403-0037 (SFD)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
701039 B MIC
Date 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
f 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.
( ) 1 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 i)Ssue.1 lYPlvt�orkers' compensation insurance coa�r�e(0& plllic To. are:
Carrier Policy No.
(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-s�hall.forthwith,comply with%those provisions I
/Date: 5, 0 " /Applicant i/f eP� , 7� y .4- r. t4?0/i!
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&-eacFi 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, ofrsuchtr;,'
permit, or cessation of work for 180 days will subject permit to. ca cellation.
„4 : _a
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.th6_61ding.,,,
construction, and hereby authorize representatives of this City to enter,`upon-
the above-mentioned property for inspection purposes.
�-Signature (Owner/Agent) (���-
Date
33
BUILDING PERMIT PERMIT
04Y3-037
DATE VALUATION ;17SSyW8.90 LOT 33 TRACT 29053-2
JOB SITE
ADDRESS 49-565 ALI C(YU.0
APN 649-52"10
i10
OWNER
CONTRACTOR / DESIGNER /EN61NEER
PJA 1Ce 38AV( yyC
am. 's Wr"Sl XpVMNG N C '
996o :1mm 1 T, awn -i 02
0968 FOBERT ST 13TE, 102
LA QUWrA CA 92.25:3
SAW =00 CA 92331
(858)653.3083 CM -0 4972
USE oT k Ci�"fi1ViJLY DQ
f1vil •V? 4 AIM ZrA ownNA. m, 1 -win o.." •1• f 1
v, 7 Ing Y1 •iT WA; I v
FOOD SPA OR DP,1VZWA -APPROACH
TRACT CONSTRUCTION �IaTjlov SP
POR-CHII)Xr10 474.790 SF
GARAMICARPORT 648,09 8k7
00145 RUC TIV34 FEE 141--0100.418.000 $905.50
PL N CNE.CK l`ZF, 101-000-439-318 V59.36
MEC:IL HIM.,z:EF, 101-000-421-000 $98,50
PLEC T RIC.&&, FILE 101-00-10-420-000 $169.52
PLUMlrf1'NG FEE 101.000=419,000 410015f1
r` p,ibw ,1 MOTION FEM'. RkSID 101-000-24.1-000 $17.50
OR1,. AIRR :PTEE . 101-W-411.000 $1:1,00
DZ;`V2LOPZrI1 IMP.A,CT TIZZ $2,405.00
FEE DEPOSIT 101.000-439.318 4750.00
t
SUE W)` AL COMMUC. 011 AND PLART OHEM-''
T4,551.08
LE33 Xr%F. • oto 11,7
-4750,00
/1 :4'3�.7J16TT 1Y=i S �J>ldlr<.i�i4�W
.801..08
G=J
MAR 3 0 2001
I III II VIII I VIII III 25
CITY OF LA QU!NTA _ IE
IFI�tARAr_F rTrn'�
-RECEIPT
DATE"� ""'
BY �
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
. •/
Ducts
Slab Grade
- / -y
Return Air
Steel ,r .-A9 —y
Combustion Air
Roof Deck
- x/
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
y
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
Finala
a
.
POOLS - SPAS
BLOC Al
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 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
_ / - -s/
Encapsulation
Gas Piping
Gas Test Z
-Z6 - S
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring _
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm) —
;ITY OF LA QUINTA '
LDING & SAFETY DEPARTMENT
777-7012
EST LINE
;` � �,INSPECTION REQU
f 777-7153
PM RENAISSANCE, LLC
Owner -
i ' T
Contractor IZ NS WEST HOUSING
I_ 0403-037
Permit Number
"POS%ON-jOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
- OURT
JOB ADDRESS
SFD - LOT 33, PLAN 3B. PERMIT DOES NOT
INCLUDE BLOCK WALLS, POOL, SPA OR
DRIVEWAY APPROACH
TYPE OF INSPECTION DATE INSP.
TEMPORARY POWER
SETBACKS - L
U/G PLUMBING / WASTE
U/G ELECTRICAL / GROUNDING
FOOTINGS / STEEL
CONCRETE SLAB -
DO NOT POUR CONCRETE UNTIL ABOVE SIGNE
ROOF NAIL / PRE -ROOF -
OKAY TO WRAP
FRAMING COMBINATION - /-
ROUGH ELECTRIC
-_ QUGH PLUMBING
iUGH MECHANICAL 6
INSULATION�-
COVER NO WORK UNTIL ABOVE SIGNED
INTERIOR GYP. BD. DRYWALL -
EXTERIOR LATH
GAS TEST
SEPTIC ABANDONMENT
SEWER CONNECTION
SEPTIC / GREASE INTERCEPTOR
MASONRY INSPECTIONS
FOOTINGS / STEEL
BOND BEAM
POOL / SPA / WATER FEATURE INSPECTIONS
PRE-GUNITE / SETBACKS
U/G PLUMBING
U/G GAS
U/G ELECTRICAL
PRE -PLASTER ALARMS /BARRIERS)
FINAL INSPECTIONS
TEMP. USE OF PERMANENT POWER
PLUMBING
MECHANICAL
PUBLIC WORKS DEPARTMENT
( ,MUNITY DEVELOPMENT DEPT.
1 _AL / JOB COMPLETED
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING
Certificate of Occupancy
Taf 4 XP QuAM
Building & Safety Department
This Certificate is issued pursuant to the requirements of Section 109 of the California Building
Code, certifying that, at the time of issuance, this structure was in compliance with the
provisions of the Building Code and the various ordinances of the City regulating building
construction and/or use.
BUILDING ADDRESS: 49-565 ALI COURT
Use classification: SINGLE FAMILY DWELLING
Occupancy Group: R-3
Owner of Building: PM RENAISSANCE, LLC
Building Official
Type of Construction: V -N
POST IN A
Building Permit No.: 0403-037
Land Use Zone: RL
Address: 9968 HIBERT ST. #102
City, ST, ZIP: LA QUINTA, CA 92253
By: STEVE TRAXEL
Date: 2-23-2005
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 9 (commencing with Section 7000) Division
PERMIT#
BUILDING PERMIT 0403-037
C WI-
of 3 of the Business and
Professionals Code, and my License is in full force and effect.
DATE VALUATION $175,008.90 LOT 33
License # Lic. Class Exp. Date
701039 B MC
TRACT 29053-2
LU
1131105
J013 SITE ADDRESS 49-565 ALI COURT APN 649-520-010
r�
Zr-
p
O' "�_
Date Signature of Contractor
OWNER
(O •
U �
OWNER -BUILDER DECLARATION
CONTRACTOR / DESIGNER / EN (NEER
PM IfENAISSANCE, LLC TRANS WEST HOUSING INC
H a
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
9968 HIBERT STET, SLIM 102 9968 HIBERT ST STE, 102
N
Z
License Law for the following reason:
LA QUI TPA CA 92253 SAN DIEGO CA 92131
() I, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure is
(858)653-3003 CBS 4972
not intended or offered for
sale (Sec. 7044, Business & Professionals Code).
as owner of the property, am exclusively contracting with licensed
USE nl FAIMY DWELJANO#
contractors to construct the project (Sec. 7044, Businqss & Professionals
Code).
N()
I am exempt under Section , B&P.C. for this reason
POOL, SPA OR DRIVEWAY APPROACH
O
Date Signature of Qwner
'
4. Q
WORKER'S COMPENSATION DECLARATION
u.) Q Cr
O
I hereby affirm under penalty of perjury one of the following declarations:
() 1 have and will maintain a certificate of consent to
TRACT CONSTRUCTION 2,873.00 SF
' X W �
0--i
self -insure for workers'
compensation, as provided for by Section 3700 of the Labor Code, for the
PORCHIPATIO 474.00 SF
GAR.'AGE/CARPORT
Q
performance of the work for which this permit is issued.
648.00 SF
UU
O
( ) I have and will maintain workers' compensation insurance, as required by
0 Q
n- LO
Section 3700 of the Labor Code, for the performance of the work for which this.
Z
permit i2j j%"- vprkers' compensation insurance 4 eI6�8�4 lino. are:
Carrier
cb �
Policy No.
ESTIMATED COST OF CONSTRUCTION75
1.
N C7
,008.90
PER.IVHT FTE SU14AURY
g
(This. section need not be completed if the permit valuation is for $100.00 or less).
CONSTRUCTION FEE 101-000-418.000 $905.50
( ) I certify that in the performance of the work for which this permit is issued,
I shall not employ any person in any
PLAN CHECK FEE 101-000-439-318 $759.56
MECHANICAL
manner so as to become subject to the
workers' compensation laws of California, and agree that if I should become
FEE 101-000.421.000 $98.50
ELECTRICAL FEE 101-000-420-000
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.
$169.52
PLUMBING FEE 101.000.419-000 $180.50
Date: Applicant
STRONO MOTION FEE - RESID 101-000-241-000 $17.50
Warning: Failure to secure Workers' Compensation coverage is
GRADING FEE 101.000.423.000 $15.00
unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in$2,405.00
DEVELOPER IMPACT FEE
addition to the cost of compensation, damages as provided for in Section 3706.
FEE DEPOSIT 101-000.439-318 $750.00
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 p'er'son upon whose behalf this application is made & each person at
whose
SUB -TOTAL CONSTRUCTION AND PLAN CHECK $4,SS 1.Ot3
�1
dao
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
LESS PRE -PAID FEES -$750.00
& 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
TOTAL PERNIlT FELT S DUE NOW $3,801.08
: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
IIIIIIIIIIIIIIIIIIIIIIIII 26
construction, and hereby authorize representatives of this City to enter upon
IE
the above-mentioned property for inspection purposes.
RECEIPT DATE BY DATE FINALED INSPECTOR
Signature (Owner/Agent) Date