0107-115 (SFD)LICENSED CONTRACTOR DECLARATION
ereby affirm under penalty of perjury Ila, 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
61/17103
m� /,1_7Xignature of Contractor
Date
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) 1, 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).
( ) 1, 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 - Policy No.
PREMONT COMPE142 X1350-060040320
(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 37.00 of the Labor
Code, I sVall foqhwith comply with thosel.:Pro Sion
ms _XY
Warnihg: Fdilure to secure Workers' Comp6nsation coverage is unlawful and
shall subjectan employer to criminal penghies and civil fines up to $100,000, in
addition to the cost of compensation, cla'mages 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 wh6se 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. 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
.11 f
the above-mentioned property for -inspection �Ypqses.
Signature (Own
BUILDING PERMIT PERMIT #
DATE VALUATION LOT 01107.4 1.S TRACT
JOB SITY
ADDRESS
APN
1
'170-' .470-4318
OWNER
CONTRACTOR / DESIGNER / EN61NEER
MADTA014 MIMA"OCIAT a -St
ANIMW 1-WRCE CORPM)MON
1
76-505 OLD MMUE52,
4 4 8 357 DW C"i YON:RD
LA QUIDTM CA 92253
11DAUA r/FMT CA 92261
(760)346-322S MIN 03011
USE OF PERMIT
MfCL1Li.71)JH0'TH2 "a1WA140qR_tr) SPECIES ACT OF 1973 (16 O.S.C.
CUSTOM CONSTRUCTION 311IM100 sp
UARAQ WCARPORT 70.00 Si?
POR.CMIA110 3512.00 15F
99ZE"TED Cogir OF C0.124SMUCTIOM
267=4M
00ma &UY
FSE DEPONT 1011-000-439-M 43rkop
PIAN CHWE.'",F, $254.34
CONFrItUCTION FOR 101-0W-416�00 $1,227."
MECHANWAL FEW 101-000-421-0-tv.
91ZCTPJCAI,'MX 101 -000-4?,0-000
PLUMBRi a IFFIE 1101-000-419-000
MONOMOTION ME - RMD 101-000-241-000 S20.72
WtAf) NO
KUKC191 PLAN
-AltT DI PUBLIC PLA 5-.--00o ,
'"no
JUL 19 2001
Ruen �ax'
C bm -01T Alpp
$4, 1 a. 33
A MOS PR. -+PaD M?M
4333.00
POW
RECEIPT
DATE
1BY
D T FINJAD
( - 0 Z..,*
I INSPECTOR
_
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
I DATE
TINSPECTOR
BUILbING 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
E,
F.A.U.
Framing
Insulation
)7
T
Compressor
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall Int. Lath
-
2 -
Final
Final
POOLS -SPAS
BLOCKWALL
AP 'ROVALS
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
ShowerPans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
;'S
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
W 4
Utility Notice (Perm)
7 - 77
V
P.O. BOX 1504
Building 78-495 CALLE TAMPICO
Address -7 3 - N 'P; k? n a -a e LA QUINTA, CALIFORNIA 92253
Owner I
malting
Address'I-A
City lZip [Te_1
Contractor
Address
A.4 —
City Zip Tel.
State Lic. City
Lic. 4
& Classif. 6_,-712-63 Lic. #
Arch., Engr.,
Designer
Address Tel.
City Zip State
7 Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereMeffirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of 1vision 3 of the Business and Professions Code, and my license is in full force and
effect .
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the follow ing
reason: (Sec. 7031.5,gusiness and Professions Code: Any city or county which requires a
permit to construct, after. improve, demolish, or repair any structure, prior to *its, Issuance also
requires the applicant for such permit to file a signed statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, or that -he is exempt therefrom. and the basis
for th rfi
qe alleged exemption. Any violation of Section 7031.5 by 'any applicant for a p
subjects the applicant to a civil penalty of not more than five hundred dollars ($560).
1-11 1 as o net of the property, or my employees with wages as theirsole compensation, will
do ihe wpr , and the structure is not intended or offered for sale., (Sec.�7044, Buisness and
Pro'..ions,116de: The Contractor's License Law does not apply to an owner of property who
builds or improves thereon and who does such work himself or through his own employees,
provided that such improvements are not intended or offered for sale. If, however, the building
or improvement is sold within one year of completion, the owner -builder will have the burden
0, proving that he did not build or improve for the purpose of sale.)
1, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner of property who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
I I I am exempt under Sec.—B. & P.C. for this reason
Date—Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No.—Company
[71 Copy is filed with the city. 0 Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of thp work- for which this permit is issued, I shall not
empi oy any person in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date_Owner
NOTICE TO APPLICANT., If, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code-)
Lender's Name—
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration it work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
con s truction, and hereby authorize representatives -of this city to enter the above-
mentioned property for inspection purposes.
Signature of a0plicant —Date—
Mailing Address
City, State. Zip
APPLICATION ONLY
LDING: TYPE'CONST. OCC. GRP.
. Number 77()-37o_ opl�
al Description T 2_ 9,16 7 40--r- 179 1--6
Project Description
S Ft No No. Dw.
s9iz'e , 3, 11 -4 —stories Units I
Newv Add 0 Alter 0 Repair 0 Demolition 0
Estimated Valuation
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
AMOUNT
Const.
Mech.
Electrical
Plumbing U]
S.M.I.
Grading
1AAV 1) 0 On"'11
Driveway Enc.
1 4- V -U I
Infrastructure
L
CITY OF LA QUINTA
PINANCE DEPT
TOTAL
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
—Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date— Permit
Validated by:
Validation:
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
Desert 'Sands'Unified School District
47-950 Dune Palms Road'
Notice: iinta, CA -02253
LA u
Document Cannot Be Duplicated � 7'60-771.;'8515
CERTIFICATE OF�COMPLIANCE
Date 7/13/01
No. 22248 'Jurisdicti n
�o
Owner NameAndr'ew Pierce Corp.
No. 78-198 Street Pinnacle Point"
city La Quinta zip 92253
APN# 770-370-017
La Quirita
Permit#0107-115
Tract # 28867 Lot # 6 Square Footage
Type of Development Single. Family Residence
Comments
Log #
Study Area
V
3174
No. of Units I
ived a cashier's check in the amount 'of $19,520. 10 for3 SFD.
At the present time,.,the Desert Sands Unified School District' doe's not collect fees on garages/carports, covered
patios/walkways, residential additions under 500 square feet, detached accessory structures or replacement mobilehornes. It
has been determined'the above-�'n-:amed owner is exempt from paying school fees at this time due to the following reason:
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to GovernmOt Code 53080 in the amount of
2.05 .'* X 3J74 or$ 6,506.70, the'property listed.above and that.buildin
9
permits and/or Certificates of Occupancy f6r.this square footage Mi- this proposed project may now be issued
Fees,Paid By CC/Palm Desert, Nat'l Bk -Autumn Sim's -346-3228
Tele0hone 7.60
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exem ted by Annette Barlow
Signature
Payment Received $6,506.70
Check No., 0823.45
40TICE: Pursuant ot Assembly Bill 3081 (CHAP 549, STAT I S.11 . 996) this will' 'erve to notify you that the 90 -day approval period in which you ma I y protest the fees or other payrn ant i . dentified
r
lbove 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�autlhorized to
:ollect them on the DistrictCs)(s') behalf, whichever is earlier.
Collector: Attach a copy of -county or citiplan checkapplication form to' , district copy forall waivers.
Embossed Original- Building Dept./Applicant Copy - Applicarit/Receipt Copy - Accounting
-0? -2001 18:21 TRADITI'ON GOLF CLUB ?60 564 2356 P.01
qradifton.
ARCHITECTURAL'NSION REViEw
June 6, 2001
Via First Cl= Maff
Mr. David C ' hap�nan
TRADMON CW8 ASSOCIATES
78-505.,Ola Avenue �52
La Quinta, CA 92253
Re: Old ' Califibmia Village
construcdon Documents .21 Submittal
Dear David,
The ADRC of TraAition Golf Club reviJew'e'd and approved the, construction documents for
The Old California Village. The Committee has asked that you*consider using solid wood
mechanical doors.
If you need any addiddhW"informatio'll, please do not.hesitateto call.
Thank you.
Sincerely,
Christina J., Dores
Architectural Review Coordinator
cc: Gary Lohman,- APC
j6 dy Jq nes, APC
Rob Parker, RGA
78505 OLD AVENUF-32 7 LAQUhNTA —CA92253� I IN — NoNE760/564-335.5 — FAx 760/564-2356
Certificate of Occup'ancy
.City of La Quinta
B
ilding and Safety Departme'nt
This Certificate issued pursuant to the requirements. of Section 109 of the Uhifofm Building . Code,
certifying - tha t, a t the i . time of.issuance, this structure was in compliance with the various ordinances
of the City regulating -building con'. struction'bruse. Forthe.follow,ing:
BUILDING ADDRESS: 78-198 PINNACLE POINT
Use Classification: SINGLE FAMILY DWELLING
Occupancy Group: R-3 Type of Construction:
Owner of Building: TRADITION CLUB ASSOCIATES
Building Official
Bldg. Permit No.: 0107-115
VN Land Use Zone: RL -
Address: 78-505 OLD AVENUE 52
City: LA QUINTA, CA 92253
By: RICHARD KIRKLAND
Date: 05-17-02
POST IN A CONSPICUOUS PLACE
�SPECIAL INSPECTION SERVICE,
REGISTERED INSPECTOR'S WEEKLY REPORT
JON TANDY
37630 Medjool Ave.
Palm Desert, CA 92211
Office (760) 772-7192
Fax (760) 772-7193
Pager (760) - 776-3338
TYPE OF
INSPECTION
PERFORMED
0 REINFORCED CONCRETE 0 STRUCT. STEEL ASSEMBLY
0 POST TENSIONED CONCRETE 0 ASPHALT
0 REINFORCED MASONRY 0 FIRE PROOFING
0
je OTHER
JOB LOCATION
'I 1 1 1(96c)
—LA
REPORT SEOUENCE NO.
TYP �FJSURE
y
DATE OF'REPORT
PERMIT -NO-
6�q-7 —k kz-;7
DA
13
DAY OF WEEK
-roe-S
MATERIAL DESCRIPTION
or(�_ja&
'2�
ARCHITECT
V\\Ja
f
INSPECTOR
HRS.CHARGED
E
ENGINEER
�-k Ks
ASSISTANTS
I
HRS.CHARGED
INSPECTION GENERAL
DATE CONTRACTOR
SUB
CONTRACTOR
4er
ck 7& A WIr
--o.A s3a i& �o'
A�\
Q ow"(x SA
r,,I?S 6 c\ Z7'�e)r
4
COPY SENT TO CLIENT 0
CONTINUED ON NEXT PAGE 0
PAGE OF
CERTIFICATION OF COMPLIANCE
I HEREBY CER71FY THAT I HAVE INSPECTED TO THE BEST OF MV
KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE
NOTED. I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED
PLANS. SPECIFICATIONS. AND APPLICABLE SECTIONS OF THE
GOVERNING BUILDING LAWS.
C&
S16WURr OF REGISjEjtD
V'M M
INSPECTOR
'I 1 1 1(96c)
:;707-77
1'7-8(/
DATE OF'REPORT
REGISTER NUMBFIR
REGISTERED INSPECTOR'S WEEKLY REPORT
JON TANDY
37630 Medjool Ave.
Palm Desert, CA 92211
Office (760) 772-7192
Fax (760) 772-7193
Pager (760) 776-3338
TYPE OF
INSPECTION
PERFORMED
0 REINFORCED CONCRETE 0 STRUCT. STEEL ASSEMBLY
0 POST TENSIONED CONCRETE 0 ASPHALT
0 REINFORCED MASONRY 0 FIRE PROOFING
d- J410 X
0 OTHER
JOB LOCATION "784%9
'LojAJOA CI -e poi Aj 7 LA i
REPORT SEOUENCE NO.
TYPE OF STRUCTURE
: i:,
5 _b
We
- IRM Ljio t -)S
PERMIT NO.
0 1 (0
DAT
itlills(
DAY OF WEEK
MATE6AL DESCRIPTION
e"(jApj 0 tj 54e.
geow
ARCHITECT
0(Z5AVM fAA-91e-
INSFFECTOR
HAS.CHARGED
ENGINEER u �ASSISTANTS
HRS.CHARGED
INSPECTION
DATE
GENERAL SUB
CONTRACTOR 16VIJe�jWCA3 F' -e CONTRACTOR
Lt 5 INI-� 5
ox
-P-4 Z,T
Pot -os bW54--p-al bk"oJ C ta C' e—, oeRIOP—
7V
COPY SENT TO CLIENT 0
CONTINUED ON NEXT PAGE 0
PAGE OF
CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MV
KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE
NOTED. I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED
PLANS. SPECIFICATIONS. AND APPLICABLE SECTIONS OF THE
GOVERNING BUILDING LAWS.
to - ) !��"
SIGNATURE OF REGIAERED INSPECTOR
it & I - --rz& (it 13V -V?
"DATE OF REPORT REGISTER NUMBFR
REGISTERED INSPECTOR'S WEEKLY REPORT
JON TANDY
37630 Medjool Ave.
Palm Desert, CA 92211
Office (760) 772-7192
Fax (760) 772-7193
Pager (760) 776-3338
TYPE OF
INSPECTION
PERFORMED
0 REINFORCED CONCRETE 0 STRUCT. STEEL ASSEMBLY
0 POST TENSIONED CONCRETE 0 ASPHALT
0 REINFORCED MASONRY 0 FIRE PROOFING
0 OTHER 9p C11w-
0 'X I
JOB LOCATION�L(,/7-=-j-q'-.g---
p-
REPORT SEOUENCE NO.
TYPE OF ST TURE
SM &
PE RM61. 7_ /JS,
DATE
DAY OF WEEK
-
MATERIAL DESCRIPTION
ARCHIT CT
C
HRS. CHARGED
ENGINEE�,
ASSISTANT�
HRS. CHARGED
INSPECTION
DATE
GENERAL t SUB
lei p
CONTRACTOR f�tOQL 'e le -Ce _CONTRACTOR
If
+
6"
VI -
r
V4., -
COPY SENT TO CLIENT 0
CONTI E)N NEXT PAG:,2f
PAGE OF
CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MV
KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE
NOTED. I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED
PLANS, SPECIFICATIONS. AND APPLICABLE SECTIONS OF THE
GOVERNING BUILDING LAWS.
�G
I
kTUj OF REGIS�nS61ECfOp
- --)- -;Z-A 1,oL ki
TE Ok
REPORT
REGISTER NUMFIFR
REGISTERED INSPECTOR'S WEEKLY REPORT
JON TANDY
37630 Medjool Ave.
Palm Desert, CA 92211
Office (760) 772-7192
Fax (760) 772-7193
Pager (760) 776-3338
TYPE OF
INSPECTION
PERFORMED
0 REINFORCED CONCRETE 0 STRUCT. STEEL ASSEMBLY w- F-?o`ILq
0 POST TENSIONED CONCRETE 0 ASPHALT 0 OTHER
0 REINFORCED MASONRY 0 FIRE PROOFING
JOB %114-
C14V Q -%Z, N --r- ;N.
REPORT SEOUENCE NO.
TYPE OF STRUCTURE
TV-4wl %
PERMITNO.
:A E,
'& 'I
' t j
DAY OF WEEK
MATERIAL DESCRIPTION
51 o to --;e- 9AP-4-
ARCHITECT
_ja%j
INSPECTOA
'T! 6 71
HRS.CHARGED
S I. -7<17
ENGINEER
ASSISTANTS
HAS.CHARGED
INSPECTION GENERAL SUB
DATE CONTRACTOR r -t-' a n',:' T-(LcV. r-oNTRAcToR
%k %t- 'S
Ou'r Be -AW -00
'!�'Ioj C" 'S'% &A 5 C3 ,I 5,e --T- C -pd )C-*-( Elp-t+
W6 1' 6 f- T -0
COPY SENT TO CLIENT 0
CONTINUED ON NEXT PAGE 0
PAGE 'Of
CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MV
KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE
NOTED. I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED
PLANS. SPECIFICATIONS. AND APPLICABLE SECTIONS OF THE
GOVERNING BUILDING LAWS.
SIGNATURE OF REGI�TMD INSPECTOR
%k 31�o It =60 I t I I 31,b - 4 4`1
1 DATE OF REPORT REGISTER NUMBFR