0209-043 (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
01 V
,D'ate,A�_Signature of Contractor`_
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 COMMERi E&INDU ' Policy No. '4x10w2exi
(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 wof kers' compensation provisions of S_ a tion 3700 of the Labor
Code, I,sh Ilrf rth ith comply with�those provisions �`
te: ,f�. Applicanf/I_.-Y %
Warning: 17ailure 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. g
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)4 11,In _ Datel 4
PERMIT #
BUILDING PERMIT
7209-04:
DATE (•• VALUATIONiUat2p*�Fri.�I LOTp TRACT
JOB SITE
ADDRESS �wr�ri�A
APN
OWNERp�
DEESIGNEERq ENGINEER
CONTRC(ACCGT��OggR��
�tgy4��p pp'� yy ne ytqq D ��yj yy �[ef�
>;. PZ.' A►l A.['H I'�.OSA S LLC
�/ ,/
Ya e p t 7 yy{
.7JLP. ['�`.L` 74 c- a' 1�Vya- L.iJ k EF I2�f3.G.r�.,1r A,'� 41 A6��)Tm,
P.O. BOX 1503
Ir/W VOMICARM..N AVE -0100
1A QUIMM CA 922M
Nh'WP0r,...r BEACU CA 92660
(949)450.9911 c7al #
USE OF PERMIT
,MOI E I?,AMC7,,1r .?R. r.A� TiM
i4fJil.1J1'40*2 TYPE 13,555644 S.F. &-UNITSoWiTH 2 I'1.di?d1)i(; VP
UNITS. PERMIT IDOES NOT INCLUDE JOLOCK WALLS OR P001.9, 7S%
IsUN) iC ED PLAN CHECK FEE FOR MULTIPLE PLAN f:HMK SAME PLAN
PORCH/RATIO 840.00 9F
APA.)2'CM'ENTi V-14 5,,,644.00 SF
E$1r'%4dIA't O) COST f?i+ COR�'ea�t' 1O"I ON
:302.40 .AD
CONSTRUCTION ME &I ,Ii0,00
PLAN iFlWKFEE 101-000-439-318 $1,!K19.26
MECI•IA1~ ICAL FRE 161.000-421.000 $263.00
X.LECTR AL. I EV, 101-000-420-01'.H1 073,02
PLUMBING F99 101-000-419-000 $349.00
STRONG MOTION iii; • RESID 101-000-241-000 M.24
DEVE .OPtZ11 IMPACT ITIM S16,009.00
ART IN PUBLIC PLA.CFS • R—VSII: 27th -000-445-00.0 �u256.OD
. L Commar trG"I�C)i�t ) PI.AX CHEMCHEM$19,V78.53
D hr,U E LESS IMM-P.E% P d S
19M, MMI, FEES VVE now
OCT O 411101
CITY OF LAQUINTA
FINANCE DEPT.
RECEIPT
DATE ' '
BY' `-�,
DATE FINAL
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
A
Ducts
Slab Grade
LReturn
Air
Steel
Combustion Air
Roof Deck
-dS7
Exhaust Fans
O.K. to Wrap
p j
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
Oe FZ6
!(--6 • o i- 7
rZ M Gr'
. o s�-
Final
Final
POOLS -SPAS
BLOCKIIVALL
�P�'ROVAL'S
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
o y S %
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
y 5?
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
(p.p
Encapsulation
Gas Piping
Gas Test
Appliances
O> GP,4 bg3 G.u�s'
3 $%
Final
COMMENTS:
�iiGtr G.(Ar�� !'��L � si s� �✓� f � o'Z7• Lim �?
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
An
Final
Utility Notice (Perm) 7
DEC -24-03 WED 12: 44. PM RIT ' CO; >F"IRE P&E INDIO FAX H. l 760 863 7072
.,,oaorr RIVERSIDE` COUNTY FIPE DEPARTMENT
r, , In cooperir!!on wi: lythe. .
CaIJfocnJa Department o/ Forestry and Fire Protection'
21, est San acin o' venue: Perris;' ,aGtamia 0.;,,(909).. ax;(909) 94
p.
Tom Tisda!a -
Fire Ulef
Proudly serving the . I)ccelnber 24; 2003:
Unineorporatcd _
Meas of Riverside
County and the City of La Quints
cines or:. Building Department: .
T. arming
41.
?3casmo�l Re: Fire and Life..Safety Clearance'
f
Calimesa
Canyon'I .ake
Coachella
Desert Iiot Sprinp
Indian Wells
00
bdio
'a
take Fk
La Quinta
Moreno valley
Palm Nwft
. v
Perris
46
Jtancho Mirage
E►
San Jacinto
ecuecu;a
Board or supervisor
Bob duster,
District
John Tevaglionc,
District 2
Jim Venable,
District 3
Roy Wit^i�n,
I)is:rict 4
Marian Astdcy.
I.)istrict 5
The Riverside County Fire DepartmentJis granting, v`fre and life safety clearance
for the followuigproject Casitas-Las Rosas .for phage I and:II;"located150920
Aven da.Bermuilk La Quinta - Pleasebcail if -you should have and Questions.
Sr4r1lTA �jayq . P,14� " g .66 L l40dco,
Kespcctfully
M1
FRANK,,KAWASAKI
Chief•Fire Department
By
Ter .
lcy
ry.
Fire Safety Inspector
EMERGENCY SERVICES DIVISION . PW INING SECTION : INDIO orTICE
82-675 Highway 111, 2;FI:, Indio, CA 92201 (760) 863-8886 • Fax (760) 863-7072
P. 2
• :i':.^:A-::::iF.+:: iLYStiM�.:?:.ark�x Lr F"'.e�,,,}ixY.:°}�i:
Certificate of Occupancy
4
Saf6 - 'De atlmen�t
of Bdilding p
ThisY Certificate is issued pursuant to .the requirements of Sect►on 109' of theCahforn►a `Building
Code; cerci in that;, at. the time of issuancYe, �this,,.structure' wras �n.:;compl�ance with ;the
fy 9.
provisions of the Building Code and the ` var►cus ordinances of `the City regulating building:
consikiction and/or.use. `
BUILDING ADDRESS,: 50!750:.SANTA ROSH PLAZA UNIT #1
Use classification: SINGLE�FAMILY ATTACHED Building Permit No.: 0209-043
Occupancy Group:.R-3 Type of Construction: VN Land Use Zone: V.C.
Owner of Building: CASITAS LAS ROSAS LLC
_7 &-4-1 /4
Building Official
Address: JEFFREY STONE DBA SUMMIT BUILDERS
City, ST; ZIP: 4700 VONKARMAN AVE. #100
By: STEVE TRAXEL
Date: 12-04-2003
MINIM
Certificate of Occupancy
4
Departrr►ent
Building. A
ts'ofSection 109 of the California Building
Thi�' Certificate pursuant "to therequire�7e
pl-
'g,-1h t at the - time suancin 6
q - h fhilt structure: qmp�i�hde' with t.he
ordinances of the City regulating, building
I?Ihe Ehiliding-1-6 de, -Code,
various
I S'o
ii �dlo
ov
fc or, �s St upcpii 6'n r use.,
W
--d'SAPCAZA UNIT- 2
BUILD'IN&ADDRESS: 50.'-7.50 SANTAR
-.A, T-ACHIED Building Permit No.: 02M-043
Use classification,: SINGLE TAMIL -Y. - T
Land Use Zone: VC
Occupancy Group: R-3 Type of Construction: VN
JEFFREY STONE D
SUMMIT BUILDERS
Owner of Building: CASITAS LAS ROSAS LLC Address. BA
City, ST, ZIP: 4700 VONKARMAN."E. #100
By: STEVE TRAXEL
q Date: 12-04-2003
Building Official
NSPICUOUS PLACE, I I . - I- - � I-.--- I
OWN
o4�a� �o Certi-ricate.of Occupancy
4
OF. '""
SuildihA S ffifrDepadMent
,
ire .merits of Section 109. of the'. California Building
This Certificate is issued pursuant to.,the.. requ. I .men
a structure was. in compliance with the
Code; -'ce'rtif'yj_ng, that,- at the time of issuance, this struc
City regulating building
i reg
,Provisions of..: the Building Co'de'an"d-tho'various ordinances,of. the. C
construction':, and/or use.
BUILDING ADDRESS: 50-750 SANTA ROSA PLAZA UNIT0.3
Building Permit No.: 0209-043
Use classification: -SINGLE FAMILY ATTACHED -
Occupancy
d Use Zone: VC -
Type of Construction: VN Lan
-3
Group: R
L -
AS of BuiBuilding:.CASITAS LAS ROSAS LLC
Building Official
Address: JEFFREY.STdNE' DBA SUMMIT BUILDERS
City, ST, ZIP:.4700 VONKAkMAN AVE. #100
By: STEVE TRAXEL
Date: 12-044003
Certificate of Occupancy
4
Building safety Department
t This Certificate is issued pursuant to the, requirements of,Secteon: 109.of the .California Building
certifying. that, at the lime of issuance, fhis structure was in corripleance, with the
' prdviseons sof the Building Code: and the various ordinances of the City regulating building,
h 3 consihi ion, and/or- use.
BUILDING ADDRESS: 50-7.50 SANTA ROSH<PLAZA UNIT:#4.
! Use classification: SINGLE. FAMILY ATTACHED Building Permit No.: 0209-043
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 VON KARMAN AVE. #100
By: STEVE TRAXEL
Date: 12-04-2003
IN A CONSPICUOUS P
u
Certificate of Occupancy
Temt 4 XP Qaw&,
Building &Safe y an
�.epa me,t
This
Certificate is, issued pursuant to ;the requirements of Section 109 of the California Building
wa"t in compliance M(�, the
f issuance, this structure mp
Ad thati. . at the time.-... o issuanc ildi
Cod!;,.qe: flWng
City - "Ailatit! bu tig
-Pro, '19n the -Bui,, in 'Code" reg:.-.
Idi and ih' ordinances of'. the 9
VIS �4� of 9 e various
construe ion andlor.use.
BUILDINGADDRESS: 50450,SANTA'ROSA PLAZA -UNIT #5-
tzm
Use classification: SINGLE FAMILY ATTACHED Building Permit No.: 0209-043
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: 12-04-200
POST INA CONSPICUOUS PLACE
Certificate of Occupancy
T '* a
-emf 4 4� , "
Building & Safety. Department
This Certificate is -issued" : ursuant 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 anal ' the various ordinances of 'the City regulating building
construction,and/or use.
BUILDING ADDRESS: 50-750,SANTAtR0SA-PLAZA UNIT46
Use classification: SINGLE FAMILY ATTACHED Building Permit No.: 0209-043
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
POST IN A CONSPICUOUS PLACE
.0 WFAM"Ir
Occuancy
certificate of . p
uicv
Departrnent
Building & Safety
4
,
'd-Pqr'�'On
to the i" -6f-Section
log -of the
.Pa,fifornia
;
Building
dinq
This is Ce this structure...was in compliance Ylththe
C0001certifyingthat,-'the jjn� of Istuqnqqi-'. C
ofMeBuilding Code and vand ..oMi6ances0f the Yrqgjg,
provisions
building
construction qad%r'use:
--750,SAN-,T-k'P.0 -PLAZA
BUILDING ADDRESS: 50
Building Permit No.: 6209-043
M -ACHED
classification: SINGLE FA ILY ATTACHED
Use cIA'si
Type. of Construction: VN Land Use Zone: t.
Y Group:
Occupgnc 3 -R-3
Owner of Building: CASITAS-LAS ROSAS LLC
5bilding Official
Address: JEFFIREYSTOWE DBASUMMIT BUILDERS
City, ST, Z I IP: 4700 VONKARMAN AVE. #100
By: STEVE TRAXEL
Date: 12-04-2003
I
CON ���of0-dCupancyCerfificate
�i
Tar-
19U
BUIIdlI1` & Safet De artmen+t
This Certificate is issued pursuant to the of Section 109 of the, California Building
;
,requirem.erits
t Coale, certifying that, at � M6 tff a of issuance; this 'structure: was �n ,compliance with the
F
rovisions of the Bwldin Code;: and the . various ordinances. of the,, Ci H re"� ulatin ;` buildin
p- 9` tY 9 9 9
I
b
construction and%r use.
`
BUILDING-ADDRESS.°50=750,-SA'NTA ROSA_PLAZA UNIT48
2{;
Use classification: SINGLE FAMILY ATTACHED Building Permit'No.: 0209-043
Land Use Zone: VC
Occupancy Group: R-3 Type of Construction: VN
R.i
�t
, ' Owner of Building: CASITAS LAS. ROSAS LLC Address: JEFFREY STONE DBA SUMMIT BUILDERS
cV
: City, ST, ZIP: 4700 VONKARMAN AVE. #100
9
u
4
By: STEVE TRAXEL
� '
f
Date: 12-04-2003
Building Official •r
'
' POST IN A CONSPICUOUS PLACE