0312-231 (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
3393s3 R
Date r+' �� Signature of Contractor �----v - "}
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 wa6es 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.
( ) 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 SST k,iF FU�atI3Policy No. W981 1,51976(0
(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 ihall forthwith comply with those provisions.
Date: f r / G f ( 4 Applicant—
Warning:
pplicant 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
whose request and for whose benefit work is performed under or pursuant
any permit issued as a result of this applicaton agrees to, & shall, indemn
& hold harmless the City of La Quinta, its officers, agents and employe
2. Any permit issued as a result of this application becomes null and void l if
work is not commenced within 180 days from date of issuance of su
permit, or cessation of work for 180 days will subject permit to cancellatio .
I certify that I have read this application and state that the above information s
correct. I agree to comply with all City, and State laws relating to the buildi
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) t _ ..A .� Datef ? P 1
BUILDING PERMIT PERMIT#
4)3;i2 -23.f
DATE VALUATION LOT .TRACT
S1:Af�7p79Ys.3.4i 7. • �
31289
JOB SITE
ADDRESS . 47, 7W_C.A1AV0RAY—tw !' {�
AP N
�M�F�►��5 i
OWNER
CONTRACTOR / DESIGNER / EN &NEER
LAKE xROr DME- VORS, WC.
74770 T•3ICHWAY 313, ZXM7 205 -
413 865 ROAIRDWAIX4204
INDIAN W IJ S CA 9221.0
PALM DRZFW CA
922111,
;760)340.0850 CMI
3024
USE OF PERMIT
TC �: riAM�.Y DWird.I.,.1 40,
SM. 3,089 SQ.FT. 1..Tt tW0 (PI. 13 TUSCAN) @ LOT O. PLUIMI T '
DOES NOT INCLUDE FNTRY WE% BLOCK Si ALLM POOL. SEPARATE.
DRUV EWT.AY,R PP. PEI' WT & IA SP, BY PUBLIC WORKS REXYD.
TRACT CONSTit JCTION %989m SF
Pokcw&'?A'r10 -78.2,00 SF
OA MOVCAk1PORT 49100 OF
EgTVJ?►TF-,D COW OF C'OTIR7'RUC710N
107,796.10
PERMU Fn SUMMARY
�'13ECI.ANICAI FEE 101-000.421-000 $111.50
ELECTPJCAL. ISE 101-000-420-000 $209.61
PLUMBING FEE 101.000-419.000 $192,50
STR.O140 MOTION FEE - =SID 101-000-241-000 $30.95
GRADING ME 101 -000 -423 -WO $13.00 .
DEVELOPER IMPACT FEE $2,405.00
.ART W PUBLIC PLAd:E8 RESI'L 27.0.000.445-000
PLAN CHF -CK FEE 101-000-439-318 $615.98
CONSTRUCTION FRE 101-000.418-000 $9417 0
A SUB. M -Al A1'. CCjX fRUC ON AND PLAIT CIMCh
x,540.68
TMU PRE -FAV) DUO
$0,00
JAN 16 2004 -FOTA1, rnmur 3! "n ue now
V W.613
CITY Qe LA QUINTA
FINAN2f PPF
RECEIPT
DATE
BY
DATE FINAL
IN��C OR
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 10/31/2(
Date Signature of Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractoes
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).
( ) 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 STATE FUND Policy No. W981131976(CA)
(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, 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
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) Date
BUILDING PERMIT PERMIT#
0312-231
.
DATE VALUATION $187,796.10 LOT ,7 TRACT 31289JOB
SITE
ADDRESS 47-750 CALEO BAY - LOT 7
APN 643-200-009
OWNER
CONTRACTOR / DESIGNER / ENGINEER
LAKE FRONT INVESTORS, INC.
J.T. HAYHOE, INC.
74770 HIGHWAY 111, SUITE 205
41865 BOARDWALK #204
INDIAN WELLS CA 92210
PALM DESERT CA 92211
(760)340-0850 CBL4 3024
USE OF PERMIT
MNGL E FALMY DWE 1_JNG
SFD- 3,089 SQ. FT. LIVING (PLAN 3 TUSCAN) LOT 07. PERMIT
DOES NOT INCLUDE ENTRY GATES, BLOCK WALLS, POOL. SEPARATE
DRIVEWAY APP. PERMIT & INSP. BY PUBLIC WORKS REQ'D.
TRACT CONSTRUCTION 3,089.00 SF
PORCH/PATIO 782.00 SF
GARAGEICARPORT 493.00 SF
ESIMATED COSI' OF CONSTRUCTION
187,796.10
PERMIT FEE SUbD4ARY
MECHANICAL FEE 101-000-421-000 $111.50
ELECTRICAL FEE 101-000-420-000 $208.61
PLUMBING FEE 101-000-419-000 $192.50
STRONG MOTION FEE - RESID 101-000-241-000 $20.95
GRADING FEE 101-000-423.000 $15.00
DEVELOPER IMPACT FEE $2,405.00
ART IN PUBLIC PLACES - RESIE 270-000-445.000 $23.74
PLAN CHECK FEE 101-000-439-318 $615.88
CONSTRUCTION FEE 101-000-418.000 $947,50
SUB -TOTAL CONSTRUCTION AND PLAN CHECK
$4,540.68
LESS PRE -PAID FEES
$0,00
TOTAL PERMIT FEES DUE NOW
$4,540.68
RECEIPT
DATE
BY
DATE FINALED
INSPECT05
S
r
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
_
t
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
L
Compressor
Insulation
✓b_z=Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
6%
Final
BLOCKWALL APPROVALS
steel
POOLS - SPAS
Set Backs
Electric Bond
Footings
Main Drain
fond Beam
Approval to Cover
Equipment location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APf ROV
Gas Test
Electric Final
Waste Lines
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
I o 6 0
Appliances
`
Final
Final d
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring .r '
Low Voltage Wiring
Fixtures° ,
MainService.
Sub Panels '
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of: Power
.Final// / 6 ,
Utility, Notice (Perm) —
COMMENTS:
March 17, 2004
Johnson & Nielsen Associates SvendH°lnu°tt
Nielsen
Per T. Ron
Consulting Structural Engineers Wen Y. Li„
Lonnie P. Maur
647 North Main Street • Suite 4-B • Riverside • CA • 92501 • (909) 686-5122 • FAX (909) 686-6752 Steen T Thomsen
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. 17th St. Ste 2.40
Irvine, CA 92780
Attn: Scotty Perry
`Re: Mountain View Estates
Lake La Quinta Lot 7
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,
. Q�oFEssioy�t
P MpG� F�
N0.3834.
Lo ie P. Mount, S.E. W EXP.3-31-2004
•
9J
JOHNSON & NIELSEN ASSOCIATES �s'grF F cA��FOQ��
Consulting Structural Engineers
C:\WPDOCS\0-FORMS\inspectn.Itr\FRAM INSP 40.010.wpd
k.-r ertwcdt6"',,of Occ ar c
TA
.14
OF Budding & Safes.Department
This CertigGate is issued pursuant io the requirements of� Section 0 ofithe: California Building'
v
Code, cern in that �at thee tirr'e of .issuance, . this structiir Sivas il� #>om fiance with the,
provisions of the Building ; Code-,-: and the various. ordinances oregulating: building
3C�ty
construction and/or use.
BUILDING ADDRESS: 47-75d'CALE'O BAY' 4
Use classification: SINGLE FAMILY DWELLING Permit: No,: 0312-234
Occupancy Group. R3Type of Construction: V-N j' = ' Land Use done: R-M
.,
Owner ofBuilding: LAKE FRONT INVESTORS. Address*>74Z70 HWY,111: STE 205
City, ST, ZIP: INDIAN WELLS. CA 92210
By: TOM MORRISON
Dater NOVEMBER 16, 2004
Building Official
POST IN A CONSPICUOUS PLACE