0007-066 (SFD)LICENSED CONTRACTOR DECLARATION
cn I hereby affirm'under penalty of perjury that I am' licensed under provisions of I
ChapeN 9 (comrhencing`with Section 7000) of Division 3 of the Business and
ycv W; Professionals Code, and my License is in full force and effect.
11;t—C:) ck License # Lic. Class Exp: Date
r` QL
[r,_ 480121 1:3 C20 C36 09/'10ixi"
6 Zr— Date Signature of Contractor
p•ti
J U (D OWNER -BUILDER DECLARATION
W W r— I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ d 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
r, N 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 15y 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 9TATR FUND Policy No. 229-00-0020350
(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 a)g!
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 j 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
UILDING' PERMIT PERMIT#
DATE + VALUATION ' LOT 1.066 TRACT
`��}�j
r , $93,926AV
JOB SITE t
APN
ADDRESS
5:24. IS A VENIDA T"10
;
OWNER ]
CONTRACTOR / DESIGNER / EN (NEER l;
_
DAVID 3- 1.,Ua:1*T.KW;;T..D
D:FV},":Lc:]i' erf CO
PO 13OX 2982
18y921 R:U- AWA.YBAY
w -
PALM DF40,ERT • CA 922.61
BKIRMUDAUUMES CA. 92261
(760)360-€3'706
MA 1526
i
USE OF PERMIT
TRACT C014STRUCTIO14
POR.C"AT10 33,00 SF
r,
MARACSFICARPORT (Sig) �Sli .bd
5 FT, WOOD VENCE 300.00 LF
EST91V.€AMM GOSr'It' 011 COORI'R."ClG7:[ON
93"Z6 40
BRIM. 1�' :' s 12`31
CUf45TK'VCT1O]N FU 101.000.418«000 $$12.50
PI,,AN f.*H CK FEE 101-000-439-318 g50€t�33
ME.CHA141CALF FEIN. 101,000.421-000 5+30,00
a
N'1, ,CTRICAL, FEE 101=000-420-000 $110.98
PLUMl INO FEE 1013 -000-419000 $110-73
STRONG MOTION F'E9 > RESID 101-000-24.1-000 $9.59
GRADING FTK 101-000.4% x•000 ��.00
Al?VI;iOI7ER IMP -ACT Fit $1,907.00
•
PRE;CISH Pid6sN 101.000.441-345 $00,00
FE;i? DEPOSIT 101-000-439-318 •"01,0.40.00
SUB -'I`t rN CCiA,+ a LTG'1'it71~]'.AM PLAN CkWfX
$3,438.87
,
PRS-PALT� u
•$1,'606,00
�rarn I;,EMV4T 7[ vs DU yaw
smwv
P''0 6 2000
aITY Of LA WI
RECEIPT
'DATE , ��7� ke
BY f��,4sy,!
DATEFINALED
INSPECTOR
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
_
_
Ducts
Slab Grade
_�
Return Air
Steel
Roof Deck
_
C
/J
r%/
Combustion Air
Exhaust Fans
O.IC to Wrap
F.A.U.
Framing
Compressor
Insulation
� � �Ap
�
Vents
Fireplace P.L.
(%
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Z-409'
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
_
r
�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:
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)
z1l(o1W v(
t; r
001,0L* T4t�l 4 4 Q"
Addrress ;?. — 1 I S} { %) 4 I f ti
Address
I In l I �, & "
kA r'
i
State Lic. City
,,-
& Classif. 4,/L _ /-w, r 12 Lic. #
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Arch., Engr.,�
Designer
Address Tel. 'r
City Zip State
Lic. # i
LICENSED CONTRACTOR'S DECLARATION." -i LJ
that I ar}� licen§€d- -der provisions of Chapter C(comrt ncing with Section
9 of t�h6 Busl�r°'e"ss and Professions Cogs, an
myrficdnse>Is-S'full force and
OWNER -BUILDER DECLARATION /
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Susiness and Professions Code: Any city or county which requires a
permit to construct, alter, 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
!or the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
I', 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, Buisness and
Professions Code: 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
of proving that he did not build or improve for the purpose of sale.)
I1 I, as owner of the property, am exclusively contracting with licensed contractors to con-
s
trucI 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.)
17 1 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
n Copy is filed with the city. O 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 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.
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 1B0 days.
I certify that I have read this application and state that the above information is correct.
1 agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives -of this city to enter the above-
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
V
APPLICAl ONLY IIIIt
1C L 1 l
BUILDING: TYPE'CONST;► __OCC.
A.P. Number ?") 3—/!n_/ 2-
Legal Description do 0
Project Description
GRP.
— o In
Sq. Ft. No.
Size / 4-1 Cir 4 Stories
No. Dw.
/ Units
New3r Add ❑ Alter ❑
Repair ❑ Demolition ❑
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.—
o n
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
6 106 C/
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`: La Quinta, CA 92253
Document Cannot Be Duplicated 760-771-8515 f
CERTIFICATE OF COMPLIANCE -
'Date 9/5/00 ` ; APN # 773-21-2016
No. , 20963 ' Jurisdiction La Quinta
Owner NameDavid Heusinkveld . -
` ,Permit # 0007-066 _
No.' 52-115 Street, Avenida Rubio Log #
City La Quinta Zip 92253 study Area
Tract # Lot # Square Footage 1533 `
Type of Development Single Family Residence No. of Units
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 or replacement mobilehomes. It
has been determined the above-named owner is exempt from paying school fees afthis 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 1,533. or $ 3,142.65 the property listed above and that build}ng NY
a,A_
permits and/or Certificates of Occupancy for this square footage in thisproposed project may no)w` be issued ,
Fees Paid By 'CC /•Palm Desert National Bank / JeffHeusikveld' . ' T'ele�hbne 76A-360 8706'x.;
. Name on the check
By Dr. Doris Wilson - �''+�'nL
Superintendent
} Fee collecq/exeted by Annette Barlow Payment Received $3,142.65Check No. 081341Signatur
NOTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1998) 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 Districts) or to another public entity authorized to .
collect them on the Olsbict('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 '. .
,
f
RC DISTRICT - PLANNING REVIEW FORM
This, form is to be used by -CDD staff for review of single family dwellings in the RC (Cove Residential)
District, in order to determine the applicability of compatibility issues or need to require the filing of Master
Design Guidelines by the applicant. It shall be transmitted to the Building and Safety Department as your
correction list. Please attach additional explanations as necessary.
APPLICANT DGH Development Corporation
SITE ADDRESS 52-115 Avenida Rubio
APN 773 - 212 _ 016 BIN NO.; . CASE NO.: 2000-2,38
LEGAL: LOT BLOCK UNIT S.C.@V.L.Q.
CHECKED BY: Stan SAwa DATE:
Inform the assigned Building plan checker upon your assignment to this case. The CDD Executive
Secretary maintains a log book to track applications and assign case numbers.
REQUIRED ITEM
Y
N.
COMMENT/CORRECTION
Compatibility Review
\3
Case logged and number assigned
Verify legal and APN information
\14
Consistent with MDG on file (as applicable
MDG filing required (5 filings since 9/3/98)
Consistency with street/surrounding area:
Colors
Materials
Architecture
Other Requirements:
r
Y� �c7 1S5L1
V1
N
J
RECORDING REQUESTED BY:
AND WHEN RECORDED, MAIL TO:
David Heusinkveld
78-921 Runaway Bay
Bermuda Dunes, CA 92211
DOC a 2000—mao 7se
06/16/2000'08:00A Fee:6.00
Page !-of 1 Doc T Tax Paid
Recorded in Official Records.
County of Riverside
Gary L. Orso
Assessor,'County Clerk 8 Recorder
M
I
u
"PAGE SIZE
DA I
PCO
NOCOR
SMF
MISC.
Is
I
I
A
I R
Lcoax
LONG
i REFUND
I NCNG
EXAM
T
VA
ASSESSOR'S PARCEL NO.: 773-212-016 The undersigned Grantor(s) declare that the DOCUMENT TRANSFER
TAX IS:
TITLE ORDER NO.: 503669-13 $ . County $17.60 $ City
_computed on the Wil value of the iweiesi Of PI-CIp- ly_convcyed, c.
ESCROW NO.: 6085 -ST _computed on the full value less the value of liens or encumbrances
remaining thereon at the time of sale.
_OR transfer is EXEMPT from tax for the following reason:
GRANT DEED
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged,
James R. Kirchgessler, a single man
hereby GRANT(S) to David Heusinkveld , a married man
all that real property situated in the City of La Quinta County of Riverside, State of California, described as:
Lot 5 Block 4 of Santa Carmelita Unit No.1 in the City of Riverside County of Riverside, State of California, as per map
thereof recorded in Book 18 Page 46 of Maps, in the office of the county recorder of said county.
Dated May 16, 2000
STATE OF CAL FORNIA
COUNTY OF j '?S
ON before me /v!�n d-�i
"Jet.^ Pub!!--, Personally appeared
4Q c s le,�
kJ
personally known to me (or proved to me on the basis of satisfactory evidence)
to be the person(s) whose name(s) is/are subscribed to the within instrument and
acknowledged to me that he/she/they executed the same in his/her/their
authorized capacity(ies), and that by his/her/their signature(s) on the instrument
the person(s), or the entity upon behalf of which the person(s) acted, executed
the instrument.
WITNESS my hand and official seal. „
Signature
da4es R. Kirchgessler
MAIL TAX STATEMENTS TO: (This area for'official notary seal)
David Heusinkveld - 78-921 Runaway Bay, Bermuda Dunes, CA 92211
h1AGGiE L. LOPEZ ir
•._�p.'I
CONI'e: # 11892',0,3 m
NOTARY ? :LIC-CALIFORNIALu ti
LOS ANGELES
;xDires JUL b, 2002 1
MAIL TAX STATEMENTS TO: (This area for'official notary seal)
David Heusinkveld - 78-921 Runaway Bay, Bermuda Dunes, CA 92211
CHARLES 0. G;ANLAND
C 191 .. - Architecture, Interiors, Space and Land Planning
Structural Calculations
2 September 2000
City of La Quinta
Department of Building and Safety
78495 Calle Tampico
La Quinta, CA 92253
Project: Single Family Residence for:
DGH Construction .
52-115 Avenida Rubio
La Quinta, California
Re: Review of Truss Manufacturer's calculations
Jim Jimenez,
I have been supplied with a copy of the truss manufacturer's calculations prepared by Trussworks of
Thousand Palms, California, for the project noted above. Upon review of these calculations I find them
to be in substantial conformance with the design intent of the construction documents.
If you have any other comments or questions regarding this or any other matter pertaining to the project
noted above please do not hesitate in contacting me.
Sincerely,
X10. Dy1 91 s� 4�
EXP. DATE, a
Charles D. Garland,
ArchitectIca
._.
35-325 Date Palm Drive, Suite 151-J -Cathedral City, CA 92234 - Phone/Fax: (760) 324-7146
%
` - 4 CBABLES-D. GARLAND
A R C H I T E C T
ARCHITECTURE, INTERIORS, SPACE and LAND PLANNING
f
STRUCTURAL CALCULATIONS
4 October 2000
.61ty of La Quints
-'
..,78-495 Calle Tampico
Quints; La - Q - t;
a; CA 92253
Project: Single Family Residence at
�,52;115 Avenida'RUbin
For DGH_45En_str_u_6ti6fi
Re:- Project Observitioh and Field Revision
To Whom It MayConcer'n,
On'o-i. about X25 September 2000 1 visited the site to perform my structural observations for the noted
project. All.aspeicts of the rough framing and concrete foundation and slab on grade were found to
be in substantial conformance; with the structural design intent of the construction, documents.
The builder,,DGH Construction asked that I review and!certify a field change that had to be made.
The shearkall between the garage and the dwelling (wall "G") had to be revised. There was a
portion of th wall in ' dicated on the plans that did not extend to the roof framing as I assumed in my
calculations. If thelength of this wall is removed from the design considerations for this wall (the
load per lineal foot goes from 204 to 277.667 plf) then the wall's nailing must be increased to 4" o.c.
for the edge nailing. I directed DGH to revise this at that time. Also, because of the construction of,
the dra�-`irujlisi called for on the plans and the fact that all of the walls were framed to a uniform ht.
There was no satisfactory shear or drag connection possible. 1, therefore directed, DGH to apply-'
3/8" CDX plywood to the side -of the ceiling drop portion of the truss, nailing it off with 8d at 4" o.c
and providing Simpson A35s at 12" o.c. from the side of the drop to the top plates. This will giv6.,
the truss adequate.drag'and shear transfer capability
If you have any -further questions regarding this projector this issue please do not hesitate to
contact,m6.
CHI
Sincerely GARS Ori
�r�l'� ' �I �. ~ tr
14:
I rf,
Certificate-of.,OccUP ancy
City of La Quinta...'s
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: 52-1 15.AVENIDA RUBIO
Use Classification: SFD Bldg. Permit 'No.: 0007-066
Occupancy Group: R 3 Type of Construction: VN Land Use Zone: RC
Owner of .Building: DAVID HEUSINKVELD Address: --P.O. BOX 2982 =
City: PALM DESERT, CA 92261. -
By: STEVE TRAXEL
Date: 12-18-00
Building Official
POST IN A CONSPICUOUS PLACE