0310-182 (SFD)U)
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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
BC ./'3112(
Date_T_
f 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 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 EXEMPTION ON FILP Policy No.
(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 rovisiog)s. `
/Date: � , . d` Applicant4-aI'd, 'f JP _ rC�i�- de
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 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 r,pu poses.
Signature (Owner/Agent: Ih t l e C/¢'a f/� Date J r' t
BUILDING PERMIT PERMIT#
'
DATE VALUATION LOT TRACT
Y ROtB.J(i 1 R LC1r i
JOB SITE
ADDRESS 49-3.15 . VEP10A. F.r;1Z1gATfD0
APN
6 3-23?I% i1iB7
OWNER _
CONTRACTOR / DESIGNER / EN (NEER
ana 801M
ACX CI ARK GrAM'L CONTRA i?
P.O. BOX 1944
51-220 AVENWA CAi2.R.A•NGA
LA QTJMTA CA 92253
;A QCiWfA CA 92253
(760)564.3511 CSU 1115
USE OF PERMIT
SI�1'C3E3°, PA�� I�i�l;:1. L.I�J•(.�
4023 SF. SfeD PERMIT DOES NOT INCLUDE, BLOCK W.A.L4 Pt?Q.L,%SPA OR_
ORNiE'WAY APPROACH
CUSTOM CONSTRUCTION 415615,00 SF
PORCRIPAT'IO 837.00 Sip
t7&11.t WC;ARPOR i`T' 704.03F
X61W iM) C:OST OF C43NS:CRUCY'.((>N'
M Ria 00
FRE RUATMARY
CONSTRUCTION FER 101.000418.000 $1,633,00
PLAN CHECK FF.9: 'I01-000-439.318 SI,293.29
DEXPG' IT 1€51.000.439.331 s -$1,000,00
I1WLCHANICA L 1??,F 101-0100.-421-000 $103.00
ELEC;TMCr L 1,111E 101.000;4-2,9.000 $229.39
PLUtdIBIN63 FEE 101-000-41.9-000 $210,00
STRi?NO MOMN rw Passau 101 %000-241-0003 338.09
OItAi INO IP99 101-000-42;3-000 $13.00
DEVELOPER 11APAC:T .FLE 12.405.00
Pkur-ISL PLkw 101-000-441-345 $100.00
ART D4 PUBLIC PLACES - ROME Z70-000-445.000 $4,12,22
c
&1UB '. 0TAI, CC NMI UCTI01;AND P3<.. k; CHECK
$16,471,49
LESE PRY! PAIDrf1X.S
-si,600.00
'1'C3'X'I�'f.P. 11�Ci' MS DDE .t!lo1A►
Z,472,49APR
0 5 2004 �6
.J
C;17Y OF LA QUiN CA
FlwA- CE DEPT.
Jt t
RECEIPT
DATED/ •,t
By',
DATE FINALED
INSPECTO
I !
OPERATION
DATE
INSPECTOR
OPERATION.
DATE
INSPECTOR-
NSPECTOR.BUILDING
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
-Y
Ducts
Slab Grade
—
Return Air
Steel
—
Combustion Air
Roof Deck
2r _2r9 — y
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 — -
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
—
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Literal
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
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)
COMMENTS:
Building�/� / --�33,
I Address/(^ " x � ,4yc j/P
Owner
/Vr• $- Mrs. Care
witviiii 4 4 "
P.O. BOX 1504
78-495 CALLE TAMPICO
�2iVSQN1�Q LA QUINTA, CALIFORNIA 92253
R. Solis ,,,
Mailing
Address ��• app(' 4
• City Li Zi el1 2-L Tel.
.LC�IM 0l -
Contractor
Address
ko l -#(,+o Av-cyv Aa �Y11QN O
Cityi•-a Q.UW►etA Zipl,2Z S Tel. —C
State Lic. City
& Classif. 0-0 Lic. fit
Arch., Engr., a M %1'e #461 s 1
Designer
Address
•#'b04- Geoff !la b r. � �- Tel.
77q - 54 9
City ('�fit.p t�ea6t IZIP1�sW0 (State I
i'� �i Lic. q
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
effect.
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors 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
fhe 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 thealleged exemption. Any violation of Section 7031.5 Dy any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
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, 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 improvements are not intended or offered for sale. If, 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.)
"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 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.)
it 1 am exempt under Sec. B. & P.C. for this reason
4
Date Owner
WORKERS' COMPENSATION DECLARATION
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.
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.)
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.
Date Owner
NOTICE TO APPLICANT: It, after 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
Ihereby 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
This is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certify that I have read this application and state 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 sof this city to enter the above-
mentioned property for inspection purposes. ())..
Signature of aQplicant S16Le.l4s- DateJXt— J
Mailing Address
City, State, Zip
03l o- 18�,
APPLICATION ONLY
LDING. TYPE CONST. _OCC. GRP. P, 3
Number 64 1 ge) — oei7
al Description 47 y11 4"P40V 472TES
ject DescriptionilI / 1F IA0711Y D06_111^1
Sq. Ft. No. No. Dw.
Size oa3 Stories Units
New ❑ Add O Alter O Repair O Demolition ❑
Estimated Valuation
PERMIT A OLINT
Plan Chk. Dep.1
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
IE Side Street Set -back fro��Anter Line
Side�Setback.fY6— ooe , vVLine
FINAL DA
Issued by:I Date
Validated bv: ___ CITY OF –A QUINTA
_..._ ___ ___sT4
Validation:
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
Comments Overpayment of $913.20 to be issued as a direct pay and mailed to: Jack Clark General Contractors,
51-220 Avenida Carranza, La Quinta, CA 92253
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 (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile
homes. It has been determined that 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
Education Code Section 17620 and Government Code 65995 Et Seq.
in the amount of $2.24 X 4,566 ' S.F. or $10,227.84 have been paid for the property listed above and that
building permits and/or Certificates of Occupancy fo this square footage in this proposed project may now be issued.
Fees Paid By OC/EI Paseo Bank - Jack C rk Check No. 435814850
Name on the check Telephone
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Sharon MCGllvrey 1 Payment Recd $913.20
ti
$11,141.04 Over/Under
Signature C
NOTICE: Pursuant to Government Code Section 66020(d)(1), this will s e to notify you that the 90 -day approval period in which you may protest the fees or
other payment identified above will begin to run from the date on which the building or installation permit for this project is issued, or from the date on which
those amounts are paid to the District(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
09/17/2004 02:32 7603403728 ,
GLS GROUP PAGE 01
Ard techm lntolom, Space aW Lw1 PhMng
Structural CalWatiom
14 September 2004
The City of La Quints
Department of Building and Safety
78495 Calle Tampico
La Quinta, CA 02253
Project: Solis Single Family Residence
49-335 Av,�a Fernando
La Quinta, California
Regarding., Project 4b servation and Field R n dsions
To Whom it May Concer n,
1 have visited the nobs xoject site to perforin code required structural ob.ammUons. At that time
I noted only minor biodd ng, nailing and strapping issues that were resohmi at the time of my visit
Some of the4 Specified STHD14's were observed to have their embedded hooks bent flush and
exposed at the side of the concrete founde 3n. The general contractor was directed to apply
HTT2Zs to the existing foaming as per the attached detail. The remedial detailing has been car-
ried out and therefore, I hereby state that the project's structure is in substaal. ial confbrMnce with
the structural design inb!nt as represented in the construction documents and structurel design
calculations.
If you have any furtiher c uestions or c ommenU regarding these issues or ;wy other issue please
do not hesitate in contac ing my firm.
Charles 0. Garland
I
744% Me Way, Susu to 5 Q M 30M o Faclk 4 (M) 34NTA
,- Certificate of Occupancy
Ce -�
4
C OF9. 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: 49-335 AVE FERNANDO
Use classification: SFD Building Permit No.: 0310-182
Occupancy Group: R-3 Type of Construction: V -N Land Use Zone: RL
Owner of Building: GREG SOLIS Address:
City, ST, ZIP: ' PO BOX 1944
By: G. SHOWALTER
�d Date: 04/15/05
Building Official
POST IN A CONSPICUOUS PLACE