9811-113 (AR)LICENSED CONTRACTOR DECLARATION
,,V,--reby 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
590090
,? 1I00
l a e �! '! 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. 1044, 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.
a 2 . c: i' f.i.I�3'x
(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
Fode, I shall-forth"with comply with those provisions. r
Date: a *+ r... ' j f Applicant -�, t. ;�,..•€' 3• , s.
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 purpose('.
nature (Owner/Agent)
/19
%
.
BUILDING PERMIT PERMIT#
DATE VALUATION LOT TRACT
JOB SITE APN
ADDRESS 5"44 EWERN"+
OWNER CONTRACTOR / DESIGNER / ENGINEER.
ROBE E & BAkR-A:RA A.;[11Jf'Fj'vl.AN CAE:, `rFCI'3 BUILDERS
54644 iNVE4 Nfi'SS `2412 A.Or'i NIDA Vis"LAI CO
LAQUIN`IA CA 52253 LA.QCIL'I`(`I'A CA 92253
(76M)564-1309 Cit;.,•#I 402
USE OF PERMIT
RESU)14�1 UAL ADDITION
102 ;sF .RC?OM ADUi`f'iO
CUS'I'f31�I CONS CRUC11(,)N
(;2.•723 DR. CAR2MON BLVD
102.00 5F
0,1A.Tg1l
LESS PR' -PAID FEES $0,00
NOV 2 1998 TAe PERlt,U'f FFR DUE NOW S204.2E:
.-ITY OF 0w
k; f tl t
RECEIPT DATE By v i r I DATE FINALED JINSPECTOR
�4
'PERMIT FEE SUMMARY
PLAN L''HECK FEE
101.000-439-318
S643� 5
(110N3`0RUCTiON FEE
1014)(Y�- 18-009.
1.9901
M12CUANUCAL Fa
IU1400.4 .1.000
$21.50
LF -:C C;ALEE-
101400-420-00
$18,57
3TRt'►;t* G l -Lyf I JN FIX - RESID
101 -000 -241 -OW
5.79
0,1A.Tg1l
LESS PR' -PAID FEES $0,00
NOV 2 1998 TAe PERlt,U'f FFR DUE NOW S204.2E:
.-ITY OF 0w
k; f tl t
RECEIPT DATE By v i r I DATE FINALED JINSPECTOR
�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 APPROV LS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. 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:
Project Address: I (� —(��SS Owner's Name: V— I -AN
A. P. Number: Address:
Legal Description: City,ST, Zip: W0 (�,& )22%(
h
r ct r:
Tele o e:
P �.
Address: Project Description: �j) 1 I o ._ (_a2.s._..
Cont a o
q
City.ST, Zip: To. f�� (54!F )
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
N0. PLUMBING FEES
1ST FL. SO FT , $
2ND FL. SO. FT. .3
POR, SO. FT
GAR SO FT.
CAR P j0 FT .4
WALL SO FT .Z
SO ET. zi
ESTIMATED CONSTRUCTION VALUATION S
UNITS
MOSILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK^ t '
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL I
WATER PIPING
NOTE: Net to ze :,sed aS prooerty :ax ial.auon
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVARCOOL HOOD
SIGN
WASHER(AUTOXDISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT 'MALL FLOOR SUSPENDED
OTHER APPlEOUiP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
KITCHEN SINK '
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE. TEWPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER 8.T.U.
SO. FT. g. c .
BATH TUB
SO. FT. jV c
WATER HEATER
MAX. HEATER OUTPUT. B.T.U.
SO. FT. RESID 0 I+. c
SEWAGE DISPOSAL
SO.FT.GAR @ xsc
HOUSE SEWER
REMARK
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL 9EATING A AIR GOND. SOLAR
SETBACK
GROUND PLUMBING'
UNDERGROUND
A -C. UNIT
COLL AREA
SLAB GRADE •
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPnC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAIl
OTHER APPlEOUiP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
S Plus x><
=$
LUMBER GR.
FINAL INSP,
FRAMING
FINAL INSP.
ROOFING
REMARK
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATK)WSOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
' INSPEGTVKS SITiNATYNE311NIT1Al5
GARDEN WALL FINAL
Desert Sands Unified School District
47-950 Dune Palms Road
Notice: La Quinta, CA 92253
Document Cannot Be Duplicated 760-771-8515
Date 11/24/98
No. 18044
CERTIFICATE OF COMPLIANCE
APN # 769-403-072
Jurisdiction La Quinta
Owner NameRobert E & Barbara A Huffman
No. 54-644 Street Inverness
City La Quinta zip 92253
Tract #
Lot #
Type of Development Single Family Residence
Comments
Permit #
Log #
Study Area
Square Footage 102
No. of Units 1
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'the following
reason: : rr
9 � �
Residential Addition 500 Sq Feet or Less ro
Rtir 1
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to Government Code 53080 in the amou t'of r`
0.00 X 102 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
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Olivia Aguirre Exempt
Signature
Telephone 760 564-1309
Check No. N/A
$0.00
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) or to another public entity authorized to
collect them on the Dislrict('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
t
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