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0209-140 (SFD)Y LICENSED CONTRACTOR DECLARATION I hereby affitrim upder penalty, 6f 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 e#``��Kx�g a��y t•Lic. Class Exp. Date a f�wvye D Signature of Contractor" Date+ t: / ::� . frJ cYr•� .. - 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. ( ) 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. 090-1040$56-03 (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 Peorr'h�'It is issued, I shall not employ any person in any manner so as to beCdme ss bfect to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation p�rovisiQns of Section 3700 of the Labor Gode, I shall forthwith comply with those�pvisions. + µ' Date:,'`,' . , j Applicant U--' 1, 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. i;:-..' `r( , Signature (Owner/Agent) i _� •""''`��` �.,. � �•_ Date PERMIT # BUILDING PERMIT, 4 DATE / VALUATION .rte LOT TRACT % / 1 ,� V 7 i7ywy'irT, piw"'ti + S c4 .. �.'!'� I JOB SITE ADDRESS 75..6�'O� PAS..11.utit.A 1VSS 111JV2; APN 770- 11 OWNER CONTRACTOR/ ER MUM. ZKCCZLY SLINWORAR 5�y�yER 1,:. W.9li�T.N C�A.I.�,ri1 �..0.1�t AP IZ'V� � 13,�. %f. 1.1•W �.,.+i 8011:I DFN OAKS LAM 20 CA X2733 PIVI9151MMOS t.'A 92,2ea ('160y0-16.114 0.131111 523 •s USE OF PERMIT MGIZ.. FAlALY I)W' rlq -LW(1 5f4)1 � l s!{31? 'bi: i.,E.S FiJCJIdt7tl t19�+,1,iiR AF'f' f3.4C}3�C C�lV1T'lr:J.,3eC Ltl:;`€ i A0,1+'I�'F��'i AL & S'TATE LAl�'�N,11dCF,.rli�19111 •'. h h�tdli l�!'� 3 � s'I�G°;E»1 ACT OF 1973 IF A-PP1AC JkBL141S REQUIPXID CUSTOM CONSTRUCTION 6,1 XOD SIF � < PORCHtPATIC? I,Si19.gfD S.F C 13F� +�{ICATi1'OI'�T l�4O�,0Ct.OF A XIS.dA.1F". 113) +v906 OF i+6'iNS111it idIM0111 W1, Z -A1551. 1X.?0 VVERIMMM? SUMMARY CONSTRUCTION F&E 101 -OOD-41 949)0 W1111" PI -AN CliFCK FEE 1�J1-t)tltl �i�3-�t1� �If �31.sJa F'ts Z DEPOSIT 101-000-439-318 -$1,040.00 YAt1lxkfA'mc.A:LFlu, 1it1-OCJ :?.2-000 a 4.fJ0 10,F?G'F"FUCtA.1,,F1% 101-000-420-000 Pl.U1e4Ui110 FIIE 101 -0100 -•119 -boo 13132.50 S'i`I1.E?1+iCl j!)s_OTION FFZ,. RUID 101-000-241-000 $52,56 ORD10 M? '10 1 -0'00 -+be 3 iJOn tm n A 17FFI~i3., VXR MPACT IBEX $714015,00 ART 111 P11HUC Pi..A.0 •'1'tFMir 2`7CI-000, 5-000 $311.tIIt .Q /ASL3B- ' .t A1N .., , , "- a 1.90-S z' k'E-PAI'D :iaJM',1,3 4),009,M) l 1 i r'+.11j L , AL 1'KIM-If 1+11.' 1O` CISOF LA A i 3y7:42.9f ANC DEPT - RECEIPT DATE r BY DAT INA LED'O INSP Tjd� _.. :,i.'.._,;`1-?":w.',r• _ it � e,.... �,.,. - is , INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings 44 &01r.,Ducts Slab Grade Return Air Steel Combustion Air Roof Deck , d Exhaust Fans 0. K. to Wrap F.A.U. Framing (, Compressor Insulation _ Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath n 17 -1 d Final Final BLOCKWALL APPROVALS POOLS - SPAS steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final I I Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines - _�� Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans OX. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test a 3 — Appliances Final COMMENTS: Final Utility Notice (Gas) 6 &c.,, S ,,,o,fi J %TS1 ELECTRICAL APPROVALS Temp. Power Pole _ _ Z �'�1 iL�nS�L �(� 12 --lo- 2 - A—A, Underground Conduit Rough Wiring J ZJ i�� l '--i 3(z5�a3 Low Voltage Wiring /p/r$d6 OL 47 6•G'a3 Sri Fixtures dr-,vr, -7a..fw 3 f Main Service Sub Panels G.F.I. Detectors Use of Power Final At the present time, the Desert Sands Unified School District does not collect fees on garages/carports; covered Otios/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 fro'mk paying school fees at this time due to the following reason: EXEMPTION, NO.T APPLICABLE This certifies that school facility fees imposed pursuant to Education Code Section 17620 and Government Code 65995 Et Seq. in the amount of $2.14X 6,170. S.F. or $13,203.80,,,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 Wells Fargo - Patrick Gough check No.. 0701100141 Name on the check By Dr. Doris Wilson Superintendent Fee collected /exempted by Crystal Scott Signature Telephone 275-7924 Funding Residential $13,203.80 $o.00 Payment -Recd Over/Under NOTICE: Pursuant to Government Code Section 66620(d)(1), this will servd'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 Wl 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 CERTIFICATE OF COMPLIANCE Desert Sands'Unified School District �N�trFns�, 47950 Dune Palrri"s Road Q BERMUDA DUNES 7' Date 11/12/02 La Quints, CA .92253 RANCHO MIRAGE 0 '� No. 23860 (760) 771-8515 � INDIAN WELLS Ce. � PALM Ivy -�INDIO QUINERT y71. Owner Skip & Kimberly Klintworth APN # 770-310-010 Address 80 Hidden Oaks Lane Jurisdiction La Quinta City La Quinta Zip 92253 Permit # 0209-140 Tract # 28470-1 Study Area Type Single Family Residence No. of Units 1 Lot # No. Street SY: Lot # No. Street S.F. Unit 1 33 78643 Peerless 6170 Unit 6 Unit 2 Unit•7 Unit 3 Unit 8 Unit 4 Unit 9 Unit 5 Unit 10 Comments At the present time, the Desert Sands Unified School District does not collect fees on garages/carports; covered Otios/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 fro'mk paying school fees at this time due to the following reason: EXEMPTION, NO.T APPLICABLE This certifies that school facility fees imposed pursuant to Education Code Section 17620 and Government Code 65995 Et Seq. in the amount of $2.14X 6,170. S.F. or $13,203.80,,,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 Wells Fargo - Patrick Gough check No.. 0701100141 Name on the check By Dr. Doris Wilson Superintendent Fee collected /exempted by Crystal Scott Signature Telephone 275-7924 Funding Residential $13,203.80 $o.00 Payment -Recd Over/Under NOTICE: Pursuant to Government Code Section 66620(d)(1), this will servd'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 Wl 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 .,A r A4 :SPECIAL -INSPECTION • REGISTERED INSPECTOR'S WEEKLY REPORT V. t JON TANDY 37636 Medjool Ave. Palm Desert, CA 92211 Office (760) 772-7192 ` Fax (760) 772-7193 Pager "(760) 776-3338 TYPE OF INSPECTION PERFORMED ❑REINFORCED CONCRETE RUCT. STEEL ASSEMBLY` ❑ POST TENSIONED CONCRETE ❑ ASPHALT ❑ REINFORCED MASONRY ❑ FIREPROOFING ❑ ��,�c�cl g1Yf4;ER JOB LOCATION' Lh REPORT SEOUENCE NO. TYPE OF STRUyTJ,LRE t wz)- n y� -' PERMIT N0.-' t y D DAV OF WEEK MATERIAL DGEES�_C/RVi\PTION 3IV ��l ARCHITEC INSPECTOR T_ HRS. CHARGED S(M A-0 ENGINEER i=ik411 G l L ASSISTANTS HRS. CHARGED`' INSPECTION DATE GENERAL1 ''�11 T CONTRACTOR •�J/SUB - ) (SAN � a��. CONTRACTOR' Cs. �p Lk�� e 4 tel 4713 (.c> t' AN . e e_— , GI ,STEEL F9 cikfn 6k0 A S = s C/VvJW'` 65�t AS Re1(sA(••6rA ' r .. �✓ W ` , t_S 1 0 V F a I � r r F • ` q p fy COPY SENT TO.CLIENT D CO TIN ON NEXT PAGE O '• PAGE OF CERTIFICATION OF COMPLIANCE I HEREBY CERTIFY THAT I HAVE INSPECTED' TO THE BEST OF M`" 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. IGNr®R OFlREGISTERE NSPECTO DATE �OF.R PORT REGISTER NUMBER X*(-Ub-U3 1HU 11:14 AM rtiWELVINU � PiiA: foUJLJfU1Y rRut r aftio _ I NEW nw- _ a' • Y-if . , RPM ' � .. - 1, :� ' - hwl• I I REGISTERED INSPECTOWS4EEKLY REPORT JORTANDY 37630 Medjool Ave. Palm. Desert, CA 92211 Office' (760) 772-7192 t Fax (760) 772-7193 Pager (760) 776-3338 4 00 TYPE OF O REINFORCED CONCRETE, TRUCT. STEEL ASSEMBLY O INSPECTION ❑POST TENSIONED CONCRETE. O ASPHALT•, O OTHER PERFORMED O REINFORCED MASONRY •, 01.FIRE PROOFING JOB L Cg (e w�� /�/ � 11 �� �Xi .JJ/v /��GJ.V�` REPORT SEOUENCE NO. TY UCTURY O" PERMIT NO. D ^ / DAY OF WEEK MATERIAL DESCRIPTION ` ARCHITEC I' I l • MRS. CHARGED �'r 'ENGINEER �O( - kajop . p J,4,:p wn ASSISTANTS HRS. CHARGED INSPECTION GENERAL`► SUB DATE. CONTRACTOR 6..w SCA t 4s. -CONTRACTOR co L s E COPY SENT TO CLIENT O CONTINUED ON NEXT PAGE O 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.' dw� 1 �ATU E OF REGIS RED INSPECT R 7 a3 �b � f ZS DA F TtEPORT REGISTER NUMRFR JON TANDY 37630, Medjool Ave. Palm Desert, CA 92211 .. __ j— - Office (760) 772-7192 �SPECIALA Fax (760) 772-7193 Pager ' (760) 776-3338 REGISTERED INSPECTOR'S WEEKLY REPORT TYPE OF INSPECTION PERFORMED ❑ REINFORCED CONCRETE ❑ STRUCT. STEEL ASSEMBLY ❑ /f ❑ POST TENSIONED CONCRETE ❑ ASPHALT ❑ OTHER'ci ' ❑ REINFORCED MASONRY ❑ FIRE,PROOFING. —(r J08 LOCATION10 I SS . Y t A 0-V� 1p REPORT SEQUENCE NO. TY OF TUREa^ j ///�� `M I�+r- PERMIT NO. - t { DA_t DAY OF WEEK MATERIAL DESCRIPTION ARCHIT T !1, - V f INSP y HRS. CHARGED ENGINEE ` 1 ASSISTANTS HRS. CHARGED INSPECTION GENERAL -- •- -•SUB _ DATE "-- CONTRACTOR -CONTRACTOR— _ _ PAf �L1D w .cam - 0_ wt _ : (� L7— e— --W /4 -e-�,Coo2oD"Wt ,(v l►a.' out` ;�=(.tl�4G • COPY SENT TO CLIENT ❑ CONT) _ D ON NEXT PAGE 0 + PAGE OF x CERTIFICATION OF'COMPLIANCE 1 HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MV SIG RE:OF. REGISTER ECTO� 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 O GOVERNING BUILDING LAWS. L DATEt OF REPORT REGISTER NUMRFR k Mau op 03 oltl;o9p 'RA 44-11001 1410NE 760 836'0656 GIBE ST-RIXTUXAL.CONSULTANTS )NTE *1 p 201-CPALM'COPSERT.'tA_ 92260 60yj3_E OkkJ760) 9360956 MAY 2,2003' l)-W-JOiNSTON:CONSTRUCT'I:)Ni`ilNC.' .1445 N. SUr4Rj S PALM DESERT; = ltc-- THF KLINTWOkTH likSlIbNI '1E 78-643 E LA Q FOLLOW A JOS NO.: 4012 Ti ciW DEAR Mr. JoHj� 9TON T -NIS LETTER Ai)V_j*S6,j HAT kRQIOREA&NTS��AkE V.1 RVED-THr SM. ... - , BLE . C6 FRtJ6- TION' 016-.R SfTJR'Vj"'* 'AT THF TIME OF vt�tcol4s-" OF: OUR BECIEVE THAT--niF 40-B T-HE:!JrIMF- !N. roEN4JCAL, CONF OOR VISIT 0R,m"dE-,;* rAT?U TR CTURAL PLANS'AND, RUFVANT EMCE S, )tl)s. ol�s c WE OBSERVEDqtlilE;BLILDING' INSTALLATION, OF DRYWALL STUCco WE OBSERVEb STRUCTURAL THE,vISUAL AND ACCESSIkE-�kkb XCLUSIONS AREAND INF 0 . R, SUCH A FOOTING SIZE RE c 46? 71� -ITEMS SU PLATE,spL Aj�b A?�V S'T' :,40,w 5, �06F SHEATHING, RA"PS, VE -Th, 9AFA'THING.).., RESPECTFU,LYS UBMITTE .1 1) ML NO Sam VICH ; L 06 * p- I REGISTERED INSPECTOR'S WEEKLY REPORT JON TANDY 37630 Medjool Ave. Palm Desert, CA 92211 Office (760) 772-7192 Fau (760) 772-7193 Pager (760) 776-3338 TYPE OF INSPECTION PERFORMED O REINFORCED CONCRETE-�TRUCT. STEEL ASSEMBLY O QP ❑ POST TENSIONED CONCRETE ASPHALT 31THER �7 ❑ REINFORCED MASONRY ❑ FIRE PROOFING��Z� JOB LOCATION e / e �� INw �� ^t • L� �/'�� (IVc GI IYVPE`RMIT REPORT SEQUENCE NO. TYPE OF STR=CTJZRE N0. f� L; w o D 1 b� l DAY OF WEEK MATE AL DESQRIE ION J+ '4 (o /� ARCHITE,, ' O I , I • fF I j� HRS. CHARGED ENGINEre A!+ "'-1 S-`7 1 ASSISTANTS HRS. CHARGED INSPECTION GENERAL `' SUB` DATE CONTRACTOR o �j� V4 w- OVI CONTRACTOR S �� SO4 w etlo 1 N da ©CS N -Nuri F A e 4-� t N 3-0 -�AR>e^w-S Co Lr - Sto c -*f c�0A 49? -44- n - e o aW Oet-bltel� u T A.!ug 3A wew _s l C'A N Cl - (- Ott '� LUID o P (,,Je-C6 0i moo/ 0 � S-6. L 16 l� COPY SENT TO CLIENT ❑ CONTINUED ON NEXT PAGE O PAGE 0F CERTIFICATION OF COMPLIANCE I HEREBY CERTIFY THAT 1 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. i• SIG ATURE OF EGISTERED IN R 64111 o �A 1 9 C DATE(bF REPORT REGISTER NUMBER I& Certificate of Occupancy0 1. ,M T OF Building & 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: 78-643 PEERLESS PLACE Use classification: SFD Building Permit No.: 0209-140 Occupancy Group: R3 Type of Construction: VN Land Use Zone: RL Owner of Building: SKIP &KIMBERLY KLINTWORTH Address: 80 HIDDEN OAKS LANE City, ST, ZIP: LA QUINTA CA 92253 -By: KIRK KIRKLAND Date: 12-08-03 Building Official POST IN A CONSPICUOUS PLACE ,