SFD (0303-008)54855 Avenida Madero
0303-008
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
SSSZlE $ ' w 1alt,, ' 0$81il
Signature of Contractors^-
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 R / • ,//, • 0 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, CCAOF Policy No. 149IT fs-01
(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 Calif omla'gand agree that if.4,should become
Subject to the workers' compensation provisio sA f Seetron 3700 of the Labor
1,-r
.-,'Code, I shall forthwith comply with those prow sAons„ -
Date: L- • / r,'^ ' Applicant` _f ^r ''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, indemnify
& hold harmless the City of La Quinta, its officers, agents and employee
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
c nsfruction, and hereby authorize representath es of this City to enter upon
the above mentioned property for inspection`purposes. R, , ` ;
.-
Signature (Owner/Agent) / 4-;, "I=" 'Date
PERMIT # '
,BUILDING PERMIT
4
'VAiL'
DATE/. ./• , UATION VLOT J,7 TRACT
JOB SITE ADDRESS 1A. WA [i1g.ID I., A'i,A73 RO
APN 774-•2444V..8
OWNER
CONTRACTOR / DESIGNER / EN (NEER
P hl.M.NN 'r' V ANS
[JAWIJAW EV11.1481J=aN WC.
Z.IRI7K4.1 CIA. .95507
iMIRS. 141 CA 92507
(760)331•20CW CBL4 15246
USE OF PERMIT
j0ob o. :1'i to h .4S r i.1 U Yqul SVi wiJ idS<!J{rK i1L lA.i., L'1fLd r. Y,i '
DR)V+`WA YAiPROACH
ItC0143TRUC ION
Ar'
€' .ifla,.i 9i1'i0 321,bG SIS
< is#tAC jCr.ti[t 3aT $!':'.04 ;,11
Z 'i:r.aMA!TKU COST OF C+~':+Nt MCI(M'iON,
183AV jP0
°.'E R MARY
t_tICTYO).X. FFIT, 101
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hYEf' f T<sCh: f -'t ? CIA _000-4 -000 .1.109.{10
? y?rr.
PLSII7rsh i:1 i "IE 101 f0w*,O—e : `j-000 $751.75
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C .il 1.A-11, 1".C:.i'i3YA 7a,.2`.TAES : .. ITY NOW
$4,41.04
'9C'`q
ti un
RECEIPT DA j / ,
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
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing —
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
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
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
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) _C7 j
COMMENTS:
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patiostwalkways, 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 3,068 S.F. or $6,565.52 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/El Paseo Bank - Paulden Evans Check No. 006486
Name on the checkTelephone 760/831-2000
Funding Residential
By Dr. Doris Wilson
Superintendent ti
Fee collected /exempted by haron McGilvrey $6;565.52 So:oo '
Payment -'Recd Over/Under .
Signature c
NOTICE: Pursuant to Government Code Section 66020(d)(1), th s 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
CERTIFICATE OF COMPLIANCE
Desert Sands Unified School District4 cso
JFDS ,
'
47950 Dune Palms Road
¢BERMUDA DUNES h
Date!'. a/14/03
La Quints CA 92253
RANCHO MIRAGE J
INDIAN WELLS r
i,, .,
No. 24320
(760) 771-8515
rye PALM DESERT LA QUINTA y
INQINDIO
y
Owner Paulden Evans
APN #
774-264-028
Address P O Box 621
Jurisdiction
La Quinta
City 1 Eureka Zip 95501
Permit #
0303-008
Tract #
Study Area
Type Single Family Residence
No. of Units
1
Lot # No. Street
S.F. Lot # No.
Street S.F.
Unit 1 16/17 54855 Avenida Madero 3068 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 patiostwalkways, 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 3,068 S.F. or $6,565.52 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/El Paseo Bank - Paulden Evans Check No. 006486
Name on the checkTelephone 760/831-2000
Funding Residential
By Dr. Doris Wilson
Superintendent ti
Fee collected /exempted by haron McGilvrey $6;565.52 So:oo '
Payment -'Recd Over/Under .
Signature c
NOTICE: Pursuant to Government Code Section 66020(d)(1), th s 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
CONCORDE CONSULTING GROUP, :INC.
ENGINEEER~ING &,CONST,RUCTION MANAGEMENT
i 3505 CAMINO DEL RIO SOUTH, # 3,50
SAN. DIEGO, CA 92108
PH: (619) 516-3377 FAX: (619) 516-3388,
MEMORANDUM/FAX COVER SHEET
r TO: FROM:
PAULDEN EVANS KRIPA
COMPANY: DATE:
05/15/03
FAX NUMBER: TOTAL NO. OF PAGES INCLUDING COVER:
PHONE NUMBER: SENDER'S REFERENCE NUMBER:
fl
YOUR REFERENCE NUMBER: -
RE"54855 AVENIDAMADERO LQ
r... _
X URGENT X FOR REVIEW X PLEASE COMMENT X PLEASE REPLY ❑ PLEASE RECYCLE
notes/Comments
i,
THIS NOTE IS TO CONFIRM THAT BASED ON THE SITE OBSERVATION, THE FRAMING
ON THE REFERENCED PROJECT 'IS -IN GENERAL CONFORMANCE WITH
i, CONSTRUCTION DOCUMENTS AND DESIGN INTENT
PLEASE CALL IF YOU HAVE ANY QUESTIONS
THANKS
n -
ie KRIPANARAYANAN
• •, j ' ,., Pilo. .: `
52654
S r Exp. 6-l03
Certificate of Occupancy
S@
City of La,Quinta 4
Building and Safety Department.,.. `FM0
This Certificate issued -pursuant to the requirements of Section 109 of the Uniform Building Code,
certifying that, at the time of issuance, this structure was in compliance with the various ordinances
of the City regulating building construction or use. For the following:
BUILDING ADDRESS: .54-855 AVENIDA MADERO
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0303-008
J
Occupancy Group: 11=3 Type of Construction: VN Land Use Zone: RC
Owner of Building:. PAULDEN EVANS' Address: P.O. BOX 621
A 95501
.ate By: KIRK KIRKLAND
Date: JULY 25. 2003
Building Official
POSTINACONSPICUOUSPLACE
u o
— -- iv -vi r -M
Information
Q .ToBuild On
" gR • CasestrshWg a Tesllrtg
TESTED FOR: PAuLDEN EVANS
PO BOX 621
TO 9-7711171 P. -01/0i
REPORT OF FIELD COMPACTION TESTS
RIVERSIDE, CA 92501
PROJECT: 54-855 AVENIDA MADERO
to QUINTA, CA
DATE, March 26, 2003 OUR REPORT NO.: 073-30116-2
TEST DATA: (1) Medium to coarse graines silty sand. OPT. MOIST, ® 10.0$
MAX I I I ICOMMENTS
TEST TEST SOtLID LAO DRY r WATER I WET DRY PERCENT I Spec
M0. I gfiPTN I iLiVATION -- NUMBER DENSITY CONTENT-OEN$try 2gnS1TV COMPACTION
I I
1 8" FG I 1 128.0 6.2 j 127.1 119.7 I '93.5 11 - A
. .._.....i.__._......... _
2 8" FGI 1 128.0 6.6 126.2 118.4 92.5 I1 - A
I_._—_...
3 8" i FG 1I 128.0 I 6.4 i 126.31 118.7 93.7 ii - A"
4 i 8" FIG 1 '128.0
6.3 125 .4 1118.8 1 92.9 1 - AY
TEST LOCATION: House pad.
71 NSV corner
2 f 3W corner
3NE Corner
._.__.---.__.. _.__.. _..._ __......_ _._..._ .._. _.._......
SE corner
. .--
f
... ... .... _._ ....... - - -
NATES: TESTS AFORMED PER ASTM D2922•06 &ASTM D3017 -se 'COMMIMT3: 1. FILL MATERIAL
BH NNWN Iba ter e Iryb wfa .3: RSE
nMPACT1t: B86e9 on maximum dry
s eaa nurt 'be on semye indipa; try g; THER ENT
" (1) ASTM D1557.-00 METHOD A
TEST INSTRUMENT:
REMARKS: PSI did not monitor the material placement
TEC;.MICIAN: Vinnie De Souza
THESE *Lilt II9SULT9 APPLY ONLY 10 rA j MCIFIC LOW10ftS NOTEO AND NAY NOT REPRESENT ANY OTHER LOCATICNS OR 94FVATIONa
REPORTS MAY NOT EE REPRODUCQO. ExCFYT IN FULL. WITHOUT WRITTEN FWAI8'ION BY OPOPESSIONAL 1MV;CE PIDVSTPWC, WC.
P81AA004 W1P
B. Y ' T FtH ' TSCCC r AT N5N DOES SPECIFICATIONS
E. UBF"`LOW Sp✓=CIFICATIODSS YION3
STANDARD COUNT M: D:
ADJUSTMENT DATA M: D:
Respectfully submitted,
Professional Service Industries, Inc.
Professional Service Indtistries, Inc. • 42-240 Green Way, Suite C • Palm Desert. CA 92211 • Phone 760!341-5790 • Fax 7601341.5794
** TOTAL PAGE.01 w*
i
April 1, 2003
Ik
City of La Quinta Building Department
d 78495 Calle Tampico
P.O. Box 1504
La Quinta, CA 92253
RE: Callister Residence
To Whom.lt May Concern:
+i This note is to inform you that we have reviewed the attached truss layout and find it
consistent with design intent and construction specifications.
1
J
jl Concorde Consulting Group, Inc.
I K.M. Kripanarayanan
j <wFESS4
! N0.
II S2654
V Exp. 6/03
II
t
sp, OF CA1.1FO
3505 Camino Del Rio South #350 * SAN DIEGO * CALIFORNIA * 92108
619/516-3377 * FAX 619/516-3388
,3 - '5' rte-• y; 2.
ca