0105-278 (SFD)0
F—
N W .
O � M
W
o Z l�
CID O C
CD
LU
r`
F-Wa
U)
Z
C0
N
ON
U °)
CL Q
Cr
L0 Q 0
X W
mVU
O
a 0)
19T Z
ob 5
r- d
g
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
789540 B fit., 31/2(
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 bf 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 „ Policy No.
5 -TATE FUND£49ffpQfl2ft227
(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
& 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) Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOTS+ TRACT
WV: J 2(X1 9 u,€ 2, tt 1 3 IN= a,85
JOB SITE
APN
ADDRESS M M AV 3 !•vW•n 14 p
9 1E0
774-2111-012
OWNER
CONTRACTOR / DESIGNER / EN &NEER
,kn-Ame-p c-Al'T,'nagaz -Bulm, ms We
ALT.109MCAU:ROME T"URDFRO INC
769951"WIMM AVINIDE
11699.5 ITP- PUMA AVEONiM
a �'A%M:1111 M.17 CA 92213
RAfMDEV"9.RT CA 92,211
(760)200.0271 C BV. b 6372
USE OF PERMIT
1G1:.•E FAIAO Y DWELLM
SPO . PIU Ml"' T'C31?a's1t.2`d 1T4CL1 03'' 131,C7C3�.1i1.M..i..d'3#00td,°,PA. OR
DIpdy134I !:iia'A 7 tal�yh37�'�tlripp?[�I.y1 t SaAi`9kl± 6tpi%y.Ati CHIRCK F4K
Y"�.gt?!blbpin�E�a:�.�s�y'�ri. t'i`�i
.&PT11,1F,0 FOR .KU1:f"IPIA l�a,J6f`ARCK �.�1' SAME MAN J E pyE.
MCT COWSTAUCTIUR ?,029,00 v
Cia^.Iic0.tfli; �i;t7.L►0 Sf
ES-IJUM '11�IX) C:ev?1�r1' 0311, C01M h:?�ISC�I.��J�
.2.410
CON rTPUCTION FLE 101-000-418-000 96NIM
w
PL&N Cli&VZK IK9 101-000-13 d- 318 $129,81
IME DEPOSIT 1101 -WO -4749-319 423&Q0
1�P.e14AN 1C,A.1. t 1. IOI-WO-421-000 $.s3.D
FITIMTRICAL IV -9 101. -OW-420.000 S913:K
PL4 DMBIRC1.t rKE 101-000-4,19-000 $119.25
S`PWIWI MOWN FRF - RFAI0 101«000.241.000 Sl;."
ORADINO YLd: 9.01 -OW -4.2 •.000 $.4O:08
i'3�',�'i<:I.{)MR I'f: RACT t~ER SIAUD
VIRLICLS ? PS. A' 'N 101-r 00--14'1- 345
"-TOTAL CaO.WRRI31'".T. MMT AND 101�AX CH1+,r':lC,
M23 P -REI -PAM FEE$
4250.00
TMALPERWr FTE8 UAW NOW
RECEIPT
DATE
BYqAT
FIN EDD
INSPECTOR
I `L
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Q
Ducts
Slab Grade
,�
Return Air
Steel
Combustion Air
Roof Deck
/
Exhaust Fans
O.K. to Wrap
I
F.A.U.
Framing
T lot
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
f �7-//
Final
Final
!.
_
POOLS - SPAS
BLOCKWALL PPROVALS
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
_
— 30 ��
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
mal/"
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICA4 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)
��
_ /-
LICENSED CONTRACTOR DECLARATION
]"herebRkaffirm 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
j' IL Professionals Code, and my License is in full force and effect.
M!i License #j` Lic. Class Exp. Date
U.)LU
7 r
0 Z P. -Date 'Y/ ," uignature of Contractor r 2��-"
co _
J U coo OWNER -BUILDER DECLARATION
HaLLl I hereby affirm under penalty of perjury that I am exempt from the Contractor's
Cn 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).
co () I am exempt under Section , B&P.C. for this reason
LO
N Date Signature of Owner
ON
0)d Q WORKER'S COMPENSATION DECLARATION
p CcI hereby affirm under penalty of perjury one of the following declarations:
r < O ( ) I 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 tl4e
O J Q performance of the work for which this permit is issued.
m Q U ( ) I have and will maintain workers' compensation insurance, as required by
O U Section 3700 of the Labor Code, for the performance of the work for which this
d H permit is issued. My workers' compensation insurance carrier & policy no. are:
Z Cartier Policy No.
J
(This section need not be completed if the permit valuation is for $100.00 or less).
( ) `Lcertify 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
3 subject to the workers' compensation provisions of Section 3700 of tho-Labor
Code, I shall forthwith comply with tho�pr vl'sions. 0,
./Applicant ,f��!`y
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. It
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'�nsspectionpurposes. j7
Signature (Owner/Agent)
PERMIT #
?�., BUILDING -PERMIT
DATE VALUATION LOT (ft'(%-27JJ TRACT
�9w 2.=tib 13 137.x.7P.5
JOB SITE j
APN
ADDRESS /
OWNER �� / ` Z 4
`�
CONTRACTOR / DESIGNER / EN (NEER
jU,T, AM CANA�iHC>M E Bt7lf?1.DEU RTC",
ALL KMMICAN 1A10 �k7 JXl T.1II 3� Uc INC ^
76995 x�`?•,ORMA ME1+ IR,
76995 :F. EMD As I N`ENUE
PIM ID T CA 92,211
VX.M DFI "r, R1 ' C A 92211
(760pw^�_ t7 C/ CBLft 6373
USE OF PERMIT
4'3) ., ' i:, 1'i' g1i11 S A3C>T i'PiCfl.lii] i73 £3C'1 WAY ;.�t�01JUSPA OR
?3R71V AYAI'P 140ACT-1, NEW TUMI, WAST FUL XA.NA<AX CT W -Y. M
APPL14D FOR N1U1,°T 1P1.N:. WIc 311.R,'rFCE OF SAME P) AX4 TYPE,
TRACT f;^aWTRUC 1014' 8
Q- 01 A.Cf9 +i aCv.91D SF
EST. SK IT.Ii3 CONT OF Ci3NSTRI:i+C�7'011T
961632.40
Saxwu y
K't7M'1' UC' ION YZJ? 101-0,004-10-000 2��Ti.1jtF
PLAN +;;HE;7'K FEE 101-000-411.7-318 �j.F.irl.7i
MEt.H.AVICAL+ fVE 101-000421-000 VJ3.50
XLECT M,AL IFF:i, 1.01.000^4213-000 3113.49
P L13MBINO 'ME 10. 1 �000.1319-00 $319.23
91 R(YJJN0 MO'd'It,M FEE, - RESID 101.00044,1-(.M. ".ft
CSPAOTHD F1'rk.Z 10 1 -GN0.4.23•_000 12(myD
DWELOPER IMPACT PEI? S11007.00
&'F.irT.IS Pa -0131 1.01-000•4G11-.145 5100.6
SUR TOTAL C014MTJC:`r'ION' +ND PLAN Ct•-.,�.OK
$3,0-19.10
:1.E1311F MVPAW 1 REJ
-$250.00
TMAL PYRM Fr MES DUZ 111,0W
S2,829,10
RECEIPT
DATE /
BY -�
DA E I JD
INSPECTOR
:.
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
_
Underground Ducts
Forms & Footings
Ducts
Slab Grade
/ l��
Return Air
Steel
Combustion Air
Roof Deck
`3r0 C
J
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
r —��j=.0
�_��
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
�7
—_/ _
Final /_f/1�
/APPROVALS
Final
POOLS - SPAS
BLOCKWAI
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—p-
_
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 TestZ�/d
Appliances
Final
COMMENTS:
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)
G�
CITY OF LA QUINTA
�Fboer>°tee BUILDING & SAFETY DEPARTMENT
777-7012
INSPECTION REQUEST LINE
777-7153
Iwner ,ALL AMERICAN HOME BUILDERS INC.
,r
contractor
armit Number
POST ON JOCONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
OB ADDRESS 54-240 AVE CAIRRANZA
SFD- PERMIT DOES NOT INCLUDE BLOCK
WALLS/POOL OR APPROACH
TYPE OF INSPECTION DATE INSP.
OUNDATION & SETBACK
OOTING STEEL
IAIN GROUND SYSTEM
(ROUND PLUMBING
'RE-GUNITE
�O NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
iONCRETE SLAB
(STS & GIRDERS
ECTRICAL GROUND WORK
NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
UGH ELECTRIC '
UGH PLUMBING
UGH GAS &GAS TEST _ �f
TING & VENT- A/C
I I wAl9�,mlmmvA—wjti lr.�
ND BEAM
TO WRAP -
OUT ❑ 4' ❑ 8'
MING f j1b l
I LAT(ON
OUT
11 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
§YWALL INTERIOR
C
ERIOR LATH
L PRE PLASTER
L FENCE & GATE
ER SEPTIC TANK
Q - ,d - p 1
FINALS
CTRICAL
MBING
L GAS TEST
71 NG - A/C
SE NUMBERS
COMPLETED
P POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING
Desert Sands Unified School District
47-950 Dune Palms Road
Notice: La Quinta, CA 92253
Document Cannot Be Duplicated 760-771-8515
CERTIFICATE OF COMPLIANCE
Date 5/24/01
No. 22043 Jurisdiction
Owner Name All American Home Builders, Inc.
No. -ate Street id
i D � �_f3f Alit ZA
City La Quinta Zip 92253
APN # 774-211-012
La Quinta
Permit # 0105-278
Log #
Study Area
Tract # BLK 285 Lot # 13 Square Footage 1,628
Type of Development
Comments
Single Family Residence
,
ved Cashier's Check in the amount of $10,012.20
No. of Units 1
At the present time, the Desert SandsUnified School District does not collect fees on garages/carports, covered
patios/walkways,.residential additions -under 500 square feet, detached accessory structures or replacement mobilehomes.
It has been determined 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 Government Code 53080 in the amount of
2.05 X 1,628 or $ 3,337.40 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 B CC/ 1st Bank - Marie By Telephone 760 413-8291
Name on the check
By Dr. DorisVilson
Superintendent
Fee collected /exempted by . Paula Rutz
Signature
fa&i
Payment Received $3,337.40(- - +
-
Check No. 58772
VOTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1996) 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 sssued or on which they are paid to the District(s) or to another public entity authorized to
;ollect them on the District('s)(s') behalf, whichever is earlier.
Collector: Attach a copy of county or city plan check application form to district copy for all waivers.
Embossed Original' Building Dept./Applicant- Copy - Applicant/Receipt Copy - Accounting
Certificate -of Occupancy
City of,La Quinta
Building and Safety Department.,
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: 54-240 AVENIDA CARRANZA
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0105-278
Occupancy Group: R3 Type of Construction: VN Land Use Zone: RC
Owner of Building: ALL- AMERICAN HOME BUILDERS,
INC.
Building Official
Address: 76-995 FLORIDA AVENUE
City: PALM DESERT, CA 92211
By: KIRK...KfRKLAND
Date: JANUARY 7, 2002
P3