9905-264 (AR)LICENSED CONTRACTOR DECLARATION
I hu"' 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
010343 B %1L3'
lk
Date �- t �, Signature of Contract6J - L
OWNER -BUILDER DECLARATION
/
I hereby affirm under penalty of perjury that I am exempt from the Contractor's i
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 Sianature 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 tt Policy No. yy ++ ���p�
i,iA _ I. VS 4D 0613"DYMVf1f -201
(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
Cdde, I s all forthwith comply with those rovi ions'
/Date: APPIicaR
Y �., ..
Warning: Failure to secure Workers' Compensation coverage i 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 ate
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. 1,agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
theabove-mentioned property for inspecti n purposes.
ignature (Owner/Agent �.I
hy,
BUILDING PERMIT PERMIT#
DATE � VALUATION S9,A 14.30 LOT TRACT
JOB SITE I/`
APN
ADDRESS x,.041 AV.FT 'AVISTA INITi,
631-7.10-05-3
OWNER
CONTRACTOR / DESIGNER / ENGINEER
C RARLES N11R'f`ONE
OLD F ASH'TClN C R AFt' RAN, INC.
1030 ELSB%tEE LN
41-881 BEACONHILL, STEL A4
WINDSOR. CA. 95492
PALM DM WC CA 92211
(760) r 7340)19 C: g. 1847
USE OF PERMIT
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117 S.F. Ia.00M ADDITICA4
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$21106
.ATY OF to QU[NTl��_�1,. 'r
RECEIPT
DATE
:eY !
DATE FINALED
INSPECTOR
rg
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 C
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
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
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
,#i57.,. i''i::tii"y:;'yYK;;l"4 (i')},} �'�hti�- •v `aM r +
- ; Desert Sands Unified School District
,;. { 47-950 Dune Palms Road .
Notice: La. Quinta, CA'92253 ,
r
Document Cannot Be Duplicated 760-771-8515
CERTIFICATE OF COMPLIANCE
Date 5/18/99 APN # 631-710-050
No. 18777 Jurisdiction La Quinta
Owner NameCharles Parton Permit #
w
No. 50-092 Street Avenida Vista Bonita Log #
City La Quinta Zip 92253 Study Area
Tract # Lot # Square Footage 117
Type of Development Residential Addition No. of Units 1 _
Comments 117 sq. ft. addition to singe tarmly residence
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered
patios/walkways, residential additions under 50.0 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 in the amount o{j4���,
0.00 X 117- or $ 0.00 the property listed above and that buildingw -t '•,
permits and/or Certificates of Occupancy for this square footage in this proposed projec- may now be
i
'
�7
Fees Paid By N/A Old Fdshion Craftsman, Inc. '' Te_ephone 77f3`51019 r �'
Ys f ,
Name on the check �t r ,�•14s
By Dr. Doris Wilsonr� = r .
Superintendent �+ ��,,�� �f ss � •�y
-Fee collected /exempted by Juanita Green Exempt $0.00
Check No. N/A
Signature
NOTICE: Pursuant of As mbly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 -day approval period in which yon may protest the fees or other payment identifiedabove 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 Distict(s) or to another public entity authorized to
collect them on the Districl('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
h
05%16/99 SLi\ 12: 25 F:AX 760 564 8418 S.Al\T.A ROSS COVE SECURITY Z001
May 18, 1999
Charles & Lynda Partone
50-092 Avenida Vista Bonita
La Quinta, California 92253
Re: 50-092 Avenida Vista Bonita
Dear Mr. Partone:
Your Architectural Variance dated March 28, 1999 regarding the room addition inside your courtyard
area has been approved under the following stipulation(s):
Actual modification must conform to the plans and specifications submitted and approved.
• The roof addition shall be, installed by Western Pacific Roofing.
The color of the walls shall match the existing stucco Surrounding the new walls),.1
• Competent and licensed professionals shall do all work in a workmanlike manner.
• All work is to be in compliance with local building codes and ordinances.
• All electrical wiring, if applicable, must be contained within approved conduit painted to match the surface
it contacts.
• Airy damage to the common areas resulting from this,modification and its construction will be repaired at
the Owner's expense. -
• 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.
Any alterations to the common area landscaping, if applicable, must be presented to the Association's
landscape contractor, Omar Garza of Shadow Palms Gardening.
•
Prior to the couunencement of any work the contractor and their subcontractor(s) must provide the
Association proof of worker's comp., liability and auto insurance; naming the Association as additionally
insured.
• -� Prior to the commencement of any work you or your contractor must provide the names of the scheduled
workmen to the security guards at the Mazatlan gate, (564-5414).
Prior to the commencement of any work you or your contractor are required to pay,a S500 refimdable -
deposit for the room addition.
Prion to the commencement of any work you or your contractor are required.to pay a one time fee of $5 per
square foot for the new roof area, as wet[ as provide a five year written guarantee covering the new roof.
Please contact the Association office once your modifications are complete for a final inspection. A copy of
the approved .variance will be mailed to you after the inspection. If you have any questions, please call.
Very truly yours,
Pamela S. Salinas
Association Manager
On Behalfofthe Architectural Committee
THE SANTA ROSA COVE ASSOCIATION
-t9 -9y1 Eiseni�r,,�s,cr
La Quinia.. Califrrnia
Michael Dobrensky / Old Fashion Craftsman (760) "7-7621
Fax: (760) 77"•76 2
klailine Address:
SANTA ROSCOVE ASSO IIO�POS101ficeHas
12710
Palm Desert; California 52'55