0005-004 (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 ,+7 Exp. Date
7407745 13
Date Signature of Contractors
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.
1
(�)/'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 P14i3E11RNITY INS. OF. Policy No. 690947659
(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 ofi Section 3700 of the Labor
Code, I shall forthwith comply with those provisions`
Date: Q C c ; 5 Applicant ` 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.
--glow 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
F 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 pu'rposes.. L
Signature (Owner/Agent) A` A -?'=r t%I� �r..''Y Date
BUILDING PERMIT PERMIT#
DATE tt i VALUATION LOT 0005-004 TRACT
rt 9317,127.70 2 24890-4
JOB SITE
ADDRESS 78-940 CrMUSt
APN
OWNER
CONTRACTOR/DESIGNER/EN (NEER
CAMAJ, Pfi CRAC MONM WC
CAIWAL laACSIC HOES INC
411150 MAC. A-R`iT-WR BLVD #200 .
4100 EAC Alt;11i'i R BLVD #200
.migimJ?0u FF.AC':Z✓T dA 92660
2EW.PUXt" BEACH CA. €2660
i
(949)622-8400 � 1503
'
{
USE OF PERMIT {
MNO.LL; FAMMY DVMLL.;11 G
SAD • PFiiM1T DOES NOT INCL1IM BLOCK IVAL.l. /POOLiSPAIDRIVEWAY
APPROA.C14 .
CJRTOM CONSTRUCTION 3,W.00 OF
PORCHPATIO 96.00 sr
CAMOEICARPORT (s% 13,053,60
f
Y',hr'L',�IATED C u E' OJT' C°-ONSMv "J.C?1'3
317,127.70
COIN6TRUCT1ON FEE 101-000.418-000 $1,402.50
Plw,.A CHECK IEEE 101-000-4.39-318 so 3p-' -26
PTY, DEPOSIT 101-000-439-318 -$751.00
MECHAN1€'AL ffZ 1.01-000-421-000 $52.00
ELECTRICAL FEE 101.000«420-000 $210,87
PLUDADINO P'Ep 101.011?CD-419-000 $225.00
STROM MOTION FEE - MUM)) 101.000.241.-000 531.171
C1R.ADING9 FEE 101.000•-423-000 $$20.00
DEVELOPER IMPACT KE $1,907.00
.AUT 111 PUBLIC PLACES - R11 IE 701-000µ2S5-000
(XII-3;'C)TAL C0MMUMION AND PLAN MMM.
$5,124.16
LE -33 :PRE-�PAED V10.9
-4V;50.60
TMAVM 1wtAW 101MI :SDI VO1+4i
$4,574,16
1 i
RECEIPT
DATE { j �I
BY 1
DATE FINALED
INSPECTOR
�
ir,f,
.1 f
W
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings(1
' (gyp
i j i
Underground Ducts
Ducts
Slab Grade
GcJ
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
— Q (
F.A.U.
Framing
Compressor
Insulation
/ O
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
U' " fi - (:.X-) L L _
Heater Final
Water Piping
_
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 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:
4r CITY OF LA QUINTA
BUILDING & SAFETY DEPARTMENT
Fnr gF'I,,�.p
777-7012': `
INSPECTION REQUEST LINF',
777-7153
Owner CAPITAL PACIFIC HOMES INC... Y µ
ContractorCAPITAL PACIFIC HOMES INC
•
Permit Number 0005-004
_ _
POST ON JOB IN CONSPICUOUS PLAC'
INSPECTOR MUST SIGN ALL APPLICABLE SP,"-."."ES78-940 CITRUS
_
FD A PERMIT DOES NOT INCLUDE
POOL/SPA/DRIVEWAY APPROACH
TYPE OF INSPECTION
DATE INSP.
FOUNDATION & SETBACK
(i
FOOTING STEEL
MAIN GROUND SYSTEM
"
GROUND PLUMBING
17o 70. Uz►
PRE-GUNITE
i
DO NOT POUR CONCRETE.UNTIL ALL ABOVE HAS BEEN SI NED
CONCRETE SLAB
_
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BE_,. :GNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST
_
HEATING & VENT - A/C
FIREPLACE
ROOF
/2-- _ : �—
BOND BEAM
O.K. TO WRAP
-
GROUT ❑ 4' ❑ 8'
FRAMING
INSULATION •
' r.
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNr"D
DRYWALL INTERIOR G
EXTERIOR LATH ( G
POOL PRE PLASTER _
POOL FENCE & GATE
SEWER SEPTIC TANK
FINALS
ELECTRICAL L
PLUMBING
FINAL GAS TEST j
HEATING • A/C
HOUSE NUMBERS 1.
JOB COMPLETED
TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UT!L!TIES OR OCCUPY BUILDING
61
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 following:
BUILDING ADDRESS:
Use Classification:
Occupancy Group:
SFD
78-940 CITRUS
Bldg..Permit No.: 0005-004
R3 Type of Construction: VN Land Use Zone: RL
Owner of Building: CAPITAL PACIFIC HOMES INC Address: 4100 MAC ARTHUR BLVD #200
City: NEWPORT BEACH' CA 92660
—"� By: KIRK KIRKLAND
Date: 6-13-01
Building Official
POST IN A CONSPICUOUS PLACE
CITY OF LA QUINTA
PLAN CHECK CORRECTION LIST
Pekarek Crandell Inc.
31872 Camino Capistrano #100
San Juan Capistrano CA. 92675
PLAN CHECK NO.: 0005-004
JOB ADDRESS: 78-940 Citrus ( Plan 1 Lot 2 )
AREA-S.F.- : 3887/ 666
OCCUPANCY
August 4, 2000
APPROVAL
R-3/TJ-1
TYPE-OF-CONST.: V-N
The submitted plans and specifications have been reviewed by VANDORPE CHou ASSOCIATES. It is
our professional opinion that the plans are in substantial conformance with the building codes and
regulations adopted by the CITY OF LA QUINTA and the State of California Amendment.
APPROVAL FOR A BUILDING PERMIT IS HEREBY RECOMMENDED SUBJECT TO OBTAINING
APPROVALS/CLEARANCES FROM ALL APPLICABLE CITY DEPARTMENTS, AGENCIES, AND
ASSOCIATIONS.
Plans checked by:
VANDORPE CHOU ASSOCIATES.
295 N Rampart Street, Suite A
Orange CA 92868
(714) 978-9780 VCA File No. LQ-11995
1
r
rQrl
Building
Address
Owner
;1
Address L`
City
o
P.O. BOX 1504
78•495 CALLE TAMPICO
CI-41 LA QUINTA, CALIFORNIA 92253
,f z
13IL�ld
Zip / a Tel.
: A
-7 / v / : y// `
Contractor
!�,/4 A,y � I
Address
ty I IZip `• ITel.
State Lic. City
& Classif. � � 7 y5 Lic. #
Arch., Engrg
Designer I' 4k bn e// I V`
Address Tel.
V.? 5ta q 9 W - 11 %-
City Zip I -1 State
L) A/1 l /% �I �� r +�� / Lic. #
PC LICENSED CONTRACTOR'S DECLARATION
I herebyy alfftm that I am licensed under grovislons of Chapter 9 (commencing with Section
700M of f]Ivislon 3 of the Busine5h and PrQfasslons Code, and my Ilcense is In full force and
SEGNAruAE DATE
OWNER -BUILDER DECLARATION
I hereby alarm that I am exempt from the Contraclor's License Law for the following
reason; (Sac. 7031.5,Busine5s and Pralassiana Coda: Any city of counly which requires a
perrmr to consln r, allor, improve, damarrsh, at repair any 5Ifucture, prior to Its issuance also
,sgwles the applrcant (or tuch peranv in ho a slQned statement that he is licensed pursuant to
rho provisions of rho Confracfor's License Law. Chapter 9 rcorntner0rlg with Section 7000) of
blvismon 3 W rho Business and Professions Cade, of that. he is exemof fheralrom. arrd the basis
lot the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit
subiecls the applicant to a civil penalty of not more than five hundred dollars (S500I,
I ) I, as owner of the property, of my empfayaes with wages as their sole compensation, will
do the work, and the structure is not intended or offered for safe. (Sec. 7044, &uisness and
Professions Code: The Confracfar'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,)
I I I, as owner of file pro pery, am exclusively. contracting with licensed contractors to con-
atruct the prefect. (Sec. 704, Bumass arrd Prolessions Cade: The Contractor's License Law
does not apply to an owner of properly who builds dr improves thereon, and who contracis for
such projet Ps warP a ccnlrac For(s) livens ad pursuant to the Contrarlw'45 Licermse Law.J
11 1 am exempt under Sec. B. & P.C. for this reason
Date
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
[7 Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need nor be completed if the permit is for one hundred dollars ($100) valuation
or less.)
I 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: W. after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions o/ 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 Namb___
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration it 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 cily and county ordinances and state laws relating to building
conslrualion, and hereby authorize representatives of this city to enter the above -
mentioned properly for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
APPLICATION ONLY
BUILDING: TYPE'CONST. OCC. GRP.
A.P. Number I�2 ��� —d)
legal Description" -
Project Description
/;
Lii �f
Sq. Ft. j lyi No. No. Dw.
Size - -) 7' Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
A GT = G [.',(Al S
1 g-,D7? _0 yq7 k Al
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal,
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
ik
TOTAL
REMARKS
6" :_`t
LA
ZONE: BY:
Minimum Setback Distances:
Front Setback from Guenter 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
Val
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
Notice:
Document Cannot Be Duplicated
Date 9/19/00
No. 20999
Desert Sands Unified School District
47-950 Dune Palms Road
La Quinta, CA 92253
760-771-8515
CERTIFICATE OF COMPLIANCE
Owner NameCapital Pacific Homes, Inc.
No. 78-940
City La Quinta
Tract # 24890-4
Street Citrus
Lot # 2
Type of Development SFR Mitigation
Comments
is in the Citrus at 3887 sq. ft.
APN # 772-101-002
Jurisdiction La Ouinta
Permit # 0005-004
Log #
Zip 92253 Study Area
Square Footage 1
No. of Units 1
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:
Under Mitigation Agreement
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to Mitigation Agreement in the amount of
628.00 X 1 or $ 628.00 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 & Co. / Mark Mullin
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Annette Barlow
Signature
_
Telephone
Payment Received $628.00
Check No. 0643003102
IOTICE: 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 fees or other payment identified
base 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
❑lleci 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