0201-107 (SFD)LICENSED CONTRACTOR DECLARATION
U) I hereby affirm under penalty of perjury that I am licensed under provisions of
H Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
N W Professionals Code, and my License is in full force and effect.
7) , License # Lic. Class Exp. Date
4'i`]29.4 C•$1 B' 3 0813112(
Date< a �7 n—T Signature of Contractor
v -
r
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.
(� ).,e_1 ave and will maintain workers' compensation insurance, as required by
S etion 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 y�+ p •�,y����y Policy No. 15745432
N.gdg g�
StA1,173`i6✓:•71.x, 1d 45432
(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
Code, I shall forthwith comply with those provisions.
Date: » Applicant ' `rA /
$'�✓i i'
tip .:,tea, J , rw-
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for inISection 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made &each at
whose request and for whose benefit work is performed under or pu
any permit issued as a result of this applicaton agrees to, & shall, i ify
& hold harmless the City of La Quinta, its officers, agents and em a s.
2. Any permit issued as a result of this application becomes null an of if
work is not commenced within 180 days from date of issuance f s
permit, or cessation of work for 180 days will subject permit to:canc llation. C!
I certify that I have read this application and state that the above inform I
correct. I agree to comply=with 911 City, and State laws relating to=the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned
pr
,op.,5y forJnspectpn purposes. ✓ i'� --
Signature (Owner/Agent) Date `
BUILDING PERMIT 'PERMIT"-
DATE VALUATION LOT 07,C)I-1t TRACT
99 2886
JOB SITE$ , r "-
APN
ADDRESS
534W DX,, G TO UA
'Till• :' 'StD�Ll2k
OWNER
CONTRACTOR/ DESIGNER/ EN INEER
D.N.B..A030CL.a; i 8
i'd'dfil.`1,ES X!`M. &, SUPPLY
'72-925 �'i�ws`\mo, #204
X35-"aZ4 :t�G-14WEMEXT
PATIA pit:, ° IRT CA 92260
INDIO CA. i*20
(760)341d3401 CBL0 00,263
USE OF PERMIT
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p{1p Wt�, /f��y�p; t�ypgy
S171)1#10111PSA j �e�U«Y.iY.i4.�6L\...�rVLttS AY .1,S1,P00.'i�{.sTUVXeV�AY
APPRCtiAMMOMMAAMPWITH .W.,MOIA, & 0'a`A` R TXMs SNCLiliJJiI KI
THE lrhl'L9A:dt}L><"'LLM SPR—CIM ACT OF 392.3 IF ACPLICM414IS REQUlitbM
MAITOM C0*918TRUi;T101H 6,194.00 Or,
POP.+,,.H&A. t'10 465.00 SP
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i��i M roc} ���>� ���� a �•� �►,s��-� »°a�a� ��.��.�
� .
PLAN C:kiit.'•CK.ME 101-000439-318 S1,699.r9
FSE DFIP( UIT 191^000.439.319 41;250M
M'i�.;CHAMC.A.L. PLO?, 101-000-421<000 S32 m
SJACTMCAL,'FHE '161,!,00`s? 420t -0 0 413" 2;s
PlIUMBi1' Q F'1rz; 1' O t- 1i1G?�°E 1 •Qiii3 374.E
a
M.ORO MOTION DBE's - RE,TID 101-000-241400 003
O AD1?443 "M :: 141••0062-423-00EI $24.tin
AM IN :P•USLIC i� IACES -1tE7= 2170.000.445-000 So.83
Y
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) cFp
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U 2 902 LIMB PRE -PAID `�
-$).250.00
� $1 °250.00
I'C}. m.17 r • Nffr 2 Ztl 1; DOE .t�'OW
56,14€2.79
®F it��ltll �
r:V„•.
RECEIPT
DAT}E•(//
BY
EF A/IJED/A//S�
INSPEC R•'"',?ea
//J//
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
62J 2- $
Exhaust Fans
O.K. to Wrap
Framing
- (, ,—/
F.A.U.
Compressor
Insulation
�6 -
Vents
FireplaceP.L. CS
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final _
BLOCKWALL APPROVALS
POOLS - SPAS
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
J� ��
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
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL PPROVALS
Temp. Power Pole 7p t_-,
Underground Conduit
Rough Wiring
Low Vottage Wiring
Fbitures
Main Service
Sub Panels
Exterior Receptacles.
G.F.I.
Smoke Detectors'
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
`.
_.
Desert Sands Unified School District
47-950 Dune Palms Road
Notice: La Quinta, CA 92253
Document Cannot Be Duplicated 760-771-8515
Date 3/20/02
No. 23062
Owner NameD.N.B. Associates
No. 53-480
city La Quinta
CERTIFICATE OF COMPLIANCE
Street Del Gato Drive
APN# 770-350-021
Jurisdiction La Ouinta
Permit #0201-107
Log #
Zip 92253 Study Area
Tract # 28867 Lot # 99 Square Footage 6194
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
2.14 X 6,194 or $ 13,255.16 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 - Rick Miller Telephone
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by
Signature
Juanita Green
Payment Received $13,255.16
Check No. 105053
NOTICE: Pursuant to embly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified
above will begin to ru f m 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 I
collect them on the D. rict('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
- Mc GEE, SUR VEYING, INC.
73-301 Country Club Dr., Ste. 102 — Bermuda Dunes, CA 92201
Phone (760) 345-3828 — Fax (760) 772-5705
April 10, 2002
City of La Quinta
78-495 Calle Tampico
La Quinta, CA 92253
Re: Pad Certification — Lot 99, Tr. 28867
w.o.# 2438
Pursuant to your request a field survey, was conducted on the above referenced project to
determine the vertical location of the building pad. The above mentioned was found as
follows:
LOT ADDRESS PAD (DES) PAD (FIELD)
99 53-480 Del Gato 148.0' 148.0'
SNP
SinJ.cGee
�`���E
L3 5479
a
o¢ -
L.S. 5479
F �
08/08/2002 0B:32 7603426164 YOUNG_ENGINEERING SE PAGE 02
YOUNG ENGINEERING SERVICES
47-159 Youngs Lane, Indio CA 92201 (phone) 760-342-9214 (fax) 760-342-6164
July 3, 2002
Tom Hartung
Building Official
City of La Quinta
La Quinta, Ca.
Dear Tom
We have performed Structural Observation per U.B.C. section 1702 for the above referenced project and
find it to be in General Conformance with the approved City plans and calculations. Please note that this
letter does not relieve the City or the Special Inspectors from determining compliance with the approved
plans.
Very truly yours,
Young Engineering Services
Jeffrey Bronz Young, S.E.
< r
JON TANDY
37630 Medjool Ave.
Palm Desert, CA 92211
Office (760) 772-7192
SPECIAL IN' • Fax (760) 772-7193
REGISTERED INSPECTOR'S WEEKLY REPORT Pager (760) 776-3338
TYPE OF
INSPECTION
PERFORMED
O REINFORCED CONCRETE O STRUCT. STEEL ASSEMBLY
O POST TENSIONED CONCRETE O ASPHALT
O REINFORCED MASONRY O FIRE PROOFING
O
O OTHER
J08 LRC�N
O e� � , A `
REPORT SEQUENCE NO
TYPS Pj!' RE
LO -F
PERMIT NO.
DAT OIL- AY OF WEEK
MATERIAL DESCRIPTION
.� / _�� S _�
,F1/
ARCHITECT
jQ,._ HRS. CHARGED
",SK.
E 0l
ENGINEER
ASSISISTAN\TTS MRS. CHARGED
INSPECTION
DATE
GENERAL SUB
CONTRACTOR CONTRACTOR
S Ib�
-WA G (ZO 84 '1'iV-1
s� jp � o � 0%
E -Q- t-- �' -
w 16 Y -3
I
o -t'w0
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Coin
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COPY SENT TO CLIENT ❑
CONTINUEN NEXT PAGE ❑
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
N T RE OF REGISTERED INSP T
DITE OF REPORT REGISTER NUMRFR-��
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