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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
674074, B 7/3'1/01
Date i -t '�� Signature of Contracto~
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.
(,J I have and will maintain workers' compensation insurance, as required by
Sec ion 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 PlTND Policy No. 046-000=9
(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-off Section 3700;& -the Labor
Code; I shall`forthwith comply with those/provisions..' /J
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 r
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•io
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 inspgction purposes.
Signature (Owner/Agent) � V �`_-"'""'Date
PERMIT #
BUILDING PERMIT
DATE % VALUATION $24%'tLOT 43 TRACT 26524
JOB SITE
ADDRESS 79-420,1;lK00KV A L;9
APN ? 7� f�4fb �;i•i
OWNER
CONTRACTOR/DESIGNER/EN (NEER
3.,,A Q[)I r A.ORCHAIM F'0,R aW_R.0
V.Far'aS C10N..9rR1,TC ,,[10.N•
P081 -OX 1716
'19--2951,,U)NICUO-1,P.1Q43.> TA.D.X
LA QXTW'I A. CA 92255
LA C�a11�•l"rA CA. 92253
C760)771.1941 CSW 2.9.3
.USE OF PERM[IT{.
ERD LDT 43•PERMIT CEOX3 NOT INCL.i.1id1,O K >;A1.AIA.4if.P00L.f3RA OR
TJR,V l;' WAY ,APPPW,ACH
TRACT CONSTRUCTION
PC3tR' i/f�.eL rio 716:130 We
Ce'aFtr'�Cri4.'�1.FxPCi49' �3a'2a1(i Ski
07.AXJL:V.EAX' ,,D COFr OF Ly1Ji.Yi7 idtSW\.n.i 0111
2494:4c30
11.'.t�t-'' +fa.r ls'RA, Mto SY
5:orNS't`1k.13d°"•'7'1014 PEP, 3.01-00 0-41 0 51,164.10
PLXN ta>iltrCK112-F, 101.000-4 9-318
FENDEPCSCi 101=C�12Ci 4��a:37t� ���i�,l1U
NIECIIJIV I CAI, FLEX, 101 •-00U,4 2 1-OCO $.182.00
k.UXTRICAL 1 RE, 101.0OU-420.00 0 $231.18
P1.1JMOMOi PEE 101 -•000 -419 -OW $285.7:
STRUNO ]MOTION PRY,- RVZ,ID 101=000.241.000 1;A.92
ORA071J0 M 101 -W-423 -000 $1.5.00
ART IN PiJBLIC,'' PlAACES - RUIT V/0-000-445.000 $122.98
:C3VVB kX)PJP,R. IM-PACN." FFY, 0,405.010
"..;
IZZU Y -PAMFM
4250.00
P[:DEC
10 2002
CITY OF LA QUINTAFINANCE nr-PT-
BY `� .. _ _
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
3
Ducts
Slab Grade
—
Return Air 6.2
Steel
_ / y s
Combustion Air
Roof Deck
44
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
— 51
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
7 J
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
I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
/
Heater Final
Water Piping
Plumbing Top Out
— %
Plumbing Final
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
j ✓3
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPR VALS
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) .p
COMMENTS: vgg"o,�
ell
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 4,081 S.F. or $8,733.34 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/California Bank & Trust - Judy @ Sparks Check No. 01898
Name on the check Telephone
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Monica Guillen $8,733.34 1$0.00
Payment Recd Over/Under
Signature`
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
\I\
July 22, 2003
WALLING & McCALLUM / LIMITED
ARCHITECTURE • PLANNING • ENGINEERING
45-190 CLUB DRIVE
INDIAN WELLS. CA 92210
City of La Quinta
Department of Building & Safety
Post Office Box 1504
La Quinta, Ca. 92253
Re: Estancias Lot 43 Residence
Lot 43
The' Estancias
Gentlemen
(760) 360-0250
FAl( (7
60) 360.0786
I have reviewed the truss calculations and corrections, and have found them to be in compliance
with the drawings.
G. V
JGW/mlm
Certificate of Occupancy
`•IG Inm �annn
OFBuildin & Safet Department
g Y p
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: 79-420 BROOKVILLE
Use classification: S.F.D. Building Permit No0105-266
Occupancy Group: R -E Type of Construction: V -N Land Use Zone: R -L
Owner of Building: TD DESERT DEVELOPMENT Address: PO BOX 17.16
City, ST, ZIP: LA QUINTA CA 92253
By: G. SHOWALTER
Date: 03/03/04
Building Officlal
POST IN A CONSPICUOUS PLACE
•