403-0036 (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 MC 1/31105
Date Signature of Contractor �' i• /
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.
(y) 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
,3isne .11v�l r workers' compensation insurancec l ert&�p�olicyj4 o. 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 shall forthwith comply with those. provisions.
,Date: 25 G /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 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 purposes.
Signature (Owner/Agent) ! *' f . �. Date
1
32
BUILDING PERMIT PERMI0403-C,16 T
DATE VALUATION $156,0(X)R % LOT �' TRACT �9 -
;,-- r,1
JOB SITE 49•'r05 ATA COQ RT
APN E47 9-51"101
ADDRESS
OWNER
CONTRACTOR / DESIGNER / EN (NEER
I'm rm1pI: sANCr., Luc
9968 DOW M -En, SILUM 102
9968 FffBr, ffF ST ME 102
LA. QTJiNTA CA. 922.53
BM DX, GO CA 92131
(856f�53-3003 CB1,4 4.972
USE O S.fTI, nw..x , ,e Jiwu v
1,19r1 - C n1l q +r .A't.) 9r•6 Y)[D I!A 't'' )•1r1 C'A'ICY 1
Xlr'.1 !':Fl R 1 tr`Y'
WdAI,I, P004 SNPA OR DRUL Aid APPROACH
TRACT C ONSTRUMION n580100 LF
1'C,t12.C.'I•i PATIr..I` 329,00 S
(kJkRA(,R? CiARPPP,T 189,00 Sl°
xSIT0.!rNm tour (Yr CONSIMUC17011
¢;a(�:1C31f.BJ
liffFY� t%' fi'1�E SUAC"Ry
CUNS` MICTION FEE 101-000A1 8-000 $839,01
PLI04 CHECK FRE 006.03
MFIC11KNICIALFEE 161-€100-421-000 $921G0
?-,1.ECTFUCA1.,F'ZZ 141_000-420 000 3158.02
P111110IN0 FFF. 101.000.419.000 S174,iff
STRONG 1MOTIONf Firm- RTSID 101-000-241-000 $15.60
-
0RUWANCI FEE 161-i O-423-000 $ x.00
WE DEPOSIT 101.000.439-318 _M0100
SUIB-TOTAL C 014S`.MUCTION AND PIF.M C%ZCX
$4,465.21
LESS PRM -PAM VNES
4/50.00
sl nTYKES IYUM Now
P��AR 3 0 200�i~
r
CITY C" LA I IIIIIII VIII III I II IIII 17
CLri"1i,1
Ft"�APtCc D' ,IE
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD,
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
- / - N
Ducts
Slab Grade
y -/ -y
Return Air
Steel
-/9-4,
Combustion Air
Roof Deck
-
Exhaust Fans
O.K. to Wrap
v _
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 ?3_ o
BLOCKWALL APPROVALS
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
• r S
Heater Final
Water PipingPlumbing
Final
Plumbing Top Out
- -
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
- S
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:
Coll
Certificate of Occupancy
Idcasronhn
wss
OF'T9� 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: 49-535 ALI COURT
Use classification: SINGLE FAMILY DWELLING Building Permit No.: 0403-036
Occupancy Group: R-3 Type of Construction: V -N Land Use Zone: RL.
Owner of Building: PM RENAISSANCE, LLC Address: 9968 HIBERT ST. #102
City, ST, ZIP: LA QUINTA, CA 92253
By: STEVE TRAXEL
t^ate Date: 2-23-2005
Building Official
POST IN A CONSPICUOUS PLACE
O� 0
-, CITY -OF LA QUI.NTA
?BUILDING & SAFETY DEPARTMENT
c �
F �^� of r+�° 777-7012
INSPECTION REQUEST LINE
777-7153
Owner PM RENAISSANCE, LLC
Contractor TRANS WEST HOUSING
Permit Number 01103-036
POST"ON JOB IN CONSPICUOUS PLACE
`= --.INSPECT-OR-MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 49-535 ALI COURT
SFD - LOT 32, PLAN 2CR. PERMIT DOES NOT
INCLUDE BLOCK WALLS, POOL, SPA OR
DRIVEWAY APPROACH
TYPE OF. INSPECTION I DATE I INSP.
TEMPORARY POWER
SETBACKS -
U/G PLUMBING / WASTE --/ 3 - y
U/G ELECTRICAL / GROUNDING L -
FOOTINGS / STEEL
rinAlf`DCTC QI AR
DO NOT POUR CONCRETE UNTIL ABOVE SIGNED
ROOF, NAIL! PRE -ROOF G - - 4t,
O ` Y TO WRAP —2
FRAMING COMBINATION
ROUGH ELECTRIC
UGH PLUMBING
GH MECHANICAL•
INSULATION %-% - 1Y
COVER NO WORK UNTIL ABOVE SIGNED Al
INTERIOR GYP. BD. DRYWALL - 2,2 .�
EXTERIOR LATH
GAS TEST ^'lei --15
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 I I J'
PLU
PUBLIC WORKS DEPARTMENT I � - C,' --,.
"MUNITY DEVELOPMENT DEPT. a 5
i L/ JOB COMPLETED • 2 3 A� 1
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING
L-6. r-140CU %,UI'4 I KAL; I UH UIZULARATION
C/) I hereby affirm under penalty of perjury that I am licensed under provisions of
H Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
04
W Professionals Code, and my License is in full force and effect.
p O Licens91039 BLss Exp' lIQS
LLJr
Z r Date Signature of Contractor
(D 0
J U OWNER -BUILDER DECLARATION
W a n I hereby affirm under penalty of perjury that I am exempt from the Contractor's
U) License Law for the following reason:....
Z. ( ) 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).
M () I am exempt under Section B&P.C. for this reason
N Date Signature of Owner
0)a Q WORKER'S COMPENSATION DECLARATION
io Q cc I hereby affirm under penalty of perjury one of the following declarations:
H- p () 1 have and will maintain a certificate of consent to self -insure for workers'
X W �= compensation, as provided for by Section 3700 of the Labor Code, for the
Om � Q performance of the work for which this permit is issued.
Q U ( ) I have and will maintain workers' compensation insurance, as required by
O 0 Q Section 3700 of the Labor Code, for the performance of the work for which this
n C, Z permit iQrA3Z-T I0Drkers' compensation insurance =4648OM92ho. are:
Carver - Policy No.
r- C
g (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: 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 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
dao & 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.
(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) Date
BUILDIN9nEnR^IIIIT PERMI #
1403-036
DATE VALUATION 1 1000 0 LOT 32 TRACT
29053-2
JOB SITE
ADDRESS
APN64!r-520-010
OWNER CONTRACTOR / DESIGNER / ENGINEER
PM RENAISSANCE, LLC TRANS WEST HOUSING INC
9968 HEBERT STREET, SUTTE 102 9968 HEBERT ST STE, 102
LA QUINT CA 92253 SARI DIEGO CA
92131
(858)653-3003 CB1,4 4972
USE 8RgE0NZ FAMILY DWELLING
SFD - LOT 32, PLAN 2CR. PERMIT DOES NOT INCLUDE BLOCK
WALLS, POOL, SPA OR DRrVEWAY APPROACH
TRACT CONSTRUCTION $580.00 SF
PORCH/PATIO 328.00 SF
GARAGE/CARPORT 584.00 SF
EFIIMATRD COST OF CONSTRUCTION
-156,000.80
PPRIVIIT FET SUBU4ARY
CONSTRUCTION FEE 101-000-418.000 $839.00.
PLAN CHECK FEE 101-000-439-318 $706.03
MECHANICAL FEE 101-000-421.000 $92,00
ELECTRICAL FEE 101-000-420-000 $158.08
PLUMBING FEE 101.000-419-000 $174.50
STRONG LOTION FEE - RESID 101-000-241-000 $15.60
GRADING FEE 101.000.423.000 $15.00
DEVELOPER IMPACT FEE $2,405.00
FEE DEPOSIT 101-000.439-318 4750.00
SUB -TOTAL CONSTRUCTION AND PLAN CHECK
$4,405.21
LESS PRE -PAID FEES
-$750.00
TOTAL PERAM FEES DUE NOW
$3,685,21
IIIIIII VIII III VIII IIII 18
IE
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR