9903-258 (CONR)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
'D'ate Signature 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).
(r) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business k Professionals
Code). 1
O I am exempt tinder Section f�&P.C. for this ea'som _V_
µ
Date � t � Signature of Owner _ '
WORKER'S COMPENSATIDEC
LARATION
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.
(This section need not be completed if the permit valuation is for $100.00 or less).
(N,) 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, I sh II forthw'th comply w,'tla those provlslons.
Date. -' '- !Applicant
V. r
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"Insp'ection purposes.
Signature (Owner/Agent `�o.�--�
PERMIT#
BUILDING PERMIT
"03-2.58
DATE`.' - VALUATION $35,M9•on LOT TRACT
JOB SITE
ADDRESS 50-100 �.�a'�i�N IDA VISTA UONU�.
APN 773-026.-017
OWNER
CONTRACTOR / DESIGNER / ENGINEER
` 150 PGA BLVD
IA (NTA CA 92253
r
USE OF PERMIT
Ct)A+ 1P1C'I*'1L
GCJLF INSTRUCT -1014 rAfat ING (614 DR Ni+.:>'Dt~il. kR
VAi.,tdXI710114 I _Gt3l;.Gf) LS
I$STTR9A'f.ED CONT T 0$' CON`3TRUCTI:DNN
35100 109
PERNUTFRE SUMMARY
.PLAN ClACM.F U7? 101-000-430-318 S206.01+5
MCI :[ANICAL .r11U, 101, -CT3:1.� v'-t�EifJ �i4.Ut
UEC'RUCAL FEI; 101410 01-420-000 $45.32
CJKAp3.` NG M, T Ot-000-423-wj $s fl,or)
STRO140 MOTf:C3Af t?rN - WWI 1, OM00-241-000
803MYTAL C,'ONS1103MIGN AND PT.t'•N CH-ECK
'SF�43.7'l
LESS PRE -PA11D RES
so(X)
',I't?'.6'E1.L PERMIT YETS DUE NOW'
%643.72
RECEIPT
DATE
BY•'•
DRi
DATE FI ALED
-71 ff
INSPECTOR
4
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
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 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 Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
Desert Sands Unified School District
47-950 Dune PalmsRoad .
Notice: La Quinta, CA 92253
Document. Cannot Be Duplicated . 760-771-8515 -
CERTIFICATE OF COMPLIANCE
' Date 3/30/99 APN # 773-021-037
No. 18517 Jurisdiction Ta Quinti
Owner NameJim McLean Golf . Permit #
No. 50-200 Street Avenida -Vista Bonita Log #
City La Quinti zip 92253 Study Area
Tract # Lot # Square Footage 616
Type of Development Commercial No. of Units 1
Comments.
At the present time, the Desert Sands Unified °School District does not collect fees on gzrages/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 tine, due to the following
reason: '
' _ yyy 777yyy...
r. EXEMPTION NOT APPLICABLE;`
' , . • .' ifs � .t+' C >t"'
This certifies that school facility fees imposed pursuant. to Government Code 53080 i1 the amount o ,
• � .� �, n, ., jet',
.31 X ' 616 or $ 190.96 the property listed above and that building s'
.permits and/or Certificates of Occupancy for this square footage in this proposed project may row be issuedR�4' +� J
Fees Paid By cash, Telephone 564-7144 '
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Adriana Gauto Payment Received $190.96,
Check No.
,Signature
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 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) o• to another public entity authorized to
collect them on the Dislricl('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,
{
41
At the present time, the Desert Sands Unified °School District does not collect fees on gzrages/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 tine, due to the following
reason: '
' _ yyy 777yyy...
r. EXEMPTION NOT APPLICABLE;`
' , . • .' ifs � .t+' C >t"'
This certifies that school facility fees imposed pursuant. to Government Code 53080 i1 the amount o ,
• � .� �, n, ., jet',
.31 X ' 616 or $ 190.96 the property listed above and that building s'
.permits and/or Certificates of Occupancy for this square footage in this proposed project may row be issuedR�4' +� J
Fees Paid By cash, Telephone 564-7144 '
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Adriana Gauto Payment Received $190.96,
Check No.
,Signature
NOTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified
above will begin to run from the date on which the building or installation permit for this project is sssued or on which they are paid to the District(s) o• to another public entity authorized to
collect them on the Dislricl('s)(s') behalf, whichever is earlier. ..
Collector: Attach a copy of county or city plan check application form to district copy for all waivers.
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting,
{
CITY OF LA QUINTA SUB -CONTRACTOR LIST ' 41 - 143 tis
JOB AIDPRA$ PERMIT NUMBER OWNER BUILDER -7,'[his form shall the with the 601ding Inspeci6oh Card at all tomes in a conspiruous 31R8
. Only persons appearing on this. list or their employees are authorized to work
on this job. Any changes to this Jist' must be approved by the Building Division prior to commencement of work. Failure to comply will result in a stoppage of work and/or the voidance
.:u:__ _ c.......,.. ......Ii....L.le...�.le SII ;-4-. +inn . nctnri F%aln.w, meet ho r mnlolarl by annlinant "On FiIA" is not an accentable response. '
Trade /Classification
Contractor
State' Contractor's Ucense
Workers Compensatiominsurance.:
C� ` Busln9ss'License >..;
Company Name
Classification
(e.g. A, B, C-8)
License Number
(xxxxxx)
Exp. Date
(xx/xx/xx)
Carrier Name
(e.g. State Fund, CalComp)
93
Policy Number
(Format Varies)
Exp. Date
(xx/xx/xx)
License Number
(xxxx)
Exp. Date
(xx/xx/xx)
EARTHWORK (C-12) X AlIW
Cr w
l� 1 Z
( ODDS
(31 o I
6c,%dzrt EA4.1-
t-Iw -tS C>33-
n' 31
I I - za'�
—1
4 r
co
CONCRETE (C-8) 7<"
i g—
1
� y S� toZ J
tl / C
LEGIONAl,G
—
-
l's
fQ JC1
FRAMING IC -611
STRUCT. STEEL (C-61)
MASONRY (C-29) . X
T S ' r.
G Z l
400937
3 / o0
0l r o0o Z�
/I
gb
2 2 po
PLUMBING IC -36)
LATH, PLASTER (C -35),X 12t4
n
(i . ,N
G �S
o
'/1!z #I C> r.7r
L.� rel - 973 5Y01
CIIb / / q-1
4014
12
DRYWALL (C-9)
HVAC (C-201
I00) X
1
iB
2qELECTRICAL
ROOFING (C-39)
SHEET METAL (C-43): `.
FLOORING (C-15)
GLAZING (C-17) '
INSULATION (C-2)
SEWAGE DISP. (C-42)
PAINTING IC -331 d"
e �'
T/3
p qp
(/1�9rrEq pF1UFlG
✓J /� 0200
.I ,I 00
UST
'14454-
Ig 00
C
CERAMIC TILE IC -54)
CABINETS (C-8)
FENCING IC -131 '
LANDSCAPING (C-271
.inl. (C-63)