0007-128 (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
691405
' ate j ~ ` �'C ignature of ContractQr�� ' " ''j 6 -
OWNER -BUILDER
-
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. 704.4, Business & Professionals Code).
( ) 1, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals.
Code).
O
[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:
O 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 A policy no. are:
Carrier PolicyNo.
3TATE FUND'
(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,forWhich this permit is issued,
/sha/not employ any person in any manner so as to becomesubject to the
rs' compensation laws of California, and agree that if .I should become
t to the workers' compensation provisions of Section 3700 of the Labor
steal orthwith comply wit those provisio ....'.
Date: �1 'I• - fJ !1 Applicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminaP penalties and civil fines up to'$100,000, in
addition to the cost of compensation, damages as provided for in Section3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application 1s hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set' forth on his
application. - ' g'"
1. Each person upon whose behalf this application is made:& each.person at .r4
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 Qwnta, 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, orcessation of work for 180 days'Will subject permit to cancellation.
I certify that 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 p perty forinspection purposes.
f r 7 C':
`Signature (Owner%Ader11�" �-1- ' 'g!•, Vin• Date? I �`" / ®
BUILDING PERMIT PERMITA
DATE ( VALUATION LOT 0007-128 TRACT
01 { C� x'79031 M 86
JOB SITES
APN
ADDRESS 51-+,349.4 W3, %', IY) D PJ VF
I .. 770-28"16
.OWNER
CONTRACTOR'/ DESIGNER / ENGINEER
DWK A SAtJDRAALADER'
CLASM..C; BTJ1Li3Ff�t`i 134C
:i1wJ.Ai`ZWaI.:1 Cid 92210
r��}7�x�lozl r 3z 11099
USE OF PERMIT
SINGU. FAI& fi7WE1,Ct G
SYD � NO 13LOCK'WALLS L)R 11)004¢ COMPLIXINICE WITH A A. WMERAL �
S'iATZ'LA1,'U'S. D4CLU1?1'Nt'.{' H.9Iit�f.l:A3•ICi9RFD V1111CIE.' ACT ON t973 (16
U.S. 1331, YT SEQ) 11f .APPMC."L,F, IS R EQUIP.EL).
CUSTOM CONSTRUCTION U06100 NF
PORCH/PATIO 1,685.00 SV
CIAitAGPICARPORT (SF) 20,6",60
ESTIAIAIrR0 COU OF, O'0HST1M(,MQK
479J925,'0
PMMf PKE WA04ARY
CONSTftUCf]ON WE 101 "( 00.41 --CID IL90:10 '
PLAN CHFXI**K Inti 101,000-439-31 i3 $1,579.49
FEE DEPOSIT •s).,2so,00
Mtl�f.'}tAAf IC A l< N' 101«000-421-000 $1ti:c. StT
1"C1,00TWA L .FEE 101 -000-420-000 S307,33
PLU MBIN113 F 1 t19 C'!t3(I Q 19-440 AA 9.75
STE.ON O MOTION FEF, - RKSiD 101.000•24 1-000 1-4t"I
OR1•LDR40 IEE 101 -0(10 -423 -OW $20.00.
DEVELOPER IMPACT EEE $1,907.00
ART IAI PUBLIC PLACES , �'sCS1i:''` O1-000.255-:000 �b0i�.s1
31.JI3•'1YA' lL C°C1X: uC i0N AND PLAN fr'EFrtK0C'
$6,506:69
I �`l PRX-.FAM M3 S
41,250.00
*.T9rAL .P.VRM FFES DUE NOW
9 2000
-2
NOV 2
UUN A.
d� tl y UiLA R
RECgPT
DATE
By,
DATE!FINALED
INSPECTOR
4 9
/.
OPERATION
DATE
I INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
- _p
Exhaust Fans
O:K. to Wrap
4-4. of
F.A.U.
Framing
- _p1 $Z"_
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T. -O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
.- o
Drywall -.Int. Lath
,, l
Final
Final —(-
BLOCKWALL APPROVALS
POOLS a SPAS
Steel
Set Backs
Electric Bond
Fobtings
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
Heater Final
Water Piping
I TIC (
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
✓ -O(
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (pas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
GiF.I.
Smoke, Detectors
Temp. Use of Power
Final
4Utility Notice (Perm) -®57
COMMENTS:
l& tla4l —t&,d0-78 ICZ6 zz o� s?
.. -. �. .- ._- _,. r-.e.�,a� __� i _-. +�: ._st;.:..,.-.:- - _ .:'K,:)-, z.i, a•�: �•N.:. r ^-� _"�. '���' r'.ri"`' ry. ,. '`` ,. ,, .. .,. r .�. _
0
P.O. BOX. 1504 APPLICATION ONLY
Building78-495 CALLE TAMPICO
Address A 7 LA.QUINTA, CALIFORNIA 92253
Ow
Maili g
BUILDING: 'TYPE"CONST. OCC..GRP. O
Address A.P. Number t0
Tel.
Legal Description Te, 28410 - J
Contractor I / Project Description
State Lic.
& Classif.
Arch., Engr,
Designer
Address
Q./
OQ
State
Lic. # ,
4 ' IV OWNER•BUILDER DECLARATION `
I hy affirm that I em exempt from the Contractor's License: for the following
reason. (See:-703L5;Buskness and ProNsalona f:ode: Any shy or county 'wh/c!i reyulres,- a
permit construct, after, improve,. demolish, or repair .any structure, pdor to --its Issuance also
requi Me appicant for such permit. to Bice a signed statement that he" k licensed pursuant `to
_the provisions of the Contractor's Ucense Law, Chapter 9(c
with Seceon 7000) of
Division 9 of. the Business and Professions Code. or that. he la• exempt therefrom, and the -basila
,for the alleged exemption.. Any violation of Section 7091.5- by any app/kent for a permit
subjects'thespplicent to aciw penalty-of:not more than;Ave hundred dollars ($500).
ti'l, 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. 70,44, Bulsnsss,and
.Professions 'Code: The Contractor's License taw 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 kitprovenlents are not intended or offered. for sale. ff, however: the building
or k -%cement is sold within one year of complethm, the owner -bulkier will have the burden
of provin9'thar is dki'nof build or knprove (or the purpose.of sale.)
1-1' 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 Lew
does ,notapply to, an owner of property who builds or improves thereon, and who contracts for
such pro act,a with a contracror(spucensed'pursuant tothe"Contrector'sL/cense Law.)
i 1 I am exempt.under Sec: S. IL 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`
Workees Compensation Insurance, ora certified copy4hereof.,(Sec:,9800,.Labor Code.)
Policy -No. Company
171 Copy Is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION' INSURANCE
,(This section need not be completed it the pemnit to for onehundred dollars ($100) valuation
or less.)
I certify that in the performance of thq work. for. which this permit. is issued, 1, shell not
employ any person in any manner b6 as to become subject to the: Workers' Compensation
Laws of Call ornia.
Date --Owner ..
'NQTICE To APPLICANT g, after making this Certilkate of Exemption you should become
subject to the Nbrkers' Compensation provisions of the LaGor Code, you mint fortIn ffh
comptywhh.such,proviskns ortfdspennitshaNbe'dernlad ovked.
CONSTRUCTIONLENDING AGENCY
I hereby affirm that there is a construction lendingiagency, for the performance of the
work for which.this permit Is -issued. (Sec. 9097,..C&ACode.J
Lender's Name
Lender's Address
This is;a,building permlt,when properly filled out„signed and validated, andis subjecUto
expiration it work thereunder'I, suspended for 180 days.
I.certify that I have read this application and state that the above Informallonae correct..
I .agree to comply with all city and countyordinances and -state laws relating .to building
construction„ and hereby authorize representatives -of Oils city to .enter the above-
mentioned,property for inspection purposes.
Signature otapplicant Date
Mailing Address
City, State, Zip
MAWR
Ft. r r it —'-
No. Dw.
Units
New Add,Q ;Alter ❑ Repair Demolition 0
ChJ% DAyip LAesr,r3
333 -1135 cau.
Minimum+Setback Distances:
Front Setback'from Center Line
Rear Setback from.Rear Prop. Line
Estimated Valuation
PERMIT
AMOUNT'
Plan Chk., Dep. -
f
Plan Chk. Bai.
Validated by:
Const.
Validation:
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
I✓ f
REMARKS
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:
~
WNITE at FINANCE YELLOW = APPLICANT PINK= BUILDING DIVISION
Notice:
Document Cannot Be Duplicated
Desert Sands Unified School District
47-950 Dune Palms Road
La Quinta, CA 92253
760-771-8515
CERTIFICATE, OF COMPLIANCE
Date 11/29/00 APN # 770�280-016
No: 21263 Jurisdiction La Quinta
Owner NameRichard Sandra ,Sladek Permit #
No. 52-350
City La Quinta
Street Del Cato Drive
zip 92253
Log #
Study Area
Tract # 28470-1 Loo 86 Square Footage 5606
Type of Development, Single Family Residence No. of Units I
Comments
'ed cashier's check for $10,819.18 and $673.12. cash.
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered
patios/wallcways; residential additions under 500 square feet, detached, accessory structures, or replacement mobilehomes. It
has been determined the above-named owner is exempt from paging school fees at.this time due to the following, reason:
EXEMPTION NOT APPLICABLE
This certifies that school facility fees, imposed pursuant to Government Codv$3089 . in, the amount of
2.05 X 5,606 or$ 11,492.30 the property listed above.and that bbilding
permits and/or Certificates of Occupancy for this square footage in -this proposed project -may nowbeissued
Fees Paid By OC /First Union /David larson
Te�iphone,
Name,,on the check
By Dr. Doris Wilson
Superintendent
Fee collected lexe ted -by Annette Barlow Payment Received $1' 1,492.30
Check No., 300900034*
Signature
NOTICE:, Pursuant of Assam* EliH 3WI (CHAP 50, STATS. 1998) this will serve to notify you that the 90 -day approval period in which you may protest the fees or other paymeW kleiffied
above will,begfn to run.from the date an which the b,ullcling or Install"m permit for this project isassued or;on which they are paid to the Dlatrict(s) or to anodes public entity-aulhort;ed to
00fla— Mem on Me lJlsfflct('s)_(s!) be -half, whichever is earlier,
Collector. Attach a eopy,,ilftounty or city plan check application form to district copy foray waivers.
Embossed Origi.nal- Building Dept./Applicant Copy - App 0 .
#icant/Receipt Copy; =Accounting
NOV-29-2000 11:12
13
TRADITION GOLF CLUB
Tradiffiff"On
AitCHITECTU.RAL DESIGN REVIEW
-�-.'
Ngvember 29, .2000
Mr. David Larson
:4
CLASSIC BUILDERS
45-270 Club Drive
Indian Wells, CA 92210
Re: S)ndek Residence
Lot 86, Tract 28470-1, 52-350. Del Gate Drive
.Dear David,
760 564 2356 P.02
via P&n Cf W Yaa
mtd Paeaftft
This letter will serve as approval:for the above referenced residence to obtain a building
permit. Conditions that apply to this submittal,have been1brwarded to and received by the
design team. - These items must be provided xo. this office no later than January 11, 2001
for review and approval,
If you have any questions or need additional information, please do not hesitate to call.
Sincerely,
Christina I Dores -
ArchitecturaLReview Coordinator.
pe: Nidde .GWVIky,, Gly of La Quinta, Building Uepartmeut (via fa)
Mark Landolt. Desigm (via first loss mail)
John' Steigeiwddt,.L =hcge Archited (via first doss°mail)
W. and Mrs. Dick Sladek. owner, (via fttAm nail)
78505 Ow AMAM 52 --- IA QtiwrA —=CA 97253-1120 Pt�760/564 3355 - FAX 760/564-2556,
TOTAL P.'02
Wls/:loo
10:48 a
.41
479974
RMEMID
r Na
ctftw& vkAj%8mw=jftj ca wo xMI&NOw (D
PAID DEC Sl 197
KAMM bm TnoiswTm
PM
WATI-TAXSrAl7mamlim-9ptaestiaae Tteolbe,Lv"
VOCLWWAKVTLMMF=TAX$T74?
hoc Zutt�tadeaEteaootttdeaod000twftieot�
MMASABOW OX
d on do guaddomom or Wm low sm as
ddmofmb
APM
TRA: -027f,91- #q&a-Dol -Z=y- S,4A%n--ra : Mo - 280
"Is GRANrEam (p
FMAVALUABLE Cd l7 i moatptaE 6 k
lItAOrrXNC:;%
bmbyGRAICM to
nicam S- SLAS K and $AMA IL SLAM, tAwbaamnd Wife an jg;Lnt tgmnto
dw=11lmdoc lwarlaadm
cmw =w
Data& Dftcelo19. 1991
somorcambmb
IL
ca mw of ftveraiLde I
W-6
bkm
Dar mfimftqpKm bebaliof
c�
Older: 00-00036208 ri wcz-iption; 1997.4:79979 Sage 1 of 2 C --t:
lib.002
Certificate of Occupancy
City of La Quinta
Building and Safety Department
This Certificate issued pursuant to the .requirements .of Section 109 of the Uniform Building Code,
certifying that, at the time of issuance, this structure was in compliance with the, various ordinances
of the City regulating building construction or use. For the fo/%wMg:
BUILDING ADDRESS: 52-350 DEL GATO DRIVE
Use Classification: SFD Bldg. Permit No.: 0007-128
Occupancy Group: R3/U1 Type of Construction: VN Land Use Zone: RL
Owner of Building: DICK & SANDRA SLADEK
Building Official
Address: 52-350 DEL GATO DRIVE
City: LA aUINTA, CA 92253
By: STEVE TRAXEL
Date: 11-19-2001
POST IN A CONSPICUOUS PLACE
�e
FROM ; KNAPP ARCH'L ENOWS,
PHONE NO. : 909 883 1543
KNAPP ARCHITECTURAL ENGINEERS, INC.
2105 N. ARROWHEAD ' AVENUE SAR BEWARDINO, CA 92406
($1.99); 883-4974 Fa% ("9),883-7543
Maar. 28 2001 W: 59PM P1
March 2&' 2001
To:, city of La Quinta
Bi4lding & Safety Deparment
Re Lot,# 86 SlAdek. Residence
Tradition Country Club
52.350 Del Cato..
La Quinta, CA7
On March 29, 2001, I pe.rfor-med A structural inspection of the subject residence and
'found the framing and foundation to. be of good quality and in substantial compliance
with our structural plams,. It is: my recommendation that the contractor be,allowed 'to
proceed with the installation of'finishes.
Respectfully pwfully submitted, Jo, el�.*xl
En)
J
McGEE SURVEYING, INC.
73-301 Country Club Dr., Ste. 102 - Bermuda Dunes, CA 92201
Phone (760) 345-3828 - Fax (760) 772-5.705
C/ry
Op 4
Friday, January 19, 2001 AV 01 I' I rA
CrtY ' of La Q�t ' a BUND/NG 22 ftV
tiH
78-495 Calle Tampico A�� S
La Quinta, CA 92253 ��'
Re: Pad Certification - Lot 86, Tr. 28470-1
Pursuant to your request a field survey was conducted on the above referenced project to
determine the vertical location of the budding pad The above mentioned was found as
follows.
LOT ADDRESS PAD (DES) PAI6 (FOLD)
86 ' 52350De1 Gato 63.0' 63.0'
A. LIV
Sincere 3 t� 5479
� X00
0
Wayne A. Mc
L.S. 5479 - -
0 0 Em 0 &1 i i
REGISTERED INSPECTOR'S WEEKLY REPORT
JON TANDY
37630 Medjool Ave.
Palm Desert, CA 92211
Office (760). 772-7192
Fax (760) 772-7193
Pager (760) 776-3338
TYPE OF
INSPECTION
PER
❑ REINFORCED CONCRETE ❑ 'STRUCT. STEEL ASSEMBLY Cfo-v-y
❑ POST TENSIONED CONCRETE ❑ ASPHALT ❑ OTHER
❑ REINFORCED MASONRY ❑ 'FIRE PROOFING
JOB LOCATIONREPORT
SZ - 3 s o TIaL G&Tro. L. -Pr (3L,&;._,Tjj
.
SEOUENCE NO.
tYPE OF STRUCTURE
Sfa S:LfDE.K 9ES ®T Dirli'wis
PERMIT NO.
DATE
3 2z o t
DAY OF'WEEK
MATERIAL. DESCRIPTION
$'i M so" . cpolt c.C;o 4945
ARCHITECT
SrovE2 LA'ODoLf
INSPECTOR
'R,`D.
HRS. CHARGED
ENGINEER
rcNRC'P
ASSISTANTS
NRS. CHARGED
.INSPECTION GENERAL " - �- - - SUB ^ _
DATE CONTRACTOR CONTRACTOR - Z W a 3 T Carl
3 Z Z o
a b .1M%J.E D P I R C g,m E" T- OF$ E. A. 519 "' A l I TN R-Z7A-Q7
W �• �~ 9^4 bed>M ENS T . H 17 — 5 Lo oyri Ot-JIS Agol>
w
(v " �.••� bI �e••�T + w►; Hoe oar
LOC14Tio�'s "%A0-14C)LA.r ®PLATE sPLicEs._,
A't
r
Pr t _Nal. 13R:u.s146-b AND aLowN CLER.Nr-1 01L
fc.,POx �NJ'E.CT10/�Lr
FXP WT -r 1 oZ
. 4
v
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, 1 HAVE FOUND THIS WORK TO-COMPLY'NVITH THE APPROVED
PLANS. .SPECIFICATIONS. AND APPLICABLE SECTIONS OF THE;
GOVERNING BUILDING LAWS,
SIGNATURE OF REGI RED INSPECTOR
3 I Z2 O I MC -80 11113 U- V?
DATE. OF REPORT REGISTER NUMBFR
s -
REGISTERED INSPECTOR'S WEEKLY REPORT
JON TANDY
37630 Medjool Ave.
Palm Desert, CA 92211
Office (760) 772-7192
Fax (760) 772-7193
Pager (760) 776-3338
TYPE OF
INSPECTION
PERFORMED
O REINFORCED CONCRETE �STRUCT. STEEL,ASSEMBLY ❑
❑ POST TENSIONED CONCRETE (O ASPHALT OTHERl P�
❑ REINFORCED MASONRY ❑ FIRE PROOFING
JOB LOCAT _
TM
y� %�
REPORT SEQUENCE NO,
TYPE OFA
Vj0
SLAO-J'
�S�
PER IT NO. ^
Oy
DATE
DAY OF WEEK
MATERIAL DESCRIPTION
^
Pr 5�
ARCHITECT
INP TOR
MRS. CHARGED
IT-I`
' �` • W
ENGINEER Ko
ASSISTANTS
'NRS. CHARGED
INSPECTION
OATS
GENERAL
CONTRACTOR
SUB
CONTRACTOR
�c
Cot's -
�
0
a
Cb
ta
eA
Rbrom no
L• G
i G
COPY SENT TO CLIENT ❑
CON NU ON NEXT PAGE 0
PAGE OF
CERTIFICATION OF COMPLIANCE
'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.
SIG O/ ATURE OP REGISTERED I EVd
1 � gl7S�
DAT4 OF REPORT REGISTER NUMBER'