and
retain die•aesdwtics of iW,SaMRooa Cove.'
Alk uric it %i ring, :if applicable,, must be cohtainod within approved conduit painted• to snatch the
surfoe it contacts,
Any alterations to the common area jandscaping must be presented,to the Associaoon'a landscape,.
•conutow, 01M G=a of Shadow Palms Gardening.
All 4rdwarp muss match in style and color with the exi!ag hardware:
A oopy of the approrved.variance will be mailed to jou after the final inspection. Please ecmeaet -
the Association Ofoe when -your modifi"ons.are dompleW..If you have any.quesdons, 01066 call me. ,
Very Yours.
la S. Salim
= Assooi&pManager on.ts.abalfof
THE ARCHITECTURAL CONIA+MMEE .
cc: Greg 5crlvens; 0. L. Scrivens Qonstruction
• .: . 49=691 Eieenhor,pr' , •
. - La;Quints,.Califoinie -•
(819) 71!4521
. Fre: (618) 7.771-.7629
Milling Addrem .
-SANTA ROSA COVE ASSOCIATION Falm-NON, Cal fornia 1M69
�,d SNI ',3Ndda Hj.IWS. WdS'[ 2T G6. EL. zntj