0312-229 (SFD)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
519186 B _ 1ori 117(
Datef ! ' , a Signature of Contractor
l •�`'µ�.�
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. fo(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 3709 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 STAT i� P�iINi� Policy No. W93)131976(C'A)
(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; l shall forthwith comply with -those provisions. I
Date: ! I 1 U / 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) N_ ' � Date
PERMIT#
BUILDING PERMIT
DATE VALUATION LOT�1d� TRACT
5 31289
JOB SITE
ADDRESS 47-498 CU.1":O'f�AY - )ti 01' 5 APN
OWNER CONTRACTOR / DESIGNER / EN (NEER
4p���E, FRONT INVESTORS, INC. J.T. yaYHOE, INC.
�
34770I17OI.1`WAY 11,1, WI 203 41865 BOARlYWAIX #204
1WIAN WELLS CA 92210 PALM MMRT CA 92211
X60)340-0850 MIA- 3024
USE OF PERMIT
SFD- 3,386 SQ.PT. LIVING (PLAN 3 TUSCAN) @ LOT 6..5. PERMIT
DOES Nar INCLUDE EITRY:GATM BLOCK WALL,% POOL . SEPARATE
DMV•Zt AY AFP. PERMIT &1$40. BY PUBLIC WOPLKS RE015.
TRACT
COp yW�STRUCTION 1.0966.00 yO�'yF
1.'OR1..i3i��PJ•'bl IO 813.60 )S�
0AW.E(CAMPORT 75$.00 9V
1a'SnI4!lAM COST OF OO, ,"07Ei'"U4'3'iON
X9 Ag 7..v
PERWW PIET S'I1Yt ARY
CONSTRUCTJON FE.P
101.000.418.000
$1,024.50
PLAN CHECK FEE
101-040-4317-:318
$960.67
ME,CHAN'[CA1. FEE
101.000--47,1-000
3111.50 ,
ZLW,TR1C,A31 FEE
.4,100-4 20-000
$203,61
PL[IMBINO FEE
10€-000.419.000
$192.sO
STRONO MOTION FEE - R.SSID
101-000-241-000
$2.0.95
GRADING FEE
101-000.423-000
116.00
DEVELOPER IMPACT FEE
$2,403.00
PPIECISF, PLAN .
1(8.1.-1100.441.345
$100.00
AW” Rt PUBLIC PLACES • R&WL 270-000-445-000
$13.`14
-x
SUB-TOD&J, COMSTAT3CrrO.N AIM PLAN 01VEIN
$4,962.47
LF.} , 3
PRE -PAW FFM-
$0,00
+ `•�'�..��
11d:.dA! I"I 8•.L'n. .6 PC
F, -NOW
$4,962.4 t
JAN 08 1004 rT"
CITY OF r
_ F1AIATtC �:A ZA :
.
a RECEIPT DATE--,7_4.,� r TIBY i IDATE FINiL-ED I'INS�R
S
INSPECTION RECORD
OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR
BUILDING APPROVALS/ MECHANICAL APPROVALS
Set Backs nderground Ducts
Forms 8 Footings Ducts
Slab Grade OK Return Air
Steel Combustion Air
Roof Deck Exhaust Fans
i O.K. to Wrap ,� .A.U.
Framing 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
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 APRVAL Gas Test
Electric Final
Waste Lines Heater Final
Water Piping 'yj Plumbing Final
Plumbing Top Out Equipment Enclosure
Shower Pans OX for Finish Plaster
Sewer Lateral Pool Cover
Sewer Connection Encapsulation
Gas Piping
Gas Test
Appliances _
Final
COMMENT :
S S L -a 1A2q/,9_
_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
,-SPECIAL INSPECTION SERVICE,�
REGISTERED INSPECTOR'S WEEKLY REPORT
JON TANDY
78-194 Elenbrook Ct.
Palm Desert, CA 92211
Office (760) 772-7192
Fax (760) 772-7193
Pager (760) .776-3338
TYPE OF
INSPECTION
PERFORMED
❑ REINFORCED CONCRETE ❑ STRUCT. STEEL ASSEMBLY
❑ POST TENSIONED CONCRETE ❑ ASPHALT ❑ OTHER
❑ REINFORCED MASONRY ❑ FIRE PROOFING
JOB LOCATION _1 _ 40n � Q�� k-ic�`
`-®�
REPORT SEQUENCE NO.
TY OF S RUCTURE �/'�
PERMIT N0.DATE
DAV OF WE
MAT AL DESCRIPTION
Z_? IC
ARCHITECT
INSP&CTOR
HRS. CHARGED
ENGINEER
ASSISTANTS
HRS.CHARGED
INSPECT40N GENERAL SUB
DATE CONTRACTOR CONTRACTOR
�v\ • Lam 1 'C'�.4 ��.
�w , l O
a o
p ol& toc r%a' S c:> "3' r, k%
- PikE-NS -
- A+0 O-cr ror, G n ZSi "' C�i,,�� V SU, k 3
q3� ls` ss-, W, �c�4.' c i�,,� moor -
• i
N (<
`A P&SFisk wit
a► � we,•l1 �jE Cor '.6 L'acgr-4a')r'S
LZrr jr
p�
C1 O -S e S a C r%r Z
Ay -ea sbn')o
COPY SENT TO CLIENT O
CONTINUED ON NEXT PAGE O
PAGE OF
CERTIFICATION OF COMPLIANCE
'HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MN
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,
51C,nE OF REGISTERE INSPECTOR
lc -17
DAVE OF REPORT REGISTER NUMBER
March 17, 2004
Johnson & Nielsen Associates SCarl B. vendHoluson
N ielsen
Per T. Ron
C o n s u lti ng S t r u c t u rat E n g i neers wen Y.L'ui
Lonnie P. Mount
647 North Main Street • Suite 4-B • Riverside • CA • 92501 • (909) 686-5122 • FAX (909) 686-6752 Steen T ni usen
L o s A n g e I e s • R i v e r s i d e • I r v i n e Jackson K. W
J.T. Hayhoe
17821 E. 171h St. Ste 240
Irvine, CA 92780
Attn: Scotty Perry
Re: Mountain View Estates
Lake La Quinta Lot 5
Dear Scotty;
J & N Job No. 40-010
This letter is to serve as written confirmation of the complete framing inspection I made at the
above address on March 17, 2004. Based on this visitation, it is my opinion, that the
complete framing is in compliance to plans and specs.
If you have any questions, please feel free.to call.
Sincerely,
QPpSfE81p�,�
GPAin
ca ti
v
NO. 38-'"
Lo ie P. Mount, S.E. ExP33'a°p4 b
JOHNSON & NIELSEN ASSOCIATES OF
Consulting Structural Engineers
C:\WPDOCS\0-FORMSVrispedn.Itr\FRAM INSP 40.010.wpd
t� Certificate of Occupancy
o o
Iucvxreu7sv .�.
G�
OF Building y p & Safety Department
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: 47-698 CALEO BAY
Use classification: SINGLE FAMILY DWELLING Building Permit No.: 0312-229
Occupancy Group: R3 Type of Construction: V -N Land Use Zone: RM
Owner of Building: LAKE FRONT INVESTORS Address: 74770 HWY 111, STE. 205
City, ST, ZIP: INDIAN WELLS, CA 92210
By: TOM MORRISON
Date: NOVEMBER 12, 2004
Building Official
POST IN A CONSPICUOUS PLACE