9909-254 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I ani 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
I ate 910 A/Signature of Contractor u
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 isnot 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.
SecI have and will maintain workers' compensation insurance, as required by
tion 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 'Policy No. }'
a s a�4 r� .+"UND t l.
(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 workers' compensation provisions, of Section 3700 of the Labor
Cod
Date: lir `1"9 hApplicomc nly t ith t, .a._.
�X ��
Warning. Failure. to secure Workers' Compensation coverage, is unlawful and
shall subject an -employer to criminal penalties and civil fines up to $100,000; in
addition to.the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby.made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or.pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such ,.
permit, or cessation of work for 180 days will subject -permit to cancellatiori."
I certify that I have read this application and state that the above, information is '
correct. I agree to comply with all City, and State laws relating.to the building -
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection
purposes. ,
VrSignature (Owner/Agent) d;��'�"'«.» Date��
V
BUILDING PERMIT PERMIT#, .
4tt,,�•�S�R
DATEj VALUATION g,�� LOT TRACT 27
JOB ADDRESS'
;k 180 VEL GATO ��@$UIV SITEAPN
! iS9-1�fQ i�3i
OWNER
CONTRACTOR DESIGNER ENGINEER
t�
ft Sgt �A1'.
s�O�o .+..%?i I i,.L". li Yr,,'.'?,, I.;,.• 1'.1le'
CON L t
es+.lE_+d i�: `.a A G.bc�� i.:?iii. �.C'. i5i .iuiir �...�i.vni i�wt�.�i1i
74.991 JONI DJUVE P1.1
(760).568-6070 C814' 2274
USE OF PERMIT
:>usk:lLg :l x1MI Y TYWRIUNG
�f; f) . NO oii.�.r€�: WIkLLS OR a�50L. t'C'�A�I�iE�iwC£'dT�✓1�il �L - k�i}l:�'ZA7 &�
STA.`s'r:• LAWS, rNUL.VD INQ'fflE [abt6J.e'tNt,`r8R)t -0 :di'1'C`W'S,A:e;!.'(.it+ x973 (166
'U.S.C. { oil, :FPV :DEQ,)*` APPLICMUi
i;1Al2PS3f�:tt,:/1ikZ�S,:il$'i" t,x`s.I..i1d! {il;`
.
ESTN,A4IA,A Ef I \+'I:Y'..'3 i1 33F CO S Y 54,9 C T :I 'N -
420,303.40
PERMIT FE E, SUNINURY
(XANS°l'ittf..3L"Y10N FEE 101-0(YI-418m000 �i,'iJ�4,Cs�►
RAN i;:W3.0K. RF
E.IEN.,.I)Elp0`".rora
9ht:1:311i�D f�'-t 7 : F:. �J 01- N-42 1430 �rlil�r.C)i!
fy`LEC k"dtd0AL F'F3?, 101AXY0420-{axJZ1
Pt;C "I''rINaFFE }�)'I.-�t3@} 4341�}6t1} 322350)
:as'E2,C);vf:iTv3ti`F"IOa1Er. 1 T 47.i7� '1 i3- C� � 11-44}(? 114s.VS
1.iD$t1f:U:3l. 0.1.1,11 is4.•-f"41. -WO. :b20A)o
151;sWElafJWN, iM`va'+,:CT F17E
caRT TN P1f9t1fC P.LA .?7S - V' Sli: $817,01
<}yT_SYvd.CONST R U(TN AND PIA�{7(CK.
g T q
ilri0l :iti�t
yr1}
- PAID FEES
�;+97!�
i•IA I a.
RECEIPT
DATE
BY '� �.
DATE FINALED -
INSPECTOR
r0
V'
f
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
E _
Forms & Footings
Z.
Ducts
Slab Grade
Return Air
Steel
Roof Deck
O.K. to Wrap
Framing
c9O
Combustion Air
Exhaust Fans
F.A.U.
Compressor
Insulation
Fireplace P.L. /,Z, to 2?
3_o�d0
y g>ej
Vents
Grills
Fireplace T.O.
,$ t
Fans & Controls'
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
_ _ / _-)-p
_
Final
Final
POOLS
- SPAS
BLOCKWALL
APPROVALS
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
Water Piping
a �^
&(
Heater Final
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
JA9_ Q� _
Encapsulation
Gas Piping
Gas Test
_
l0 —�/-a: S L'
Appliances
Final
COMMENTS:
/0
(/
,
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)
v
ui
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P.O. BOX 1504
Building+ ' ( r f �q,� 78-495 CALLE TAMPICO
AddrpcW 1 9 I I t i �� l/ Y LA QUINTA, CALIFORNIA 92253
APPLICATION ONLY 7 ! 0 9 -2'S'1
VWItCI ' I /� � I `������ r.y ' ����' / , ) I�1111 1'11\I/�. TVt1L•/�A\IC.T l� I'.flA
Mailing r t f -- -- - - -- - --- -
Address
A.P. Number •-
City Zip Tel. n r t/ (k �
1 Legal Description L-U�l Y l
Cbntractor Ps1A
F t
•t ` Project Description
Address (� V 1� y
City
Zip
Tel.
State Lic.
8 Classif.
City
Lic. #
Sq. Ft. /[ q G2 2 NO.
,��
SNo.tories
iz
Size "'j I C� Stories Units
s
Arch., Engr.,
�
-'
Designer ` - 1 /(Sy
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New Add O Alter 0 Repair ❑ Demolition ❑
,1-� � ��1 �,S,� 65t�'
Z 'e�l�ta
State
Lic. #
4 LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
ellecl.
SIGNATURE _ DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5.Business and Professions Code: Any city or county which requires a
permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to file a signed statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis
for the alleged 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, andthe structure is not intended or offered for sale. (Sec. 7044, Buisness 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 linprovements are not intended or offered for sale. It, 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.)
I I 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.)
1-1 1 am exempt under Sec. B. & P.C. for this reason
.1
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
n Copy is filed with the city. O Certified copy is hereby furnished.
VO <
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.)
1 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: If, 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 �P
This is a building permit when properly tilled out, signed and.valiciated, and is`subject to
expiration if work thereunder is suspended for 180 days.
I certify that I have read this application and slate 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 applicant Date _
Mailing Address
City\State, Zip
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
4
TOTAL`
a AMOUNT
4. 1 n(x)
Wit -IF
F,REMARKS Ilinlf n 1 i999
TV
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:
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
Sent By: WHITE'S;
760 347 0296; Sep -17-99 12:50PM; Page 2/3
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Tradition
ARCHITECTURAL DESIGN REVIEW
August 5, 1999
Mr. Greg Butler
CITY OF LA QUINTA
78-495 Calle Tampico
La Quinta, CA 92253
Re: Dove/Neumeyer/Baird Residence
Lot 66, Tract 28867, 53-180Del Gato Drive
Dear Greg,
CITY OF LA Chi. NTA
AUG 9 REC,0
BUILDING ,Pjjs;L, 6,t�F`TY
Via First Class Mail
and Facsimile
Please accept this letter as approval for the above referenced residence to obtain a building
permit. Conditions that apply to this submittal will be forwarded directly to the architect,
Ms. Kristi Hanson.
If you have any questions or need additional information, please do not hesitate to call.
Sincerely,
Christina J. Dores
Architectural Review Coordinator
/cjd •_
pc: Kristi Hanson
Brian Luddington
1�1.T
> t, `. ., i' .s'• � i... ,.� p' S �;) � � y �' `''.c> ) L� � j.IC2?L`. ,'.%a. t;�,�
CNdY Dowm-WADFC%Dwe ffxyc.BHrd.dry.wpd
78505 OLD AVENUE 52 -- Ia QuiNTA - CA 92253-1120 - PHONE 760/564-3355 -- FAx 760/564-2356
TRADITION GOLF CLUB 9 760 564 2356 08/05/99 11:0715 :02/03 NO:371
Tradition
ARCHITECTURAL DuioN RF -VIEW
August 5, 1999
Mr. Greg Butler
CTTY OF LA QUINTA
78.495 Calle Tampico
La Quinta, CA 92253
Re: Dove/Neumeyer/Baird Residence
Lot 66, Tract 28867, 53-180Del Gato Drive
Dear Greg, .
Via Arst Class Mail
and FamintUe
Please accept this letter as approval for the above referenced residence to obtain a building
permit. Conditions that apply to this submittal will be forwarded directly to the architect,
Ms. Krista Hanson.
If you have any questions or need additional information, please do not hesitate to call.
Sincerely,
Christina J. Pores
Architectural Review Coordinator
/cjd
pc: Kristi Hanson
Brian Luddington
0
I
cnw ome.ru,�aun►�n�+.�aams.00,
78505 QLD Avenue 52 — L4 QoNTA --- CA 92253.1110 -- PHONE 760/564-3355 -- FAX 7601564.2356
Desert Sands Unified School District
47-950 Dune Palms Road
Notice: , La Quinta, CA 92253`
Document Cannot Be Duplicated 760-771-8515
CERTIFICATE OF COMPLIANCE
Date 9/24/99
No. 19373
Owner NameDove/Neumeyer/Baird
No. 53180 Street Del Gato Drive
City La Quinta
Tract # Lot #
APN # 769-180-020
Jurisdiction La Quinta
Permit #
Log #.
Zip 92253 Study Area
Square Footage 4982
Type of Development Single Family Residence No. of Units 1
Comments
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered
patios/walkways, residential additions under 500 square feet, detached accessory structures or replacement mobilehomes.
It has been determined the above-named owner is exempt from paying school fees at this time due to the following
reason:
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of
1.93 X 4,982 or $ 9,615.26 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/ 1 st Community Bank/ Brian Lettington
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Sylvia Carrasco
Signature li�c9
Telephone
Payment Received $9;615.26 ,
Check No. 089295
10TICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 -day approval period in which you may protest the tees or other payment identified
bove will begin to run from the date on which the building or installation permit for this project is sssued or on which they are paid to the District(s) or to another public entity authorized to
ollect them on the District('s)(s') behalf, whichever is earlier.
Collector: Attach a copy of county or city plan check application form to district copy for all waivers.
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting
�y °� .fWQut«rw
PUBLIC WORKS CLEARANCE LETTER
FOR i
CUSTOM HOME LOTS
Dear Builder:
Prior to issuance of a building permit, you will be required to obtain clearance from the
Public Works Department for one, or more, of the following:
1. Verification that rough grading is complete, and the pad elevation certifications
prepared by a licensed surveyor, or.engineer, are on file in the Public Works
Department.
2: Verification that infrastructure improvements and other required tract -improvements
are complete, or sufficiently advanced to warrant building permit issuance..
3. Prepare an engineered grading plan that provides for on -lot storm water retention,
and have it checked and approved by the Public Works Department.
• Tract 26524 (Estancias) y
• Tract 26769 (Mountain View Estates)
4. Prepare an engineered grading plan that provides for building pad grading in
accordance with the existing soils report and tract grading plan, and have it
checked and approved by the Public Works -Department.
• Tract 28034 (South Valley Estates)
FOR INTERNAL USE BY PUBLIC WORKS DEPARTMENT
TRACT: 2 51;�6 7
L
TION
- - F:IPWDEFnDOCSIFFORMS%PW CLEARANCE LEI'TER.ts
COMMENTS: I
JOSEPH N. CICCHINI, P.E.
CIVIL AND STRUCTURAL ENGINEERING
P.O. BOX 4206
PALM DESERT, CA 92261
TEL: (760)-776-6687
December 16, 1999
The City of La Quinta
Department of Building and Safety
78-495 Calle Tampico
La Quinta, CA 92253
RE: Griggs Residence
52-590 Del Gato Drive
Gentlemen:
This is to confirm that the structural portion of the construction work performed on the
single family residence was found to be in substantial compliance with the plans
prepared by Joseph N. Cicchini, P.E.
Sincerely,
9SEH N.
JNC/sel
)/, L j- - t' �__
CICCHINI, P.E.
DAPROJECT\GRG2_19\OFFICE \griggs
�oQ�,oFESS/Q
7N. C C'.
C.,
CZ,
NO. 35727
�x�i2eS
J?A v
:�.'v
:C:A:L:IFF ®��
Certificate of Occupancy
Cifftybf 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 'fol/awing:
.BU.ILDING ADDRESS:-. 53-180 DEL GATO DRIVE
Use'Classification: SFDBldg. Permit No.: 9909-254
Occupancy Group: R 3 .Type of Construction: VN Land Use .Zone: RL
Owner of Building: DOVE/NEUMEYER/BAIRD
Building Official
Address:
By:
STEVE TRAXEL .
Date:
01-25-01
POST IN A CONSPICUOUS PLACE
i
FEB -28-2000 03;00 PM YOUNG ENGINEERING 760 342 6164 P.02
4: Y
YOUNG ENGINEERING SER VIUES
47-159 Youngs Lane, Indio, QL 92201 (760) 342-9214 (760) 342-6164
February 28, 2000
Tom Hartung
Building Official
City of La Quinta
Re: Dove/1Veum6er/Baird Residence -53-180-Del Gato, lWe Traditions, La Ouinta
Dear Tom,
We have reviewed the framing for the above referenced project and find it to be in general conformance
with the approved structural plans with the exception of the items listed below:
• . Shear wall 44 at the Garage - Stab bolt threads stripped, re -move and replace nut and rethread
stab bolt.
• Shear wall #23 = Scab on a 2x6 stud w/2 -16d staggered at 6" o/c next to damaged stud. Scabbed
on stud need only reach the blocking adjacent to the header._
• Shear walls #33 and 34 were to be double sided shear walls type "B". Sheathe un -sheathed side of
shear wall #33 per shear wall type `B" panel. Shear wall #34 - Nail shear wall per type "D" panel
(SW #34 one-sided type "D" panel).
• Sheathe exterior rear wall of Great Room per type "A".
If you have any questions please call.
Sincerely,
QapfESS/0
Jeffrey B. Young S.E.
/A. No. x044 yG
u
�^JON TANDY
37630 Medjool Ave.
s�QF�P�alm"Desert, CA 92211
Office (760) 772-7192
SPECIAL• `' 4. Fax (760) 772-7193
REGISTERED INSPECTOR'S WEEKLY REPORT Pager (760) 776-3338
TYPE OF
INSPECTION
PERFORMED_
❑ REINFORCED CONCRETE ❑ STRUCT. STEEL ASSEMBLY ❑
❑ POST TENSIONED CONCRETE ❑ ASPHALT ❑ OTHER
❑ REINFORCED MASONRY ❑ FIRE PROOFING
JOB LOCATION3— I ^ 1 �j +�� �• LA QV `o\ -T f
l(,`/ l-- a eJ
REPORT SEOUENCE NO.
TYP FLI UREJ
��d\� G
PERMIT NO.
DATE
DAY OF WEEK
MATERIAL DESCR TION^ /L
1G'L
ARCHITECT
INSP TOR
MRS. CHARGED
ENGINEER �ou
+^ cj
`
ASSISTANTS
HRS. CHARGED
INSPECTION CO TRACTOR `(i�1H Ti)" J- i N 1- CONTAACTORV
DATE Lo't4t. S �
w o kbcrA C 064 CO(S--
o �a
"Fe .2L(n LJJ U,40i" �s
. S x i 0 To
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1-0 W(c) q -S God • S - � � �-� '
t ' � ee..•� � ri � Cows- l�.e.
COPY SENT TO CLIEN
CONTINUED ON NEXT PAGE 0
PAGE OF
CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MY
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.
' IGNA RE/ OF REGISTE INS61 -Tza PECTOR
4����
O E OF REPORT REGISTER NUMBER
3A. -O
Job Kne:�-�—
C.
S3 FABRIC= AEFORT Been Late:
.rob No.*'
Fab. am lily a(E.S. and ate •
*Materials and weldments conform to plans and specifications and AISC, and AWS Dl.l
Shipping Mark
905 SHEL
Special Deputy Insp.
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Special Deputy Insp.