0208-320 (SFD)/ LICENSED CONTRACTOR DECLARATION
1 ,hereby affirm under penalty of perjury.that'l 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
72SC + BMC 1124
�} i�
ate `� � / •y� -?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'
eeompensation, 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 JMtwMPT 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 thosq(provisions.
bate: �•- 1- .r' - Applicant _ >�� ,r .
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, indeffffiuv
& hold harmless the City of La Quinta, its officers, agents and emplo
2. Any permit issued as a result of this application becomes null and
work is not commenced within 180 days from date of issuance of c
permit, or cessation of work for 180 days will subject permit to cancell
I certify that I have read this application and state that the above informat n i
correct. I agree to comply with all City, and State laws relating to the bu ding
construction, and hereby authorize representatives of this City to enter
the above-mentioned property for inspection purposes.
Signature (Owner/Agent)--1%r Date
BUILDING PERMIT, PERMIT#
OM -320
DATE VALUATION LOT TRACT
0.t,aaa,�0
JOB SITE
ADDRESS 4)Al%1M, . SA 4A
APN
71. aZ
OWNER
CONTRACTOR / DESIGNER / EN INFER
J1t py'ELLF=
F6?MTJC EIABUA►T, TQC.
,12-990 HOM&OMAr 'M-)
P O 3O% 21398
PAT,Vt DWERT CA 92251
P.AAl::ilA DESFIRT CA 92261
(160)465.9343 CB1,4 438.3
USE OF PERMIT
SFD a 2319 SQ, It r. LTtf lmrjf '?,iib SQ.3t'7i'. aAR'Aag, 393 SQ.Ir, r, a
COV.PATIO PILI MIT DOEl HOT .INCL.UD WAi.,I,S, FENCES NOT, AND �
SPA,. .A SEPI RA`1'1? PERMIT IS :Id IULFtED FOR Lal2Ti3EW'AY APPROACH,
TRACT COMTRUC"T1014 2,319,00 av
PORCH/PATIO 393.0019 F
C}AId.ACEIC.ARPORT 720.00 V
i:VI4a"I<`.1ED COST OF COMIRIUt� JC.�OTT
145;Z60.00
CONSTRUCTION "RE 101 -01[1 0-418400 00 "Op.;rt1
PLAN CHECK FEE 101-000-139-318 $692.0
FEE DEPOSIT 101-000.4.3.9.3113 42.191,0
MECHANICAL FZZ 101-000.421.0100 $13J.00
F1 ECTIUCAL FEE 101-000.920-000 5144,4"7'
PLUIt6BniO FEZ 101 -OM -419-000 $166.00
MONO MOTION VEEP • .R05.111D 101.000.241.004 S4.53
0R.P6T.JM0 FEE $115.00
DEVELOPER IMPACT KE $2405,00,,
.
PIiPCISE PLAN 101
SAES.-.tOdALT CO S I Min LbON AND PLAN 'KRECaL.
$4iiJ8.,3
LESS PRE•PAXD'r=
-$250,00
e
TOTAL. 'PKRM3T �'Ir�,'S DUE :[SOW
AUG 181003*
1
ITY OF LA. QUANTA /
FINANCE DEPT.
RECEIPT
DATE
A � i!5 e.o �
BYDAT
S i"` .
NALE�•.
1_1;�
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
v
Combustion Air
Roof Deck
Exhaust Fans
OX to Wrap
3
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
<
POOLS - SPAS
BLOCKWALL
APPROVA S
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
z- 6
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
7 --
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
-O3
Encapsulation
Gas Piping
Gas Test
_
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas) E
ELECTRICAL APPROVALS
Temp. Power Pole .O ?j
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)
Date 8/5/03
No. 24784
Owner ' Jerry Ellenz
Address 72990 Homestead Rd
City Palm Desert Zip 92261
Tract #
Type Single Family Residence
CERTIFICATE OF COMPLIANCE
Desert Sands Unified School District
47950 Dune Palms Road
La Quinta, CA 92253
(760) 771-8515
APN #
C).
BERMUDA BERMUDA DUNES
Cn RANCHO MIRAGE C'J
r,�. INDIAN WELLS 'ter
PALM DESERT
t� LA QUINTA
4INDIO y71.
773-241-008
Jurisdiction La Quinta
Permit # 0208-320
Study Area
No. of Units 1
Lot # No. Street S.F. Lot # No. Street S.F.
Unit 1 25 52230 Avenida Montezuma 2319 Unit 6
Unit 2 Unit 7
Unit 3 Unit 8
Unit 4 Unit 9
Unit 5 Unit 10
Comments
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 2,319 S.F. or $4,962.66 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 CC/Valley Independent Bank - Jerry Ellenz Check No. 293143
Name on the check Telephone 760/340/6682
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Sharon MCGllvrey,, Payment Recd $0.00
$4,962.66 Over/Under
Signature C
NOTICE: Pursuant to Government Code Section 66020(d)(1), this will erve 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
P.O. Box 1504
IY 78-495 CALLE TAMPICO
5h,njng Brighter Than Ever LA Q U I N TA , CALIFORNIA 92253
September 30, 2002
Mr. Jerry Ellenz
Pacific Habitat Inc.
P. 0. Box 2898
Palm Desert, CA 92261
(7 60) 777-7000
FAX (760) 777-7101
SUBJECT: HOUSE PLANS FOR 52-230 AVENIDA MONTEZUMA
Dear Mr. Ellenz:
Staff has reviewed your plans for the above -noted house and based on that review it
is my interpretation of the Code, you will need to provide an access way of 15 feet
along the house to get to the garage in the rear of the property. This decision is based
on -Section 9.150.080(A.8.d.) of the La Quinta Municipal Code (attached).
You have the right to appeal my decision within 15 calendar days of this date to the
Planning Commission. I have enclosed the necessary application form which must be
submitted with the fee of $175.00, to this Department for scheduling before the
Planning Commission.
Should you have any questions concerning the above information, please contact me
at 760-777-7125.
%-ummunity uevelopment Director
JH:bjs
Attachments
j . 4
�- CITY OF LA QUINTA SUB -CONTRACTOR LIST
JOB ADDRESS PERMIT NUMBER 0208=32D OWNERS '�e.v 7 BUILDER
This form shall be posted on the job with the Building Inspection Card at all times in a conspicuous place. Only persons appearing on this list or their employees are authorized to work
on this job. Any changes to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result in a stoppage of work and/or the voidance
of building permit. For each applicable trade, all information requested below must be completed by applicant. "On File" is not an acceptable response.
se .'
2-
Trade / Classification' as fication
Co ntractor
State.Contracfor s Gcen
Carrier Name
(e.g. State Fund, CalComp)
Policy Number
(Format Varies)
Company Name
Classification
License Number
S
o� ��-!/Nrf�
(e.g. A, B, C-8)
(xxxxxx)
f�
EARTHWORK (C 12)
CONCRETE (C'-8)
T-31
03
FRAMING (C 5)
STRUCT STEEL (C751)
MASONRY (C=29)
1pa, 9 4G a-72
2 .5 2
PLUMBING (C-36)
�" — �• a b'`
2
LATH :PLASTER (C=351 '
So sza2
DRYWALL.IC-9):
y C de
1
HVAC:IC 20)
It
20
% $"
o
ELECTRICAL (C 10) :.
N e e fC 1 �G
`° _ to
q(� 1011 ��
ROOFING (C 39)
W
c10L
/5'77757,
SHEET METAL (C 43):: :..20
MY
o f
FLOORING
I _ /V{
00 2
/v - a
-30
GLAZING (C 17)
Lo e/
-0y
OO1
/•
INSULATION (C 2)
i<
.2225
O o
:SEWAGE DISP.(C-42):
PAINTING (C 33)HU
CERAMIC TILE"(6-54 Y
owe /A e T"t,
v '
'CABINETS (C-.6)
a 9Av C.
�2
3/goy
FENCING (C 131
�4 C / �.� lL 4 ' /'z
5'6 tJL
81
LANDSCAPING (C 27) ,
C- f'< wbI� T& 7, c
b3 00a
POOL
-
3 - -a
se .'
2-
Woike�s Compensation.Insurance
City.Busmess. icense
Exp. Date
(xx/xx/xx)
Carrier Name
(e.g. State Fund, CalComp)
Policy Number
(Format Varies)
Exp. Date
(xx/xx/xx)
License Number
(xxxx)
Exp. Date
(xx/xx/xx)
S
o� ��-!/Nrf�
/a -i -i
f�
T-31
03
66,7f
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7- 7e
CHARLES D. GARLAND
011991 .�.
Architecture, Interiors, Space and Land Planning
Structural Calculations
31 October 2003
The City of La Quinta
Department of Building and Safety
78.495 Calle Tampico
La Quinta, CA -92253
Project: Single Family Residence for:
Pacific Habitat
.52-230 Avenida Montezuma
La Quinta, CA
Regarding: Project Observation and Field Revisions
To Whom it May Concern,
On 30 October 2003 1 visited the noted project' site to perform code required structural
observations. At the time I noted only minor blocking, nailing and strappirig issues that were
resolved at the time of my visit.
Therefore, I hereby state that the project's structure is in substantial conformance with the
structural design intent as represented in the construction documents.
If you have any further questions regarding this project please do not hesitate in contacting me
hrUa ULA
74-854 Velie Way, Suite 5 ❑ Palm Desert, CA 92260 ❑ Phone: (760) 340-3528 ❑ Facsimile: (760) 340-3728
REPORT OF FIELD COMPACTION TESTS
OUR REPORT NO.:—::5 1 �" CLIENT: / f L
DATE: PROJECT:2I— 0NI
NUCLEAR GAUGE INFORMATION AND
DAILY STANDARD
CAIBRATiON NUMBERS
VARIATION. PERCENT.+I- GAUGE ADJUSTMENT
% VARIATION FROM
CAUBRATION
COUNTS
FROM SHEETS
DRYPERCENT
DENSITY, COMPACTION
PCF
LAST USE
lTROXLF3V_IAMPBELL
94r
I�,,,_.r.-
GAUGE TY�E:
MOISTURE:
MOISTURE:
MOISTURE: MOISTURE:
MODEL NO.: � �-
DENSITY:
DENSITY:
DENSITY: DENSITY:
PHUCTOR INFORMATION
TEST
NO.
READING I
QUOTIENT/
PCF
SOIL
ID NO.
TEST
DEPTH, IN
ELEVATION
OF TEST
MOISTURE
CONTENT,
%
WET
DENSITY,
PCF
DRYPERCENT
DENSITY, COMPACTION
PCF
COMMENTS .
94r
4
X553
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A1. "c I V ✓'
Y I '�'�'
J I �7�.
75
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TECHNICIAN:~� .,'A L, ��J oll i4 AIK' .A. II � r 1J�1 f
MMEhT 1 =FILL MATERIAL (1(I A e RESULTSCOMPLY WITH SPECIFICATIONS r f �� /
2 = BACKFILL VjJ B COMPACTION PERCENTAGE DOES NOT COMPLY WITH SPECIFICATIONS
3 BASE COURSE C RETEST OF PREVIOUS TEST /J �,
a SUBBASE 0 - MOISTURE IN EXCESS OF SPECIFICATIONS
S=SOit. CEMENT E -MOISTURE BELOW SPECIFICATIONS
6 =OTHER
WHITE -OFFICE YELLOW -INSPECT. PINK -FIELD FILE
Certificate of Occupancy
U -
. QUM&
G OFT19� Building & SafetY Department
artment
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: 52-230 AVENIDA MONTEZUMA
Use classification: SFD Building Permit No.: 0208-320
Occupancy Group: R3 Type of Construction: VN Land Use Zone: RC
Owner of Building: JERRY ELLENZ Address: 72-990 HOMESTEAD RD
City, ST, ZIP: PALM DESERT CA
By: KIRK KIRKLAND
Date: 5-5-04
Building Official
POST IN A CONSPICUOUS PLACE