0205-128 (SFD)N
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LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter (commencing with Section 70 00) of Division 3 of the Business and
co
W Professionals Code, and my License is in full force and effect.
:D c) License # Lic. Class Exp. Date
Cy LO
LU VV3 141(
f`
Z ti /Date i Signature of Contractor`
o.
H OWNER -BUILDER DECLARATION
aI hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
CO ( ) 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).
as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
U5 O I am exempt: under Section B&RC. for this reason
ODate Signature of Owner
rn
U Q WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations;
( ) I have and will malntain 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
Seddon 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 E fShI ' T Poljcy No.
(This section need not be completed'ifthe 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 workers'.compensation provisions of Section 3700 of the Labor
Code, I. shall forthwith comply with those provisions.
Date: Applicant ' i i ,
A,
Warning: 'Fall u re to secure Workera' 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 Bullding.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, indemnity
& hold harmless the. City of La Qulnta, 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 readdhis 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.
y
Signature (Owner/Agent) Et ` "" � ' `��'�-Date 1
T#
BUILDING -PERMIT PERMIin 12P-6-
2 Ell
DATE 1 VALUATION , LOT89 TRACT � ,� �J 1
JOB ADDRESS SS,57,44ti%R).G'!63'.�(?Dr?'Jl�1'lt. ITE
APN 776-780 -0V -
OWNER
OWNER
CONTRACTOR/'DESIGNER %EN INEER
N111194 WFLI..S C~A W,2210
USE OF PERMIT
sml,A"l.x DI WUTAW
SF0. LOT V. PFAMIT t3O S NOT INCLUDY BLOCK WALLS. lao04
SPA Clic D11MV 1 MAY APPROACH
CUSTOM k. (AiS'T RUC:TTOTI f� 1 A.01 Wil?
PORC.'HIPA.T1O I,n.(30 w.
tt�,1�CII+lC'A1tPCIli'C I,:sii5.4't ;gip
1~x'1'[ IAIMD £:C'TIN OF C:'ONS".M.Ufi'dT4MI
IS291 W IX)
:i131ad_h.y
C.OMSTRI ri;'i 1014 RM 101 _(tt A 1 t? -1000 v,►_�9, w
PLAN C.Hir.4 K 1i`l;.2, 101 _000-4:,9-31 S $1.;714.60
FEE MPOOIT 10.1..cjflr,)-439-318 -51,tiU{'"
MZCN,ANI(,AL .nLY- 101 •- 0004 L 1 �0Of) $207.00
FAIRCTRIC.A1: FF01 101.000-420.000 $1132.43
PLj:r;MHrN0 FFIE 101-0100.419-000 $329,09
0YRO�NO Iw1C)`i YOW PEF • w IZID 1011-f1(0-2 41.000 $4 .91
;;'Ir,M10110 ME, 101-d.W4.2N_ 0(A) $1�#.0
DE 01,,6411 :ft, IMPACT rv,?E, 544031.00
A RT 11! PUBLIC PLACES - 12ESIC 72
aiJki-TC.VPAL. (''0W'b1, 'R1 C"f,11YK AND
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C r F LAQUINTA
F1CEDEPT
EIPT
DATE
BY
DAT IN L
INSP.Ec R
le o
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
(>
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.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
-
Final
Final
SLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
C►
Heater Final
Water Piping
L_ li
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
_
- / - Q'L
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL .APPROVALS
Temp. Power Pole 7 oJj
Underground Conduit
Rough Wiring
Low. Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
FinalQ.k
Utility Notice (Perm) �i ,
COMMENTS:
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Lot # No. Street S.F. Lot # No. Street S.F.
Unit 1 B9 52440 Del Gato Drive 6124 Unit 6
Unit 2. Unit 7
Unit:3 Unit 8
Unit,4 Unit 9
Unit 5 Unit 10
Comments
At.the.,presenttime, the Desert Sands Unified School iDistrict,does not collect fees on,garages/carports, covered patios/walkways, residential additions under 50
square feet; detached accessory structures (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation)'or replacement mobile home
It has been determined thatthe,above-named owner is exempt from -paying school fees at thistime due to the following reason:
EXEMPTION NOT APPLICABLE
This certifies: that school facility fees imposed pursuant to
Education' Code -Section 17620 and Goverrtment'Code'65995 Et Seq.
in the amount of $2A4:X 6,124 S.F. or .$13,105.36 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 Bank - Lori Hatzopoulos Check'No. 07377.03507
r5jame on ineTHICK Telephone
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Crystal Scott $13,105.36
Payment: Recd over/Under
Signature
NOTICE`. Pursuant to Government Code Section 66020(d)(1), this will serve to notify you that the 90 -day approval period lin which you may protest the fees or
otherpayment identified above wiil;begin'to run from the date on which the building or installation permitfor this project is.issued, or from,.the date on'which.thos
amounts are paid to the Dlstrict(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
The CRY of'La, Quinta
Departnent of Building and, Safety
78495 Calle Tampico
La Quinta, California 92260
Re5.24.40 Del Gato
Lot 89, Tract 28470, The Traditions
La Quints, California
Gentlemen:
The construction of, the structural framing portion of the subject residence has in my
'opinion, been constructed in accordance with the Structural Plans prepared ;by
Joseph N. Gicchini, P.E., dated June 24, 2002.
C�
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Clochini, P.E.
No. 35727
Exp. 6-30-9003
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
EINFORCED.CONCRETE O STRUCT. STEEL ASSEMBLY O
O POST TENSIONED CONCRETE O ASPHALT O OTHER
0 REINFORCED MASONRY O FIRE PROOFING
JOB LOC
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REPORT SEQUENCE NO.
TV�STZUCTURE /
PERMII•T'NNO..
n AY Of WEEK
MATERIAL DESCRIPTION
AfIQHITECTINS=C
u r.T 1+a (e :'.Ie5
HRS. CHARGED
NEER
0 C IC SR,20 1
ASSISTANTS MRS. CHARGED
INSPECTION GENERAL sue ;L
DATE CONTRACTOR _ CONTRACTOR 'J'Et
AR 1 c -T'S
COPY SENT TO CLIENT ❑
CONTI N NEXT"PAGE O
PAGE OF77
CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MV
KNOWLEDGE ALL OF?HE ABOVE REPORTED WORK;UNL'ESS OTHERWISE
NOTED. I HAVE FOUND THIS WORK TO COMPLY WITH'THE APPROVED
PLANS_SPECIFICATIONS. _SPECIFICATIONS. AND APPLICABLE SECTIONS OF THE
GOVERNING BUILDING LAWS.
T( rt, ..
N R F REGISTERED ffz
OATIA OF RE ORT REGISTER NUMBER
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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 REI1.NFORCED CONCRETE RUCT. STEEL ASSEMBLY
O POST TENSIONED -CONCRETE 0 ASPHALT
0 REINFORCED MASONRY 0 FIRE PROOFING
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MATERIAL DESCRIPTION w
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CONTINU ON NEXT PAGE O
PAGE OF
CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT I HAVE, INSPECTED TO THE BEST OF MV
KNOWLEDGEALL 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.
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REGISTERED INSPECTOR'S WEEKLY REPOR
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
❑ REINFORCED CONCRETE arSTRUCT. STEEL ASSEMBLY ��-❑ �- p
❑ POST TENSIONED CONCRETE ❑' ASPHALT �gTNER
❑ REINFORCED MASONRY ❑ FIRE PROOFING / U*I" P^f`
JOB LOCATION e
REPORT SEQUENCE N0.
TYPE". SPVE
PERMIT C)� 0_45 F}
a
DATE I
DAV OF WEEK
MATERIAL DESCRIPTION -�
ARCHITECT
oNeS
HRS. CHARGED
C- t T-
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EASSISTANTS
o� C� « ,w t.
NRS. CHARGED
INSPECTION
DATE
GENERALSUB
— CONTRACTOR' CA
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COPY SENT TO CLIENT D'
CONT WON NEXT PAGE D
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 THISWORK TO COMPLY'WITH THE APPROVED
PLANS, SPECIFICATIONS., AND APPLICABLE SECTIONS OF THE
GOVERNING BUILDING LAWS.
,��ka, ,
1 T E OF 1STERE .iN PEGTOR
o a s
DA`TE OF FIEPORT REGISTER NUMBER
REGISTERED INSPECTOR'S WEEKLY REPORj
JON TANDY
37630 Medjool Ave.
Palm Desert, CA 9221.1
Office (760) 772-7192
Fax (760.) 772-7193
Pager (760) 776-3338
TYPE OF
INSPECTION'
PERFORMED
❑ REINFORCED CONCRETEUCT. STEEL ASSEMBLY O �,v1la
CI POST TENSIONED CONCRETE ❑ ASPHALT iEA 104
❑ REINFORCED MASONRY ❑ FIRE PROOFING
JOB LOCATION + 10 -4e -,L (_;A^ V if
jP,EERMMIT'NO. S (�,�
t, 'l ^ `�
REPORT SEGUENCE NO.
TYPE F_ RE eu
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7E/�O O 3
DAY OF WEEK
MATERIAL DESCRIPTION
ARCHITECI
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IN �`• T--
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ASSISTANTS
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COPY SENT TO CLIENT O
CONTINUED" XT PAGE O
PAGE OF
CERTIFICATION '.OF COMPLIANCE
I HEREBY CERTIFY TWAT I HAVE INSPECTED TO THE BEST OF Md'
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.
�J-1,
f7
I0ATUR OF 0EGISTERED $pECTO
/(� �) J
` —
DATE .OFR PORT 3 REGISTER RNNUMBER
s-.
REGISTERED INSPECTOR'S' WEEKLY REPORT
JON TANDY
37630 Medjool Ave.
Palm Desert, CA 92211
Office (760) 772-7192
Fax. (760) 772-71:93
Pager (760) 776-3338
TYPE OF
INSPECTION;
PERFORMED
❑ REINFORCED CONCRETE ICT. STEEL ASSEMBLY ❑
13 POST 'TENSIONED CONCRETE ❑ ASPHALTDTHER ,�
❑ REINFORCED MASONRY ❑ FIRE PROOFING (,( uol
JOB LOCATION �
1 V
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REPORT SEQUENCE N0.
TYPy6Fy�TURE (� I ��,p
``/ "��
PERM 17.P10 _
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D� a
DAr°OF WEEK
MATERIAL:DEESSCC\\RIPTION`,
ARCHITECT
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1 0 _
MRS. CHARGED
EB(j{0oc �,!' �; a 1�
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ASSISTANTS
HRS. CHARGED
INSPECTION GENERAL w
DATE CONTRACTOR
SUB
CONTRACTOR
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COPY SENT TO CLIENT ❑
CONTINUED ON NEXT PAGE ❑
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.
NATUR .OF REGISTER INSPECTOR
03 0
DAkE OF REPORT REGISTER NUMBER
Certificate, of Occupancy
T-af 4 412"
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: 52-440_ DEL GATO DRIVE
Use classification: SINGLE FAMILY DWELLING
Occupancy Group: R-3
Owner of Building: SANDY &NANCY STUDER
l b'�
Building Official
Type of Construction: VN
Building Permit No.; 0205428
Land Use Zone: RL
Address:
By: KIRK KIRKLAND
Date: 8-27-03