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9606-138 (AR).y 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 5900910 Date Signature of Contractor•_Z-e_cY r r A.J,.,: 0 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. (Xyf 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 t•cy a� a,; itI'r&i'ty?jyr permit is°fs�s�ed. MyVl compensation insurance carrier & policy cy no. are: Carrier Policy No. (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 3700 of the Labor Code, 1 shall forthwith comply with those provisions. � Date: k 172/ Applicant -..n;,...-`1 � 14—_J_ � J-1 at:' a t � 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 pur�p}oses. Signature (Owner/Agent)!:: • �.1C='• { Date �1 ko BUILDING PERMIT PERM'9-IM DATE 45126/96 VALUATION ,Pj009.90 LOT JOB SITE ADDRESS 0 574 Vf 4TA 601NI T A OWNER CONTROL# TRACT V 6 2 1 CONTRACTOR/DESIGNER/ENGINEER '% f3 -,3'S0-006 LA OUN`!'A. CA 92253 TA. QUJT,1 [A. CA 92251 f7,l:ti75�1ri�1 41 (615)%4-1309 CaLo 402 USE OF PERMIT 81 K .�, F 1`:. KESIDI N'1'IAL X11>6131014. ES`i`iM'i°'4;i1)MST OF CONSTRiftt.". ON11 PRXIdgIT O'ld E S#;.MfV3H1RY c©13muc TioN to m, 101 2000-4iS-wo $<►o.bo S'i O 10, UnCI 104111 REE RESTI) 101 1-M-0211 5.63 P1,AN CkfE'CK.1-lits 10.1 0()4)4114'-31# SUB -TOT AL CGNSMUC"RON AND PLAN CHECK sJUN 2' 1996 BY RECEIPT — BAT == ' I BY I DATE FINALED . I INSPECTOR 6,3ot- . o s15(1,9"7 $0.00 INSPECTION RECORD 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 Exhaust Fans OX 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 Fixture- , -Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) COMMENTS: Desert Sands Unified School District Notice: 82-879 Highway 111 • Indio, CA 92201, Document Cannot Be Duplicated 619-775-3500 CERTIFICATE OF COMPLIANCE Date 6/25/96 , ' APN # 773-350-006 No. 14639 Jurisdiction, La Quirita: "Owner Name William T.,O'Brien Permit # . No. 49574 Street Vista Bonita Log # City La Quinta Zip 92253 Study Area 109 * Tract # Lot # Square Footage 81 ' Type of Development Residential Addition No. of Units 1 Comments , atrium enclosure At the present time, the Desert Sands Unified School District does not collect.feeE 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 _ R This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of 0.00 X 81 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 N/A --'Telephone 564-1.309 - y Name on the check By Dolores A. Ballesteros r• V ' Superintendent Fee collected`/exempted by Pauline Pearson Exempt `' *.00 Check No: ` N/A Signature 1j � Live 4 - t -4-k kq d/Y\— 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 June 25, 1996 c) Bill O'Brien . 49574 Avenida Vista Bonita - La Quinta, California 92253 " Re49574 Avenida Vista Bonita Dear Mr. O'Brien: Your Architectural Variance dated June'l 1, 1996 has been approved with the following stipulation(s): • All work shall be done in a .workmanlike manner by competent and iic,en' - professionals. Actual modification must conform to the -plans and specifications submitted and approved.. _• •. ; All work is to be in compliancewith local building codes and ordinances. Y Any damage to;the common areas resulting from this modification and.its constructi)n will be repaired at your expense. •. Weep screedswhere foundation and patioconnect must not be covered.. • Contractor, must provide the Association proof of worker's comp., liability and auto insurance prior to the'commencement of any work. • You, or.your contractor are to provide a ,list of names of the workmen for the security guards at the Mazatlan Gate. • 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 electri'cai wiring, if applicable, - must be, contained within approved conduit painted tomatch the surface it contacts. • Any alterations to the common. area landscaping must be presented to the Association's landscape contractor, .Omar Garza of Shadow Palms Gardening.. A copy of your approved variance is enc(osed'.�Please contact the Association Office wherj your modifications are complete. If you have any questions,�please do not hesitate to contact tLe office. at the . number printed below. Sincerel o Pamela S. Salinas Association'Manager THE SANTA ROSA COVE ASSOCIATION /pss Enclosure xc: _ Cal-Tech Builders y Files .. 49-991. Fisentiotivr,.r La, Quinla. California (619),777-76 Fax:. (614) 777-7622 klailing Address: SANTA ROSA COVE ASSOCIATION P��sl alfi�e ltnx 12710 Palm 1)escrI California 922ii '