04945 (SFD)Building
Address
Owner
Ronald ?i,ekaar
T4hf 4 4 Q"
Mailing
Address 51-330 iterrt_
City Zip Tel.
Contractor
Address
City
State Lic.
& Classif.
Arch., Engr.,
Designer
Address
City
Zip I Tel.
Lic_ #
Tel.
Zip (State
Lic. #
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
SIGNATURE DATE
OWNER -BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5.8usiness and Professions Cado.' Any city dr county which requires a
patmil to fQ construct. alter, lmpreve, domoh, of repair any sDzrcfure. prior to Its lssuanca also
inquires (ire applicant for such permk to fine a signed statement that he a licensed pursuant to
the provisions of the Cwlmcfor's License Law, Chapter 9 (commencng with $action 7000) of
&vision 3 al the Business and Protessions Code, or that he is exempt lherefrum, and the basis
for the aNeged exermtkrrr. Any vldaiioo of Section 7031.5 by any aPpr+ra+t for a permit
sutlgecta the app6cenf 10 a cfv'7pwtalty of not moro than five hundred donam J$500).
G 1, 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 saie. {Sec. 7044. auisness and
Professions Code: The Contractor's License Law does nor apply to an owner of properly who
b0ds or koproves therew and who does such work hfmselr or through his own employees,
provided that such arrprovements are rmf intended or offered for salve. N, howaver. (he brgdfig
Of impmvan*nf is sold within one Year of completion, the o w+er•buirder wNl have rhs burden
al proving (hat he dirt not barrld or improve for the purpose of sale.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and Profmsst ms Code: The Contractor's License Law
does nor apply to an owner of property who bulds or improves thereon, and who contracts for
such projects with a contraclor(s) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec B. & P.C- for this reason
IDate Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, tabor Code.)
Policy No. Company
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS'COMPENSATIONINSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of thg 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 CalttornIa_
Date Owner
NOTICE TO APPLICANT- 11, agar making tries Cerlfhcate of Exemption you should become
subject to the Workers' Comperrsalim provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Chd Code.)
Lender's Name _
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certify that I have read this application and stale that the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this city to enter the above -
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address _
City, State, Zip
No. 04945
BUILDING: TYPE CONST. OCC. GRP
Number 774- '--: 1
ILegal Description
Project Description
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
si, 669
PERMIT
AMOUNT
Plan Chk. Dep.
5 ? 7 ;] r i,
Plan Chk. Bal.
Const.
Mech.
71 ( . ;] 0
Electrical
76.64
Plumbing
112.00
S.M.I.
S . 7 r;
Grading
2'711.00
Driveway Enc.
2 n . I ()
Infrastructure
1,921.80
TOTAL
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by; Date 1 2 / " / ",Permit
Validated by:
Validation:
Desert Sands Unified School District
+� ^ CERTIFICATION OF PAYMENT
11 3 V �1�.�7 4 OF
BE Ijr SCHOOL FACILITY FEES
TO: City of La Quinta DATE:
Department of Community Development
78-105 Calle Estado
La Quinta, CA 92253
v
L-�- z
This is to rtif t%-a
developer of ' , which is
located at &/ ) within
this District, has paid school facility fees imposed pursuant to the
au hority genera t by Gvv rnment XdeA t . ojiyE080 in h ❑ nt of
$ ( C�rDli
covering a total of re feet of [ re ential or
( ) industrial/commercial development and that bui - ing permits for
this footage in this development may no -be issued by your juris-iction.
Lf'o'r SERT SANDS UNIFI SCHOOL DISTRICT
White - Buildin Deplartment ■ Yeflow -FFjaccHiities Planning • Pinkl- Accounting i Gold - veloper
71( 10)-37
ION D
SECTION C
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