403-0038 (SFD):t
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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 :13 Bic � 1131105
Date '4 —� _G r Signature of Contractor /Ir'�'
OWNER -BUILDER DECLARATION i
I hereby affirm under penalty of perjury that I am exempt from the I ontractor's
License Law for the following reason: 0
( ) 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 sof .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 STATS :BUND . Policy No. 000.1548/1:0-02
(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 I f
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.
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Signature (Owner/Agent) ter fir' r1Yr•�� Date '7- -Zi `''
3�
BUILDING PERMIT PERMIT#
DATE VALUATION LOT TRACT
S145,,�S95. " S4 291053-2
JOB SITE
ADDRESS $!2 .sem df LI C.0UWr
APN
C49W_Jq lo
OWNER
CONTRACTOR / DESIGNER / EN (NEER
PIA RMIMS ANC E, LIQ
UZANS 'F.S'fi IiOUaING 19C
9968 IMBERT MIRIFT, UUME'l 02
9968 IRBETIt'T ST ST'S, 102
L.AQUI TA CA 92253
9AN DIE00 CA 42131
(858)653-3003 C B14 4972
USE OF PERMIT
NI.Q • LXYr :J+1. FLJLN LAX. PEFUTITF i 000 NUT INCLUDEF Alia: ur,
t�'.ALIA Pt 3C 4 -SPA OR 0R1WWAY APPROACH
OCH
TRACT C•O'NS°ik1;UC: ION Z462.00 SP
P01tcHff)Xr!0 ; 216.00 5F
O.ARA.GE/C.A1'11$ORT SF
i+ a TRD Cob- .' 01 Comm'E'!C'•°rlo-r'
145,59S400
CONSTRUCTION FEB 101.:000.414.000 5:100150
PI—KN CFi1:.+r"K FE is 101 _00("39-31 9 $672.21
MsEO-H;A141CAL FEE 101-0100.421-000 $85.30
ELEC1"1:1CA1.. ME 101-000-420-0W $i191.39
PL;1.}1! IDYNO FREE 101-000.419-000 $162,50
ST1 ONO MC ITTOh' PLIE - ? ESI'D 101 ••000-241-.000 '$14.56
ORALDIM PEZ 101-000-423-000
DEVELOP 110ACT 1 137 $2,405.00
FEF i,1E1'GW 101.000-439-318 _M0.00
SUB -1 i`� � AL COiS 'iitT.TC''CiC?t+i aM .PL A N C.IMM
TA.306, 66
IX -51N 11RE-PAM
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4r,50100
DIE NOW
MAR 3 0 2004
I IIIIII VIII III VIII IIII 32
G!F ANCE
DEPTTAa a
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
_ o —AK or
Ducts I el ill
Slab Grade
— /Q — >r
Return Air
Steel
/ ..
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
D
F.A.U.
Framing
— e' — I
Compressor
Insulation
7 _ ��, g,
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
_L
Drywall - Int. Lath
_
Final .? a
BLOCKWALL A PROVALS
Final
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
IL
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines�$
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
zO.K
for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
—
Encapsulation
Gas Piping
Gas Test
'Appliances
Final
Final Tj
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:
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Certificate of Occupancy
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: 49-595 ALI COURT
Use classification: SINGLE FAMILY DWELLING
Occupancy Group: R-3
Owner of Building: PM RENAISSANCE, LLC
Building. Official
Type of Construction: V -N
INA
Building Permit No.: 0403-038
Land Use Zone: RL
Address: 9968 HIBERT ST. #102
City, ST, ZIP: LA QUINTA, CA 92253
By: STEVE TRAXEL
Date: 2-23-2005
CITY OF LA QUINTA
ILWNi �& SA FEN DEPARTMENT
/ ' 7,77-7012
IN`S-`PECTION REQUEST LINE
77-7153
Owner �'1VI RENAISSANCE, LLC
ContractorRANS-WES'TtHOUSING
"`
Permit Number.' ;'0403L 03�
. ° .-
POST JOBiN-c— dNSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 49-595 ALI COURT
SFD - LOT 34, PLAN IAR. PERMIT DOES NOT
INCLUDE BLOCK WALLS, POOL, SPA OR
DRIVEWAY APPROACH
TYPE OF INSPECTION DATE INSP.
TEMPORARY POWER
SETBACKSAl- %l'
U/G PLUMBING /WASTE h �/
U/G ELECTRICAL/ GROUNDING �-
FOOTINGS / STEEL
CONCRETE SLAB
DO NOT POUR CONCRETE UNTIL ABOVE SIGNED
ROOF NAIL / PRE -ROOF
OKAY TO WRAP
FRAMING COMBINATION
ROUGH ELECTRIC
-- UGH PLUMBING
GH MECHANICAL - -
INSULATION 1 / y
COVER NO WORK UNTIL ABOVE SIGNED
INTERIOR GYP. BD. DRYWALL
EXTERIOR LATH c
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 -O S
ELECTRICAL
PLUMBING,
MECHANICAL
PUBLIC WORKS DEPARTMENT 2 2r G
r UNITY DEVELOPMENT DEPT. I
1. - L /JOB COMPLETED J .1
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING
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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 HIC 1131105
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 '
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
ef i j�$ued.Jvty_1p(orkers' compensPatolicyinsurance , 7i i &$052no. are:
(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, 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. 1'.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
BUILDING PERMIT PERMI0403-038
DATE VALUATION 3145'395 00 LOT 34 TRACTJOB SITE
29t7J3-L
ADDRESS 49-595 ALI COURT AP" 649-520-010
OWNER !' CONTRACTOR/DESIGNER/EN (NEER
PM RENAISSANCE, LLC TRANS WEST HOUSING INC
9968 H1BERT 9TREET, 9LnTE 103 9968 HIBERT 9T 9TE, 102
LA QUINTA CA 92253 SAN DIEGO CA: 92131
(858)653.3003 CBL# 4972
USE OF PERMIT
SINGLE FAhM.Y DWELLING
WALLS, P004 SPA OR DRIVEWAY APPROACH
TRACT CONSTRUCTION $462,00 SF
PORCH/PATIO 216.00 SF
OARP,OE1 CARPORT 461.00 SF
ESMIATED COST OF CONSTRUCTION
145,595.00
PERNIIT FEE gUAD &ARY
CONSTRUCTION FEE
101.000-418-000
$800,50
PLAN CHECK FEE
101-000-439-318
$672.21
MECHANICAL FEE
101-000.421.000
$85.50
ELECTRICAL FEE
101-000-420-000
$151.39
PLUMBIN(3,FEE
101-000.419-000
$162.50
STRONG MOTION FEE - RESID
101-000-241-000
$14.56
GRADI"NO FEE
101-000-423.000
$15,00
DEVELOPER IMPACT FEE.
$2,405.00
FEE DEPOSIT
101.000.439-318
4730.00
SUB -TOTAL CONSTRUCTION AND PLAN CHECK
LESS PRE -PAID FEES
III II III I III VIII IIII 33
IE
$4,306.66
-$750.00
TOTAL PERNUT FEES DUE NOW 1 $3,556.66
RECEIPT I DATE I BY I DATE FINALED J INSPECTOR