0209-049 (SATT)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
584616 B ,� 01/31l.2C.
Date -Signature of Contrabtor�✓ _
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
S ction 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:
Cartier (;C,;1;{viMMErPG1NDUO' Policy No. '(giC092m,
(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 we kers' compensation provisions of Section 3700 f'the Labor
Code, I shat fo hwith comply�with thos.wp ovisions-_,
Date: X.. Applic�an��
Warn! g Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon.
theabove-mentioned property for inspectiga" rpose 3
Signature (Owner/Agent) ' Date,
" BUILDING PERMIT PERMI0209g04.9
DATE VALUATION sAS3 deo?uo LOT B-18 TRACT 2-M9
JOB SITE
ADDRESS : - SX�WU i�D$t,E1,1?'1`.W
APN 770-02&001
OWNER
CONTRACTOR/DESIGNER/EN (NEER
CA AS LA JR10I1M LLC
JEEFRRif C. £y^1 O1+11:.1.>I':?. SUMM.MJ;,1ZT.Ci DJZRi
P101 BOX 1503
4700 VONXMl�M4 AVE.9100
LA QUNTA CA 'x'2253
A1EWPORT fflt,.Ad9 CA 92660
(949)450-991'1 01W
USE OF PERMIT
SR;I(+3. ,E 17AIo+A3. Y A`1TACIM
HUdLI78NG 0 TYPE t1, 3472 S.F. S -M TS. !?URMI T OC3&.S- ;1,40
:MCLUD9. 81AX1~'atl'ALLS OR POOLS, 75% WEDUCED PI.AH CHF CK FKFZ FOR
iaAUUf1PL9 PLAN C:HFC.K SAME' YPS.
FOR--ClYPATIO 340.00 a1•
APARTMENTS V. -N 3,�?3.00 SF
EM.Y.:i7{d'A= C091'01? COL9 W l:.'L+F,FJM`.!'iT
2,93,52 72.0
7'k'RIt U.FEN S AMY
CONOTRUC T 1O'N FEE 101-OOiI-416-000 $1,moo
PLAN CHECK P"OF 101-000-439-:318 $311.17
MECHANICAL FEE 101.000--421.000 $24:1.01)
ff:B.,Zt^,-TRJc;ALu FEE 101-000-42E2-000 $.m V2
.s.,... -
1'LUMBINO FRE 101-000-419.000 5389.00
S"TiRONQ MOTION FEE - F:ESlD 101,.-,900-241-000 $29.3'
r31 VELOPRR IMPACT FFE
ART %11FP BI IC Pl- ACF°,:270-000-445�000 $233.92
.D y`�'l2z-'1,0 t'\L CC1..1 1-iCx10N A1�C91?T,.�,N, MEi�X
1 3,94 �.£�i
$0.00
OCT o luaz
CIN OF LA QUINTA
FINANCE DEPT ,
RECEIPT
DATE
•/.
.BY
DATE JINALE9,
INSPECTOR
�...
-fit. .
/ ) p
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
7 BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs i
Underground Ducts
Forms & Footings
. o
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
V p 3
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L. +
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wali Firewall
Exterior Lath 1
197
Drywall - Int. Lath
(,� • c3
fes- I
_
zyn%of
.2-. o Z rT
cro &_ Gtr &C-45,
e 7 • 3 S2
Final
low �POOLS-SPAS
Final1 AR
BLOCKWALL�A OVALS
steel
Set Backs i
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 '
Water Piping
./ S7
`
Heater Final
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
3, ?, , p
Appliances
Final
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
fi
Final
Utility Notice (Perm)
COMMENTS:
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
584656 B 01/31/2(
Date Signature of Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that lam 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).
(,) 1, <'a,.owner,-of .thee property, :am.. exclusively contracting with�.licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
O I am exempt under Section B&P.C. for.this reason
Date : Signature of Owner
WORKER'S COMPENSATION f7ECL•ARATION
I hereby affirm under penalty of perjury one of" -the following declarations:
( )• I have and wilt 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 theviiorkfor which this permit is issued.
(. ). I have'arid'witl maintain workers' compensation insurance, as required by
Section 3700 of, the labor Code, for the, performance of the work -for which this
permit is issuedi•My worker s'`compensation;insurance carrier &.policy_no. are:
Carrier COMMERCE�DUS' Policy�No. 4dC9692873
(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:thatdf.l 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, 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) Date
PERMIT # `� C
T, G
BUILDING PERMIT
0209.049
DATE VALUATION $293,527.20 LOT B -g TRACT 29909
JOB SITE
ADDRESS 50-690 SANTA ROSA PLAZA
AP" 770-020-001
OWNER
CONTRACTOR/DESIGNER/EN 1NEER
CASITAS LAS ROSAS LLC
JEFFREY C. STONE DBA SUMMIT BUILDER
P.O. BOX 1503
4700 VONKARMANAVE.#100
LA QUINTA CA 92253
NEWPORT BEACH CA 92660
(949)450.9911 CBL#
USE OF PERMIT
SINGLE FAMILY ATTACHED
BUILDIN0#8 TYPE A, 5472 S.F. &UNITS. PERMIT DOES NOT
INCLUDE BLOCK WALLS OR POOLS. 75% REDUCE6PLAN CHECK FEE FOR
MULTIPLE PLAN CHECK SAME TYPE.
PORCHIPATI0 84.0.00 SF
APARTMENTS V -N 5,4W.00 -SF
EsTIlVIATED COST OF CONSTRUCTION
293,527.20
PER11iIIT.FEE SiUMMARY
CONSTRUCTION FEE 101=00,0-418-00.0 $1,318:50
PLAN CHECK'FEE 101-000-439-318 $321.17
MECHANICAL FEE 101-000-421-000 $263.00
ELECTRICAL FEE 1.01-000-420-000 $373.02
PLUMBING FEE 101-000-419-000 $389;00
STRONO MOTION FEE • RESID 101-000-241-000 $29.35
DEVELOPER IMPACT FEE $16,008.00
ART IN PUBLIC PLACES '• RESIE 270-000-445-000
SUB -TOTAL CONSTRUCTION AND PLAN CHECK
$18,935.86
LESS PRE -PAID FEES
$0.00
TOTAL PERMIT FEES DUE NOW
$1$,935.86
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
DEC -24-03 WED 12:44' PM RIV . C.Q. FIRE P&ElND`I0' FAl(.P:O ; r 760;.863. 7072 P. 2':
RIVERSIDE .COUNTY FIRE DEPARTMENT
In:c0oper0i!on wi `h th¢.
c California Deperrlment o/ Foreslry and.Fi�e Protectroil
•F:: —
ax1909.�
"2 est:san -Jacinto; venue. Perris, ad a: C..+'(909); ( );.
?onITisUa
`Fire Chief
,Proudly seining the December 24, 2003 „
:Unincorporated
Areas of Riverside
County and the City of La Quints
Cities of:. Building Department
Banning
B"Umolt Re: Fire and Life Safety Clearance =. '
Calimesa -
Canyon I Ae
° The Riverside County Fire Depatmentas;granting fire and life safety clearance
Coachella
for the following project Casitas;Las'Rosas„for phage I and II, iocated 50920
Desert Hot Springs Avenida Bermudas; La Qulinta Please call if you should have and Questions.
Indian Wells SANT�4 RSA C
pt zA. g BV1LI�t ..
Indio
4A
take P"'Isirku-C,
0
La Quirita 'Respectfully
titi
Moweno Valley
FRANK KAWASAKI
Palm Dc,”
�r
Chief Fire Department
.Perris
A .. ..
Rancho Mira
4
San Jacinto
e.uccu;a By � ` � 0 �
Terry
Board orsppervisons
Fire Safetylnspector.
Bob )luster.
ni5trict
)ohn Teva gtionc,
District 2
Jim Venable,
District 3
MV Wilso4
District 4
Marron Ashley.
District 5
EMERGENCY SER I/ICESDIVISION-• PLAI ININGSEMON • INDIO OFFICE
32 675'Highway 111, 2n° FL;lndio, CA .92201 • (760) 863.8886 • Fax (760) 863'-7072
f OccupancyCertificate o�
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G Y OF 'B%iildin & Sa:fet y De artmen t
Building . 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
rovisons of the: Buildin Code and the various ordinances of the Cit regulating buildin
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3 construction and/or use.
BUILDING ADDRESS: 50-6.60 SANTA ROSA PLAZA .UNIT #1
Use classification: SINGLE FAMILY ATTACHED Building Permit No.: 0209-049
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: VC
Owner of Building: CASITAS LAS ROSAS LLC
Building Official
Address: JEFFREY STONE DBA SUMMIT BUILDERS
City, ST, ZIP: 4700 VONKARMAN AVE. #100
By: STEVE TRAXEL
Date: 12-04-2003
Certificate of Occupancy
T -a
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Building & Safety Dep'a'rtment
I
This Cbrtificate is issued pursuant to the requirements of Section 109 of the California Building
certifying e * of issuance, this structure Was in coMp" ce
Code, 7 thpt,,-at the time -lian withth e
I I
s * f the City regulating building
provisions oftheBuilding Code and the' various ordinance* 0 .9
tion -and/or -use.
BUILDING ADDRESS: 50-690 SANTA�ROSA', PLAZA UNIT #2
Use classification: SINGLE FAMILY ATTACHED
Occupancy Group: R-3, Type of Construction: VN -
Owner of Building: CASITAS LAS ROSAS LLC
Building Official
Building Permit No.: 0209,049
Land Use Zo ne VC
Address: JEFFREY STONE DBA SUMMIT BUILDERS
City, ST, ZIP: 4700 VONKARMAN AVE. #100
By: STEVE TRAXtL
Date: 12-04-2003
IN A CONSPICUOUS PLACE
Certificate of Occupancy
T4&t 4 4 Q", -
Building 9 -Safety Depariment
This Certificate is issued pursuant to the. requirements of Section 109 of the California Building
Cole, certifying that, ' at. the time of issuance, this structure was in compliance with. the
proyisions of the Building Code and the various ordinances of the 'City regulating building
construction and/or use.
BUILDING ADDRESS: .50-690 SANTA ROSA PLAZA UNIT #3
Use classification: SINGLE FAMILY ATTACHED
Occupancy Group: R-3
Owner of Building: CASITAS LAS ROSAS LLC
Building Official
Building Permit No.: 0209-049
Type of Construction: VN Land Use Zone: VC
Address: JEFFREY STONE DBA SUMMIT BUILDERS
City, ST, ZIP: 4700 VONKARMAN AVE. #100
INA
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By: STEVE TRAXEL
Date: 12-04-2003
- Certificate of Occupancy
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oF9 Building & Safetyp Department
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This Certificates. 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 Cod and the various ordinances_ of the.. City regulating building
construction and/or user
BUILDING'ADDRESS: 50-690 SANTA ROSA PLAZA UNIT #4
I
Use classification: SINGLE FAMILY ATTACHED
Occupancy.Group: R-3 Type of Construction: VN
Owner of Building: CASITAS LAS ROSAS LLC
Building Official
Building Permit No.: 0209-049
Land Use Zone: VC
Address: JEFFREY STONE DBA SUMMIT BUILDERS
City, ST, ZIP: 4700 VONKARMAN AVE. #100
By: STEVE TRAXEL
Date: 12-04-2003
SPICUOUS PLACE
Certificate of Occupancy
19U
oFBuilding,& Safety Department
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' This Certificate is issued pursuant to ,the requirements of Section 109 of the California, Building
, itCode, certifying that, at the time of issuance, this structure was in compliance with the
.' provisions of he Building Code and the various ordinances of the City regulating building
construction and/or use. -
BUILDING AQDRESS: 2-690 SANTA ROSA PLAZA UNIT #5
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Use classification: SINGLE FAMILY ATTACHED Building Permit No.: 0209-049
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Occu anc Group- R-3 Type of Construction: VN Land Use Zone: VC
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°T Owner of Building: CASITAS LAS ROSAS LLC Address: JEFFREY STONE DBA SUMMIT BUILDERS
City, ST, ZIP: 4700 VONKARMAN AVE. #100
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By: STEVE TRAXEL
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Date: 12-04-2003
Building Official
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This Certificate is. issued pursuant to -the requirements of Section 109 of the California-Buildin
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6ode,' ce�rtifyjng that, at -the time of issuance, this structure was in compliance . with the.
provisions &fjhe*1$uilding Code and :the various -ordinances of the City reigulating. building
construction and/or use.
BUILDING ADDRESS:, 50-690 SANTA ROSA PLAZA. UNIT #6.
Use classification-, SINGLE FAMILY ATTACHED Building Permit No.: -0209-049
Occupancy Group: R-3 Type of Construction: VN Land We Zohe: VC
Owner of. Building: CASITAS.LAS ROSAS LLC
HBuilding Official
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Address: JEFFREY STONE DBA SUMMIT B I UILDERS
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City, ST, ZIP: 4700,VONKARMAN AVE. #100
By:- STEVE TRAXEL
Date: 12-04-2003
A CONSPICUOUS PLACE
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Owner of Building: CASITAS LAS ROSAS LLC Address: JEFFREY STONE DBA SUMMIT BUILDERS
City, ST, ZIP: 4700VONKARMAN AVE. #100
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Date: 12-04-2003
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POST IN A CONSPICUOUS PLACE
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Certificate of Occupancy
Building &.Safety Department
` This Certificate is issued pursuant to the requirements of Section 109 of the California Building
19 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
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BUILDING ADDRESS: 50-690 SANTA ROSA PLAZA. UNIT #8�
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Use classification: SINGLE FAMILY ATTACHED Building Permit. No.: 0209-049
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;_. Occupancy Group: R-3 Type of, Construction: VN Land Use Zone: VC
Owner of Building: CASITAS LAS ROSAS LLC
Building Official
Address: JEFFREY STONE DBA SUMMIT BUILDERS
City, ST, ZIP: 4700 VONKARMAN AVE. #1.00
By: STEVE TRAXEL
Date: 12-04-2003