0306-0294 (AR)49350 Avenida Anselmo
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
645369 F3... c ' 05/31/2(
Y
Dater t`- ` 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).
( ) 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 STATE FUND Policy No. 229-OfYA047-2003
(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, I shall forthwith comply with those provisions.
Date: 1:T Applicant
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 a
whose request and for whose benefit work is performednocW
rs t to
any permit issued as a result of this applicaton agrees t
& hold harmless the City of La Quinta, its officers, ageployees.
2. Any permit issued as a result of this application becotZid f
work is not commenced within 180 days from date ucckkrr
permit, or cessation of work for 180 days will subject pellation.
I certify that I have read this application and state that the id>31Rs1correct. I agree to comply with all City, and State laws ret5dconstruction, and hereby authorize:representatives of thiter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent f ' Date / • . "
5
' BUILDING PERMIT PERMIT
-0
DATE VALUN LOT TRACT
- . • , sKIA01.40 13819
ix?iart I
,
JOB SITE
APN
ADDRESS 49-350 A1IM1DA MM
OWNER
CONTRACTOR / DESIGNER / EN (NEER
PM. n C 68sFu "
J.t1 DOI" COA15MUC7I014
49-350 AMENIDfl AbME'IM0
74.040 TfWX 11149.-297
LA QUTWA, CA 92253.
:PA iv! DEERT CA
92260
(760)340.0905 Caw
5248
USE OF PERMIT
RI 1,' MI1Ai. ADDITION
808 SF DETACHM C1U STROUSiEi'i!L 5Ir UARAOI;.T001 CBE:.
CUSTOM CONSTRUCTION 208,00 9F
POR.CI• IPATIO 190.00 SF
0 ARAdiMAR °ORT I.M. 00 SF
j
LS17`.iii416'1XD COS.tr' OF C01g911C8t1C'I:0N
80,601,40
:I''.4 t}14.IT FEE 9MIMARY
CaMSTRUCTION FF& 101-000-418-000 $554.00
PLAN CHECK FEE 1111-000-4.39-31e $449,92
kJi.F'. HANIChAL FEE 1 11 *000.421.000 $6610
I£Lir,0TRICA,I, FRP 101-000-420-000 WX
PL U It4.131NG FEE 101-0100.419.000
S TRONO MOTION IBIS. -".SID 101-000-2111-000
GRADDIO FEE 1 1 rC24 0.4 -0017 333,Op
SUB -TOTAL C01!ST11UCq1014 AND PLAN CIMMC
Toni, oni, ff'3 ' r, ns Dix wow
UINTA
EPT ' IIIIIIIIIIIIIIIIIIIIIIIII
45
moo,
IE
RECEIPT DATEBY t✓3 DATE FINALED. INSPECT
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
- - y
Ducts
Slab Grade
Z -
Return Air
Steel
2 -12 -. y
Combustion Air
Roof Deck
3 ,V-
Exhaust Fans
OX to Wrap
tv v
F.A.U.
Framing
3 —3 b -
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
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 Ones
-'—`�/
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 Vottage Wiring
Fixtures
Main Service -2 . ✓ y
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
Comments Received $1,740 - $1,729.12 = Change $10.88
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:
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to
Education Code Section 17620 and Government Code 65995 Et Seq.
in the amount of $2.14 X 808 S.F. or $1,729.12 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 Cash-J.A. Dolan Check No. N/A
Name on the check Telephone 340-0905
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Patricia Barbuzza Payment Recd $10.88
$1,740.00 Over/under
Signature Q�".
NOTICE: Pursuant to Government Code Section 66020(d)(1), 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 issued, or from the date on which
those amounts are paid to the District(s) or to another public entity authorized to collect 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
IIIIIIIIIIIIIIIIIIIIIIIII
46
CERTIFICATE OF COMPLIANCE
��l�s
IE J
Desert Sands Unified School District
�`� cy
�� o
47950 Dune Palms Road
Q eERMUDA DUNES
Date
12/15/03
La Quinta, CA 92253
CHO
RAN MIRAGE
No.
25276
(760) 771-8515
INDIANWELLS � WE
`��, P LA QUINT y
'Q INO y�
0
Owner
Pierre Cossett
APN #
631-351-001
Address
49-350 Avenida Anselmo
Jurisdiction
La Quinta
City
La Quinta Zip 92253
Permit #
0306-294
Tract #
LQGE1
Study Area
Type
Single Family Residence
No. of Units
1
Lot # No. Street
S.F. Lot # No.
Street S.F.
Unit 1 138/9 49350 Avenida Anselmo
808 Unit 6
Unit 2
Unit 7
Unit 3
Unit 8
Unit 4
Unit 9
Unit 5
Unit 10
Comments Received $1,740 - $1,729.12 = Change $10.88
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:
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to
Education Code Section 17620 and Government Code 65995 Et Seq.
in the amount of $2.14 X 808 S.F. or $1,729.12 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 Cash-J.A. Dolan Check No. N/A
Name on the check Telephone 340-0905
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Patricia Barbuzza Payment Recd $10.88
$1,740.00 Over/under
Signature Q�".
NOTICE: Pursuant to Government Code Section 66020(d)(1), 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 issued, or from the date on which
those amounts are paid to the District(s) or to another public entity authorized to collect 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
Notice:
Document Cannot Be Duplicated
Da;fe 7/16/96
No. 14649
Owner Name Bob Smith
No. 49350
City La Quinta .
Tract #
Desert Sands Unified School District
82-879 Highway 111 �illllllllllllllllllllllll 47
Indio, CA 92201 iE
619-775-3500 - — - - --
CERTIFICATE OF COMPLIANCE
Street Avenida Anselmo
Lot #
Type of Development Residential Addition
Comments
APN # 631-351-001
Jurisdiction La Quinta
zip 92253
Permit #
Log #
Study Area 122
Square Footage 68
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:
Residential Addition 500 Sq Feet or Less
EXEMPT
This certifies that school facility fees imposed pursuant to Government Code 53080
in the amount of 0.00 x 68 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 N/A
Name on the check
By Dolores A. Ballesteros
Superintendent
Fee collected /exempted by Pauline Pearson Exempt
Telephone 360=7792
`n
$0.00
Check No.
Signature Y^ -
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