0208-321 (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
fa4i35;s�3 X3Mti 012t
/Date �'p ` f�� Signature of ContractoF-7"t-;!---7,,'/-/yam' -_..._
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 COMP'INSUR, Policy No. (148-9P 000,3268
(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: %fc. f Applicant
Warning: Failuretosecure 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
fore 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
coh, struction, and hereby authorize representatives of this City to enter upon
the' above-mentioned property for inspection purposes.
rSignature (Owner/Agent)f%�'�" Date/ -
BUILDING PERMIT PERMIT#
Qty^ 31
DATE. VALUATION LOT TRACT
6" ?.L1.1 U 7 1 IX, 260
$1, 46"W
JOB SITE
ADDRESS
APN
774-231-M
OWNER
CONTRACTOR / DESIGNER / EN INEER
45675 ru'VW«1; Y 1).RTV1E
75..465 M_0NT.6E:1.10;CrRW9,
A. QtnNTA- CA 92253
MINN WMIP CA 9 210
(76(f),340-6244 (MIX 582-1
USE OF PERMIT j I
MY S. f". SFIX Pir}#Si41T COP -'S'1 NOT MCLtYMP 8t,,f9•C:lt WALI, I)OOL Of
DRIVUWAYAPPROACH -
TRAM CCNISTRUCT1110M 4497,00 FF
PORCHIRK` IO %.00 Sly
CONSTRUCTION SEE 101.000.41.8.000 $"4106
PLJUI 01 i CK FFIE 't o I -000,t-: 0,318 $669. 9
PER DPOSIT 101.000.439.318 4250100
VIRChUa1dK4* 1;1'.FR 011.00 421.000 $77.00
F.IX.CMICALFEE 101-000-4 20-000 110,46
Pi:LrM B IN WE 101-000-419-000 *1311.23
STROM MOT)CM ME- RPSID 101-00044 1 -000 $14,69
ORADINO FEE 101-000-423-000 $15.00
EJEWEL OPER IMPACT FEE v,405411
PRECISE PIW4 10'.1-000-441-345 $100105
U..S.5 Pn-FAMHMS
,$`2.50,00
)W
40A9
rFES IiN
CITY OF
RECEIPT
DATE
� !r:, ,
BY ;y
G .
DAINA
1/ OG
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
TINSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
. Q
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
— C7
Exhaust Fans
O.K. to Wrap
�_� ���
F.A.U.
Framing
_ Gf_G
Compressor
Insulation
_
_
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wail 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 Lines
pZ L Gf3 A-7
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:
/
AMXW *0/44W (? �kvNO/�j — atwo t 4 rl11W
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)
Date 2/5/03
No. 24119
CERTIFICATE OF COMPLIANCE
Desert Sands Unified School District
47950 Dune Palms Road
La Quinta, CA 92253
(760) 771-8515
4J FISC
Q BERMUDA DUNES r
RANCHO MIRAGE
INDIAN WELLS d
PALM DESERT ,y
LA QUINTA
�INDIO^�
O .J
Owner
David Sohn
APN # 774-231-007
Address
45675 Gurley Drive
Jurisdiction La Quinta
City
La Quinta Zip 92253
Permit #
Tract #
BLK 260
Study Area
Type
Single Family Residence
No. of Units 1
Lot # No. Street S.F. Lot # No. Street S.F.
Unit 1 7 54400 Avenida Montezuma 2497 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 2,497 S.F. or $5,343.58 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/Pacific Western Bank - David Sohn Check No. 219511
Name on the check Telephone 760/3460477
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Monica Guillen $5,343.58 So.00
Payment Recd Over/Under
Signature f;
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
LAA ENGINEERING
20644 OLEANDER AVE
PERRIS, CA 92570
TEL #(909)943-6042
FAX #(909)943-6042
CITY OF LA QUINTA
LA QUINTA, CA
RE: TRUSS CALCULATION
JANUARY 8, 2003
I HAVE REVIEW THE TRUSS CALCULATION AND FIND THEM IN ACCORDANCE WITH THE
FRAMING PLAN SOHN RESIDENCE, 54-400 AVENIDA MONTEZUMA, LA QUINTA, CA.
SINCEF
LEO A.
;EIllGINEERlli G
20644' OLEANDER AVE �
PERRIS, CA 92570
TEL #(909)943-6042
'FAX #(909)657-5 , 42
PEROJECT: SHItLORES"I®E CE
LA QUINViA, Ca
Date JUNE 2E, 2002
CITY OF LA QUINTA BUILDINQ AND SAFETY DEPARTMENT
LA QUINTA, CA
FOR SHIELDS RESCEiNCE
LOCATION: HOUSE AT
5440 AVENIDA MON-TEZUMA
LA QUINTA, CA
I HAVE REVIEWED THE HOUSE AT THE ABOVE ADDRESS AND FIND TIi4T THE
ENGINEERING STRUCTURAL COMPONENTS HAVE BEEN INSTALLED IN
ACCORANDANCE WITH THE PLANS AND SPECIF'ICAT'IONS APPROVED BY THE CITY
OF LA QUINT'A
SINCERELl
L . AGUiLIER.r1'k�';
Td WdST:ZT 200E 02 'SpW 'ON XHJ WOdd
Certificate of Occupancy
T -'&f 4 4 4"
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: 54-400 AVENIDA MONTEZUMA
Use classification: SFD
Occupancy Group: R
Owner of Building: DAVID SOHN
Building Official
Building Permit No.: 0208-321
Type of Construction: VN Land Use Zone: RC
POST IN A CONSPICUOUS PLACE
Address: 45675 GURLEY DR
City, ST, ZIP: LA QUINTA CA 92253
By: KIRK KIRKLAND
Date: 3-16-04
P.O. Box 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
March 17, 2003
Mr. Michael N. Scuro
75-465 Montecito Drive
Indian Wells, Ca 92210
SUBJECT: MINOR USE PERMIT 2003-393
(TEMPORARY TRAILER)----
Dear
RAILER)---
Dear Mr. Scuro:
(7 60) 777-7000
FAX (760) 777-7101
The Community Development Department has approved your request to establish an
8' x 27' trailer at154-400 Avenida_ Montezuma in La Quanta, subject to the attached
plan and the following conditions:
1. Obtain a building permit including an electrical permit for temporary power.
2. Provide restroom facilities to accommodate personnel.
3. Mounted on the exterior of the trailer close to the front door shall be a written
notice providing emergency personnel your 24-hour emergency phone number
they can call in case problems arise that need your prompt attention (i.e.,
minimum 1 " high letters).
4. Install one 2A1013C fire extinguisher inside the trailer by the front exit door.
5. No temporary signs are permitted unless separately approved by this
Department.
6. Removal of the trailer is required and .shall be done by September 19, 2003, .
unless a time extension is applied for and granted by this Department. The
Community Development Director may extend the permit for a set time period
if needed. No fee is charged to extend this permit.
7. Dust control measures shall be employed if construction parking is allowed
adjacent to the trailer. Such measures may include watering the site regularly
or laying gravel in the area for parking.
P\Martin\MUP 03-393.wpd .
F41
t
I
8. Trailer skirting shall be installed within 30 days if the trailer is mounted above
finished grade level. Temporary landscaping is not required to screen the trailer
if skirts are installed and the immediate area.around the trailer is kept clean and
free of construction debris.
9. The City may elect to add Conditions to this application request to mitigate any
problems that arise not previously addressed herein.
This decision may be appealed to the Planning Commission by anyone provided they
submit the necessary paperwork and filing fee of $175.00 with this office within 15
days of approval of this permit.
Should you have any questions please contact meat (760) 777-7068.
Sincerely,
JERRY HERMAN
COMMUNITY DEVELOPMENT DIRECTOR
MARTIN MAGANA
Associate Planner
c: Betty Sawyer, Executive Secretary
John Hardcastle, Code Compliance
Tom Hartung, Building & Saf_e
P\Martin\MUP 03-393.wpd
2-7- ra.� let