9901-028 (AR)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter i) (commencing with Section 7000) of Division 3 of the Business and
ci W ; 9rofi„ssionals Code, and my License is in full force and effect.
O <h License # Lic. Class Exp. Date
ti U-)
rIZ,_ i -1 1113(11/99
6 Z r- tpate-1 /Signature' of Contractt'o�r.�_\��'.,
6 0 1'?—
`– OWNER -BUILDER DECLARATION1
J b
W WWI hereby affirm under penalty of perjury that I am exempt -from the Contractor's
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).
C'') () I am exempt under Section B&P.C. for this reason
LO
N Date Signature of Owner
Q N '
C7
2< WORKER'S COMPENSATION DECLARATION
C) 2 Z I hereby affirm under penalty of perjury one of the following declarations:
Lo < O () 1 have and will maintain a certificate of consent to self -insure for workers'
X W Y= compensation, as provided for by Section 3700 of the Labor Code, for the
Q J Q performance of the work for which this permit is issued.
ED Q U I have and will maintain workers' compensation insurance, as required by
Q U : Section 3700 of the Labor Code, for the performance of the work for which this
d � Z permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
cb O i r1 i f3 I?'J 7 2 !>-`�3 fJ;.l'A Gf) It 111995
J (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
3 subject -to the workers' compensation provisions -of *Section 3700 of the Labor
Code I shall forthwith comply with those provisions.
date: j
{�YApplicant`._"
--,Q(y1 �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 attor ey'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 t
construction,,- and hereby authorize reprr se e'ntatives of this City to enter upon
the above mentioned property for inspection p6irposses.
ignature (Owner/Agent) .
f ?i ce- ' _A/ Date
BUILDING PERMIT PERMIT#
DATE VALUATION 52487ifS,20 LOT .� TRACT
ADDRESS 79.005 SANSAN111'�OTE0 JOB SIfE
-t
APN 6464 60-002
2
OWNER
CONTRACTOR/DESIGNER/ENGINEER
ROGER, MMATO
1,ShIG CONSULTING SH.KV E'S
78005 SEL.I*1'1'IMU-tHO
+1275 CA LE QUf1.0
LAQtJfKfA CA 92253
LA.WINI-A. CA 9.2253
(760)771-2144 CU -9 4999
USE OF PERMIT
kf',StUr:�'I AL ADI:; TIGN
IrsAMODHL AND .i5a S.1'. ADDITION
Cu sToNt COlti.�i',ti um..'i0irf 1,588.00 cif•
C014TRAL r AMOL[Nf 125.W).w I -S
1 S'I VNIATED C OS'f OF CONS*f RUC710,N
248.705.20
PERMIT FEE SUMMARY
Cf.JNNI'IbUIZ7fION FEE' 10)-M)-418-000 ffit.[r,1.Ui)
KAN f"}!i?.t. K FFT, 1014PI-439-319 K466 2ti
NIF30IM41CAL PCX 101-000-421-000 S I, i 7.50
1iLECfRICAL- mil's 101.000-420-ii()0 $139.58
PLfjMBINO FEE 101-000-419-000 5237.E
STRc>1,OIN4017t'ihfFIT, RES11) 101-1)(N1-741-000 114,87
ORi11t:)II40 FEL 101-000-123-000 $20 W
INFRAt IFRUCTURE FUT" 225-000-44-1-3,12 $2, 781,37
ARTIN P138LfC P1.1MMS - RES11; 701-(M-1,55.000
SIfR-RIT ►_r("ONSI'Rl ICTION ANT) PLAN ('111_CK
S'%.971 XJ
LESS PRI-' PAM VEE S
S.000
10> Alli P'.ktl9m' F':#!:S 1aiI1!: NOW
SSA71.84
RE IPT \�
DATE
BY /
FIN11-0
INSPECTOR
INSPECTION RECORD
L OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
=Ducts
Slab Grade
2 - _
Return Air
Steel
Combustion Air
Roof Deck
^ Z—
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
r
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation.
Condensate Lines
Party Wall Firewall
Exterior Lath
-UG
Drywall - Int. Lath
—2
'
Final
Final
BLOCKWAa
APPROVALS
POOLS - SPAS
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
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
-Ott
Appliances
p -fl5' S m
- i
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) _
Building 79-�s SA
Address
Owner I'V � r{
Mailing -pep
Address
city alzj f t4l Zilp�
Contractor
LS M 6.
Address P.
n, Poax
•t4f 0 4 "
P.O. BOX 1504
78-495 CALLE TAMPICO
a M*i
A"190(
Tel.
S3
Zip q��_3 ITel.
State sit. _ 7 , 2 II ICity `
8 Classif. E� Lic. # �i� l o
Designer
Address? ) /� )C Tel
t (�
Stae
410 ,•�/ CA IZip� � 1Lic.t#
f j'� LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
Doo) of Division 3 of the Bysli s and Professions Code, and my license is in full forcect.e and
I OWNER-BUJLDER DECLARATION
I hereby affirm that I am exempt fr m the Contractor's License Law for the following
reason: (Sec. 7031D5,Business and Professions Code: Any city or county which requires a
permit to consfrugyif alter, improve, demol)sh, or repair any structure, prior to its issuance also
requires theplicant !or such permH to Tile a signed statement that he fs licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 othe Business and Professions Code. or that -he is exempt therefrom, and the basis
for
the allgged 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).
l-: 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, Bufsness 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.)
II
I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct 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.)
11 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 ^I I -.s.' Z/ r�
n Copy is filed with the city. D Certff.ied copy is tier Ayrf rhished.
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 thg 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., It, alter 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 if work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information is correct.
I 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 aQplicant Date
Mailing Address
City, State, Zip
RAI
APPLICATION ONLY
BUILDING: TYPE'CONST. OCC. GRP.
P. Number
Legal Description
Project Description DZ)& /116--yu
Sq. Ft.
Size
New CYl* Add
PERMIT
Plan Chk. Dep.
Plan Chk. Bal. -
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
No. 1 No. Dw.
Stories 1 Units
Alter ,Q Repair ❑ Demolition ❑
2`15
AMOUNT
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: I r
Cl7l q i3
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
CERTIFICATE OF COMPLIANCE 4�J�.FIED o
Desert Sands Unified School- District
47950 Dune Palms Road ¢ BERMUDA DUNES O
Cn RANCHO MIRAGE d
Date 9/6/07 La Quinta, CA 92253 INDIAN WELLS
PALM No. 29676 LA UINTA)
QINa y'3
Owner Cossette APN-#- 686-152-022
Address 78-005 San Timoteo Jurisdiction La Quinta
City La Quinta Zip 92253 Permit #
Tract # Study Area
Type Residential Addition No. of Units 1
Lot # No. Street S.F. Lot # No. Street S.F.
Unit 1 78005 San Timoteo
Unit.2.
Unit 3
Unit 4
Unit 5
Comments
132 Unit 6
Unit 7
Unit 8
Unit 9
Unit 10
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patiosANalkways, residential additions under 5
00 square feet, detached accessory structures-(spacesthaYdo-.notcontain facilities for -living; sleeping, cooking, eating or sanitation) or replaoement mobile ho
mes. It has been determined that the above-named owner is exempt from paying school fees at this time due to the following reason:
Residential Addition $00 Sq Feet or Less
EXEMPT
This certifies that school. facility fees imposed pursuant to
Education Code Section 17620 and Government Code 6.5995 Et Seq.
in the amount of $0.00 X 132 S.F. or $0.00 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 Exempt - Keith Brinson Check No.
Name on the check Telephone
Funding Exempt
By Dr. Doris Wilson
Superintendent
Fee collected
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 o
r 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
C
Payment Recd
7� ;Over/Under=
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 o
r 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
L Q 2 c,A&7--;bM G 401-46 L=- _a
Commun-ity Azzoctat i.on
P. 0. Box 162
La Quinta Ca 92253
Telephone: 760/564-2177 FAX: 760/564-4882
May 28, 1998
Planning Department
CITY OF LA QUINTA
P. 0. Box 1504
La' Quinta Ca 92253
RE: Remodel of Residence
78-005 San Timoteo
Gentlemen:
The Architectural Committee of La Quinta Golf Estates has reviewed plans for
subject remodel.
The plans are approved subject to confirmation that the elevation meets the
following specification:.
The'height of any structure shall not exceed 20 feet from
the highest crown of any street adjacent to the lot.
This restriction is not readily verifiable on the plans.
If you have any,questions, please contact the office.
Yours truly,
MORGAN U. WARD
Co-chairm
ARCHITECTURAL COMMITTEE.
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OUTDOOR/INDOOR
Murray combination meter sockets and load
centers listed on this page are Underwriters'
Laboratories listed as service entrance
equipment with bonded neutrals. The 100
ampere through 200 ampere JA devices have
meter socket sections supplied with 4 meter
aws for use on 120/240VAC 10s-3 wire services.
hese outdoor/indoor devices have a pull box
section that meets or exceeds EUSERC
requirements, and load wiring may exit top or
bottom.
400 ampere JB, JK and JL devices are rated
10-3 wire 120/240VAC. The units combine a
400 ampere load center with a self-contained
meter mounting device for use with a Class 320
lever bypass, K-4 bolt -on meter or Class 320
non -lever bypass plug-in meter.
These 400 ampere devices have mounting
pads for line conductors with two studs per
pad to accommodate NEMA two hole style
compression connectors normally supplied by
the utility for underground service. Alternate set
screw lugs are available. See Accessories on
page CO -6.
Wire range is maximum allowable for wire -
bending space provided. Lugs may
accommodate larger wire. Refer to National
Electrical Code or product wiring diagram for
speck wire sizes.
METER COMBINATETION
O
SECTION
CO
PAGE
5
In addition to local code and National
Electrical Code requirements, the serving
utility may have special requirements for
metering devices. Confirm meter socket
acceptance prior to order placement.
Accessories -
See page CO -6
Wiring Diagrams -
See pages CO -7 through CO -9.
Knockout Data -
See pages CO -10 through CO -13.
Outdoor/Indoor, l -Phase, 3 Wire, 4 Jaw, 120/240 VAC, 10,000 AIC
Load Top or Bottom, Meets EUSERC Requirements, Ring Type
Branch Provisions
MainStd. Pkg-1 Std. Pkg-1 Dimensions - Inches m Wire
Amps Brea S Max Cat # Approx. Semi -Flush Approx Hub Ran
(Max.) Breaker Spaces Circuits Service Cat M UM Eaeh gt. Lbs. Cat M Ust Each gt. Lbs Prov. Length Width Depth Cu/AI
MAIN BREAKER. FACTIDRV INSTAI I iin
100 ME09675R 12 24 OH/UG
JA112CY $315.00 27.50 JA112CW $315.00
29.50 HS 23 14% 5 #4-2/0
125 ME09677R 12 24 OH/UG
JA412CY 575.00 28.50 JA412CW 575.00
30.50 HS 23 14% 5 #4-2/0
200 ME09685R 20 40 UG
- - - JA220CW 823.00
42.00 HS 34 14% 51h #1-250kcmil
ME09685R 20 40 OH/UG
JA220RK 857.00 35.50 JA220VH 857.00
40.00 HS 34 14% 5'h #1-250kcmil
MP220OR 32 40 UG
JA232CY 847.00 60.00 - -
- HC 28% 201A 61/4 #4-250kcmil
ME09MR 40 40 OH/UG
JA240CYO 878.00 40.00 - -
- HS 34 22 5'h
MAIN BREAKER FIELD INSTALLED
#1-250kcmil
125 MP -TO 4 2 OH/UG
JA004CY $158.00 25.50 JA004CWO $158.00
27.50 HS 24 14% 5 #4-2/0
200 MD -A or MP -T 4 2 OH/UG
JA904CY 427.00 32.00 JA904CWCD 427.00
34.00 HS 34 14% 51h #1-250kcmil
Underground Service' 1 -Phase,
3 Wire, 120/240 VAC,
400A Maximum, 22,000 AIC
Load Top or Bottom, Meets EUSERC Requirements
Branch
Branch Provisions
Service
Socket Disconnect Max
1YPe
ox.Pkg-1
Sum Approx. Hub
Dimensions-Inches0 Wlrem
Amps
Amps Spaces Circuits
S
1.
�y Class 320 200A0 30 40
Cat k x UM Each WWgt. Lbs. Prov.
J8230S $2,552.00 130.00 HV
Rang
length Width Depth Cu/AI
401h
Lever
30'/4 6'/4 1 set of 2
Bypass 400A. 24 42
JB424S 3,885.00 143.00 HV
401h 30'/. 6'/. studs per leg
K-4 200A0 30 40
Bolt on
JK330S 2,552.00 130.00 HV
40'h 30'/. 6'/.
400A 24 42
JK424S 3,815.00 143.00 HV
401A 30'/4 6'/4
Class 320 200AG 30 40
Non -Lever 200A0 30 40
JL230RS 1,678.00 130.00 HV
401A 30'/4 6'/4
Bypass
JL230S 2,552.00 130.00 HV
40'A 30'/. 6'/.
400A 24 42
JL424S 3,815.00 143.00 HV
40'h 30'h 6'/4
T One or two MRT breakers, not to exceed 125A total.
m Check utility for
m Dimensions shown are representative of outside box length,
m H required, order NEMA stud mechanical lugs from
approval.
m One MP2200KH installed. Provisions provided for one
width 8 depth (±A-) and do not include allowances for
mounting bumps, endwalls, covers, hubs or hardware
Consult
Accessories, page CO -6.
® For Semi -flush application,
additional MD -A or MD -H 200 am max.
( pa I style service
protrusions. factory for specific details lt required.
order flushing kit.
disconnect to feed a remote load. Consult Circuit Breaker
® Semi -flush versions also suitable for overhead service.
1 MP22o0KH installed, Prov. for 1 MPT or MRH7 (100 amps
MPT or
Coordi nation Chart on page LC3 for downstream
® Sselections.ee accessories on page CO -6 for semi fl�nge
max.® Consult circuit breaker
to on
-flush kit.
word natichehotoenload.
page LC3 for downstream selections.
Discount Schedule "A" ��