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9810-015 (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 Exp. Date 4230.12 B / 5131100 �Da e t t 1 Signature of Contractor's { ' 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 Policy No. JNICARE IN CO. S1P50.01�-.-15710 (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 subjectlo the workers' compensation provisions of Section 3700 of the Labor Co e, I shall forthwith comply with those provisioner~ pate: + _ '� ' �L �Applicant Warning: Failure to secure Workers' Compensatlo overage 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. l,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. ignature (Owner/Agent) / r Date-! t BUILDING PERMIT PERMIT# , /,1�'15 DATE VALUATION LOT TRACT 11 r 25, qg S 42'1,471RO 39 28470-1 JOB SITE ADDRESS 52-100 +<..i'4'A7'iR N COUR APN ?��1«I62-titi.3 OWNER CONTRACTOR/DESIGNER/ENGINEER RAYMOND 14 & BARBARA LOS[ DE Wi'111" C:C,?N!� j RCT ON .INC ` (76( 773-4764 CT3i.#` 14%, USE OF PERMIT "NOLE %°FiM.0 .I -WELLINC; ��FtJ -1'ERIVST DOFsS NOT fNC---T()D.E %3t.O'3-! A•LL OR I>OOL CUSTOM LOiNISTR:UCVOitil 4,996.00 3F PoRCk1/PX IO 1,026,00 SF GARAGE/CA'ili'OXY 931.00 S1: E.S7'Ilt'1A ED COS' OF C'O.�dSTPZUC'I'a IN' 421,473.34) I'%ItMIT .FEE SNUNi'MARV WNSTHWT RYN FfE 101-000-418-000 S1.76CM W,AN(.14E s,; FE -13 101.-0W- P-3!9 $1,40.58 FEE DEPOSIT 101-0190-4139-318 -$1,000.00 M1;.C.1bkN1CAr. FLE 101000-411-000 S169.0 aEC'TRICAL FES 101 -000 -*420 -OW $292.88 PI,i.TNIIIINO rEv 101-000-414410n $272.'1 Sl'TS.L 1401biC''TION rf-ZE - RL S10 1,014)00-241-000 $4z 15 C;WWANc7FEE 101-000-4.+'3.000 520.011 1N1FRAfFfX(iC'!;'URI±: k'F2X 22`*000-443-3 42 Sfi,1!OO.C►0 A T IN tyIM1,1C, PLAC YS - Ott~Si.I 7N -tK1(1-2:55-000 14 68 , j , ` USS PPT, d -PAID FEES -$1,000.01) NOV 2 1998 ., OTAL PFIRN11T F E S OVE NNO v),xaw ±� RECEIPTT i ,. DATE BY uzw DATE FINALEDINSPECTOR 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 A— Exhaust Fans O.K. to Wrap F.A.U. Framing Compressor Insulation — Vents Fireplace. P.L. Grills Fireplace T.O. Fans & Controls Party Will Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall -'Int. Lath C — Final Final 6 'BLOCKWALL APPROVALS steel POOLS - SPAS 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 Lateral Pool Cover Sewer Connection // -Encapsulation Gas Piping Gas Test Appliances ZWK 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) COMMENT G V 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 11/25/98 No. 18047 Jurisdiction Owner NameRaymond H. & Barbara Losi No. 79-353 Street Montego Bay Dr City Bermuda Dunes zip 92201 Tract # Lot # Type of Development Single Family Residence Comments APN # 769-162-001 La Quinta Permit # Log # Study Area Square Footage 4996 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 mob'ileh'omes. It has been determined the above-named owner is exempt from paying school fees at this time due to the following reason: .L . N� EXEMPTION NOT APPLICABLE �r This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of 1.93 X 4,996 or $ 9,642.28 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/Palm Desert National Bank/Rayond Losi Telephone Name on the check By Dr. Doris Wilson Superintendent Fee collected /exempted by Olivia Aguirre Payment Received $9,648.28 n Check No. 74296 Signature NOTICE: 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 above 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 collect 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 jo►�' 'ca � cz V S OF THS Dear Builder: Prior to issuance of a building permit, you -will be required to obtain Public Works Department approval for one of the following: 1. Verification of pad elevation by a licensed surveyor or engineer. 2. Engineered grading plan for project requiring on -lot retention. Tract #26524 (Estancias) Tract #26769. (Mountain View Estates) 3: Verification that the building pad has-been graded and compacted in accordance with the soils reports, and tract grading plan. Tract #28034 (South Valley Estates) Public Works Authorization- L&r S9, I -AcT G'4 -100 CfTAT ,o� T c:PWauth.ltr/da 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: SFD Occupancy Group: R 3 52-100 CITATION COURT Type of Construction: VN Owner of Building: RAYMOND & BARBARA LOSI Building Official Bldg. Permit No.: 9810-015 Land Use Zone: RL Address: 79-353 MONTEGO BAY DR. City: BERMUDA DUNES, CA 92201 By: STEVE TRAXEL Date: 10-29-99 POST IN A CONSPICUOUS PLACE 1JA�� 2 JON TANDY ��. ftV37630 Medjool Ave. 8U/Lo11VG,4e6�v Palm Desert, CA 92211 oniOffice (760) 772-7192 INSPECTIONFax (760) 772-7193 Pager (760) 776-3338 REGISTERED INSPECTOR'S WEEKLY REPORT TYPE OF INSPECTION PERFORMED ❑ REINFORCED CONCRETESTRUCT. STEEL ASSEMBLY ❑ POST TENSIONED CONCRETE ❑ ASPHALT ❑ REINFORCED MASONRY ❑ FIRE PROOFING ❑ ❑ OTHER JOB LOCATION !'A_ ,0 T (f N CQvceX- LA (2'�) ; �� A 1 ( REPORT SEQUENCE NO. TYPE OF STRUCTURE r0 L®5i des Lam, �_ PERMIT NO. gyp- OtS DA E -�-q`j DAY OF WEEK MATERIAL DESCRIPTION _ . �+ D ARCHITECT��� Af VNSPEC HRS. CHARGED ENGINEER S ASSSSTISTANTS f HRS. CHARGED INSPECTION DATE GENERAL" ' t, CONTRACTOR = -@ �C/ i � CONTRACTOR �/ 4 C T12�5 �� Z �-� 5 Lc�l� S^ 1i� F to 0 s N e e --z-(- w- ��s s io b C� S w e -L vo irJjje-c-cI- S l' -{••c w e' (Ann -S '-S -(u 0 S TO -S&O p c.-X-&-z1-w 6-- , co L• ' F� e,3&. a4- 14.S t A�a 0 fit? u. o COPY SENT TO CLIENT O rzov,INUED ON NEXT PA ❑ 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. — ( ll SIGNATURE OF�EGISTE D INSPECTOR q'),� DATE OF REPORT REGISTER NUMBER J November 17, 1998 To: Building Department La Quinta, CA Dear Sir: Subject: Losi Residence, in Tradition Club Truss Calculation review 6362 LA JOLLA BLVD., LA JOLLA, CA 92037 TEL: (619)459-5665 Per your request we have reviewed the truss calcs from Spates Fabricators and they are in general our Specifications (live load 16 psf, dead conforms with the structural plans approved by the City, load 24 psf and def. Limited to 1/400) and UBC 94. Please call us at (619) 459-5665 if there is any question. IRT�' _ � w0.�R® � •fie( ��' Sincerely S38 Exp.3-314' f Mehrdad Hemmati S.E.s, Sri,,, T,}1 Cc: Thomas j an -w ay AlA 2151 W California Street San Diego, CA 92110 z-tao CrgI G7 4) 6362 LA JOLLA BLVD., LA JOLLA, CA 92037 TEL: (619)459-5665 January 15, 1999 To: Building Department La Quinta, CA Dear Sir: Subject: Losi Residence, in Tradition Club Truss Calculation review Per the contractor's request we have reviewed the scissors truss(34 foot span) calcs from Spates Fabricators and they are in general conforms with the structural plans approved by the City, our Specifications (live load 16 psf, dead load 24 psf and def. Limited to 1/360, deflection= l.1") and UBC 94. Please call�us:�at�(619) 459-5665 if there is any question. Sincerely; Mehrdad Cc Thon 2151 San T Building S2 - /b0 T4t4t " P.O. BOX 1504 78-495 CALLE TAMPICO Q -T LA QUINTA, CALIFORNIA 92253 Mailing I Address — City Zip Tel. Contractor ,-, 11 Address 7 City Zip Tel. b 1'13 - U State Lic. City,. & Classif. i .n -12 ,....� �, Sl II Lic. # Arch., Engr., Designer '" NA 3 \ V1'CA�-., Address Tel. City t Zip I Stater - C% 3 C11.\ \ Lic. # C k 16 LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter (commencing with Section y 1 7000) of Division 3 o1 the 8 ' ss and Prof"ions Code(and'my license is in full orce and effect j.�.G-.." .-/.�;,�• �.l%o`� �o /� � 9 A SIGNATURE I - T.. o_. 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 lila-a signed statement that he is licensed pursuant to .the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of; r? Division 3 of the Business and Professions Code, or that.he is exempt therefrom, and the basis for thealleged exemption. Any violation or Section 7031.5 by 'any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500)• 1: I, as ovine ,ot,tfie property, or my employees with wages as their sole compensation, will do the wor and: the structure is not intended or offered for sale. (Sec. 7044, eulsness 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.) I1 1, 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.) i7 1 am exempt under Sec. B. & P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION 1 hereby affirm that I have a certificate of consent to self -insure, or a certificate of Worker's Compensat'on Insur _ e or a certified copy thereof. (Sec. 3800„Labor Code.) Policy No`s+R '-, �ompyayl �!•of ­CFCopy is filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is lot 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: 1f, 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. -f �1 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 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 -of this city to enter the above- mentioned property for inspection purposes. Signature of aQplicant -Date- Mailing ateMailing Address City, State, Zip 98ro- o�� APPLICATION ONLY BUILDING: TY761-16Z P�/E'CCONSTT. OCC. GRP. A.P. Number 6 1 - 16 2p- col II Legal D•escriptionLo 3l y'oLe:f Pr lb'ectoesc Description "�/b0 O. 2. f �VtIS� s Sq. Ft. No. No. Dw. _Size �� b Stories Units New)) Add ❑ Alter ❑ Repair ❑ Demolition ❑ PERMIT AMOUNT Plan Chk. Dep. /, UO lk.' Plan Chk. Bal. Const. Mech. y” Electrical Plumbing S.M.I. , Grading Driveway Enc. Infrastructure TOTAL REMARKS e �i ZONE: BY: 1 Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line r1 Side Street Setback from Center Line Side Setback from rx�el LI FINAL DATE IIPECTOR Issued by: Date An 1P mit Validated by: Validation: lik ,• ` WHITE = FINANCE YELLOW = APPLICANT PINK =BUILDING DIVISION ", 3 a- J \/)V O — T ,.