0312-046 (AR)'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
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J %qyyyyy 9 / h /////}}
Signature of Contractor
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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).
O I am exempt under,Section , B&P.C. for this reason
Date Signature' of Owner
WORKER'S COMPENSATION DECLARATION
I hereby affirm .undeCpenalty 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:
Cartier pZRjq,.jtRpD ELPLLY Policy No. w 4goAD.27
(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 J shall orthwith comply withh,those'provi'slons. '
Dater �t G Applicant +'-. *• i. ", �" w�
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, indemnity
& 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 purposes.
Signature (Owner/Agent) i, 19--:.1 (�-�'~ Date(?J
.."t'r J PERMIT#
BUILDING PERMIT
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DATE VALUATION LOT TRACT
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ADDRESS moi. -3#1.s+P1�+1*171.T P-.:. 1KACi, •
7754314W
OWNER
CONTRACTOR/DESIGNER/EN INEER
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1.,A Qt u�i rA CA 92253
LA Qi.1TNTA CA 92253
(7600175.7933 CBu 3212
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USE OF PERMIT
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CITY OF L 0,i��,1INT@e
F1HXNC E DEPT.
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K—A24 CHECK. ME 101.000.439.318 ssul
C014S'TRUCTIO 3 1L 401 f361tSK�1f5-Ql &t3t.�?0
RLEC 'MAL IME 1',01-000-420.00O $21,00
STR0140 )k3®31074 FRE - RF -SID 101-000-2410000 a9
SM-710—ML L (1098T1'cUMIaNAND PLM MECK. To155,2A
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':�'i TAL FIRMU1 FEES DUE NOW
RECEIPT
DATE
12 , `
,BY �
.
TE ED
,
INS TOR
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
m
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wali Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final —
BLOCKWALt APPROVAL
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:
CERTIFICATE OF COMPLIANCE 'A"FIED
sc
Desert Sands Unified School District �q�cS�°o
47950 Dune Palms Road ¢ BERMUDA DUNES r
Date 12/22/03 La Quints, CA 92253 Ln RANCHO
NDIAN WELLSE
I
No. 25312 (760) 771-$515 C.?_`, PALM DESERT y
V LAINTA
INDN010
Q
O
Owner Bob Osborn APN # 775-131-033
Address 80385 Pebble Beach Jurisdiction La Quinta
City La Quinta Zip 92253 Permit # 0312-046
Tract # 20717-U18 Study Area
Type Residential Addition No. of Units
Lot # No. Street S.F. Lot # No. Street S.F.
Unit 1 80385 Pebble Beach 108 Unit 6
Unit 2 Unit 7
Unit 3 Unit 8
Unit 4 Unit 9
Unit 5 Unit 10
Comments
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 (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile
homes. It has been determined that 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
in the amount of $0.00 X 108 S.F. or $0.00 have been paid for 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 Check No.
Name on the check Telephone
Funding
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Steve Ricci Payment Recd
Over/Under
Signature
NOTICE: Pursuant to Government Code Section 66020(d)(1), this will serve_ t 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 thebuikiing or installation permit for this project is issued, or from the date on which
those amounts are paid to the District(s) or to another public entity authorized-tQ.(:jj fact them on the District('s) behalf, whichever is earlier.
NOTICE: This Document NOT VALID if Duplicated
Embossed Original - Building Department/Applicant Copy -Applicant/Receipt Copy - Accounting
f
REGISTERED INSPECTOR'S WEEKLY REPORT
JON TANDY
78-194 Elenbrook Ct.
Palm Desert, CA 92211
Office (760) 772-7192
Fax (760) 772-7193
Pager (760) 776-3338
TYPE OF
INSPECTION
PERFORMED
❑ REINFORCED CONCRETE
❑ POST TENSIONED CONCRETE
❑ REINFORCED MASONRY
❑ STRUCT. STEEL ASSEMBLY
❑ ASPHALT �THER
O FIRE PROOFING
C ^
0 (�
JOB LOCATION -
l rj LA(,K-w
REPORT SEOUENCE NO.
TYPE ST UCIURRER � D ;
�G
PERMITN�O'Yj
D
03
DAY OF WEEK
MATERIAL DESC\IPTION
ARC
lEC ��
IN SPE TO
MRS. CHARGED
5
ENGINEER
ASSISTANTS
HRS. CHARGED
INSPE ION GENERAL �O ii /
DATE - CONTRACTOR (•n,l'•'
SUB
CONT RACTOR
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COPY SENT TO CLIENT O
CONTINUED ON NEXT PAGE 011/
PAGE OF
CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF W
KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE
NOTED. I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED
PLANS. SPECIFICATIONS. AND APPLICABLE SECTIONS OF THE
GOVERNING BUILDING LAWS.
W V`'
S NATUR O REGISTERED SP CT
0 03 %
ATE OF q EPORT REGISTER NUMBER