0207-229 (SFD)�, ' -r• _ .;,. ._ ' .� .. T ,. _ ,�. s. - s. a.: ..- �4f�g SFr
1
„. LICENSED CONTRACTOR DECLARATION
I hereby "affirm under penalty of perjury that I am licensed underprovisions 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
718280
r� „ (i!�
ate t ,Slgfature of Contractor 2 -,fes:
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
ti
Date • Signature of Owner
WORKER'S COMPENSATION DECLARATION
- OR
I hereby affirm under penalty of'perjury one oftthe following'declarations:
O I have an d,.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.
4,(/ ) 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 j;l?@ 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 he Labor
Ole, l shall forthwit comply with,tKo-se p ovlsions.
'f DatAppllcant'';�
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 poses.
Signature (OwnedAge��j' -_P�Dat'
BUILDING -PERMIT PERM'T#
t
DATE VALUATION s�y�"�d«17 LOT TRACT
-.t Z. BL K 215
.JOB SITE
ADDRESS p a53—>XVAlrFA�e1,,�_AVAX�RM)
APN
OWNER
CONT(R•A�CTiOpR//DESIGNER /EN (NEER
FFyy��
cov),: AJ.i:'iMr,7.al Js 6
.1..�f`+�..i'lV4i•J• hJ.
12-14 X 1WG •1 00D ROAD
SAWTA MA CA 92705
LA QM. TA C. A 92 2.5
(700)564.71820 Mlift 0206,14
USE OF PERMIT '
r.
PFIYi'yM111' C19M.0 NOT INCLUDE BLOCK `'it1':AL `? .1000L i; R-
iF{�5�1 S.lfe. SM.APPROACH
�V �Rir. 4TA4� Lxt" �� tLOA.ruf H
0-I,
TRACT Ct.X1+1:'1'1'RUCT10 4 1,8.51.00 sp • -'
�
PORCIy.pl'ato I
tt�02.t00 C9?
klfi'Ffi.ri16.%7=-a�,AA.['Od'v.E Wild4V tN�n
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3vs'MMA!= COW QF C'O.MMUL OR
1 1t)1ZMV
L''OA107RUCTaoN FE ?: 101.0004 18-000 SMA
PLAN CHECK EEK 0,, 101-000-439.518 $5011H
MECHANICAL ME -•000421-000
101-000-420-000
PF..UM.MO IW -000-419-000 FxS.i�t
S b Rc9M MO't:NTR M - ft'011D 101-000-241-000 511.04
Q;p,4.DINV Fail }01 -100 -42 -3 -ON $15,00
D E1'i:Wt1 R I MPAkC't C`00; �,d�405.rflY
-
P1`EV118119 PLAN 1f�`i�fitl�•�1�31-:3�1� �41?O.flD
��UM°Ci,f.�i�"3�+T11:b�";A�f,C3t. 31C.T gi,CT
,1?21 �f7AID 17y.10
:iD
,Iai3�.E4
-$25000
CITYOF LAQUIN7A
-i
FINANCEDEPr ;
RECEIPT
DATE ,�
BY '., i''
DATE FINALED
INSPECTO //
INSPECTION RECORD
OPERATION
DATE
I INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs O _ U
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
_
Roof Deck ��_®_Z
Exhaust Fans
O.K. to Wrap /��/
Framing S 2—
F.A.U.
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 7D_ -;2T 'oZEr7—
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection �p a2 �'pL
Encapsulation
Gas Piping
Gas Test U
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:
Cue, ocq,�Cc(yafi , �aJT
Building
Address J �J
.Owner
Mailing
Address
Contractor
f G+Git�Ct/
P.O. BOX 1504
��//�'�.��•��,/,78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Address
CityZip Tel.7Cl
/
r �I
State
Cla sif. ��v Lio
B #
Arch., Engr., l
Designer r r'" t1
Address J Tel.
'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
n.
reaso(Sec. 7031.5,Business and Professions Code: Any city,or county which requires a
permit to construct, alley, !improve, demolish, or repair any Structure, prior to'its issuance also
requires the applicant for such permit to file a signedstatement 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 thealleged 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, 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 impryove for the purpose of sale.)
CI I, as owner of the property, am exclusivelyJcontracting with 'licenset7,contractorsto,con-
struct the project. (Sec. 7044„i 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 cohtractor(s) licensed pursuant to the Contractor's License Law.)
I') I am exempt under Sec. r B. 8 P.C. for this reason
Date Owner '
+ = i 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. 0 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 thg workfor 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, 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 r
Lender's Address y
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 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
APPLICATION ONLY
BUILDING: TYPE'CONST. O/CC. GRP.
A.P. Number
Legal Description
Project Description AI'V-( I[74/r
Sq. Ft, `� S No. No. Dw.
Size fes} Stories Units
I N Add O Alter O Repair ❑ Demolition ❑
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
p "'
Plan Chk. Bal.
`
Const.! if
Mech.'
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
r 1
TOTAL
REMARKS
JUL 0 PA11141
ZONE: BY:
Minimum Setback Distances:
Front Setback frorr' 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
Comments (4) Cashiers Checks - 63096 - $3961.14, 63095 - $3608.04, 63097. '$3961.14 and 63094 - $3608.04
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patios&talkways, 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 $2.14 X 7,074 S.F. or $15,138.36 have been paid for the property listed above.and that
building permits and/or Certificates of Occupancy for;this square footage in this proposed project i'tay now be issued.
Fees Paid By !St Bank - Sharon Bilis Check No. see above
Name on the check Telephone 760/56,4-7820
Funding Residentia0.
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Crystal Scott $15,138.36
Payment Recd OverfUnder
Signature
NOTICE: Pursuant to Government Code Section 66020(d)(1), 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 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, whiciever is earlier.
NOTICE: This Document NOT VALID if Duplicated
Embossed Original - Building Department/Applicant Copy - ApplicanUReceipt Copy - Accounting
CERTIFICATE OF COMPLIANCE
t
v�Fsc
Desert Sands Unified School District
��'
'
47950 Dune Palms Road
^o
Q BERMUDA DUNES r
Date
9/16/02
La Quirlta, CA 92253
RANCHO MIRAGE t:jINDIAN
No.
23618 .
() 760 771-8515
WELLS ti
_ PALM DESERTLA y
e UINTA
.
INI.
Owner
Cove Development/Legacy Homes
APN #
Address
see below
Jurisdiction
La Qui-ita
City
La Quinta Zip 92253
Permit #
Tract #
Study Area
Type
Single Family Residence
No. of Units
4
Lot # No. Street
S.F. Lot # No.
Street S.F.
Unit 1 21
53600 Avenida Diaz
1686 Unit 6'
Unit72'19 y---53350 –Avenida -Navarro --'--------71851----
_
_ - Unit-7—
nit7Unit
Unit3 4
52070 Avenida Obrgon
1686 Unit 8
Unit 4 20
53340 Avenida Navarro
1851 Unit 9
Unit 5
Unit 10
Comments (4) Cashiers Checks - 63096 - $3961.14, 63095 - $3608.04, 63097. '$3961.14 and 63094 - $3608.04
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patios&talkways, 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 $2.14 X 7,074 S.F. or $15,138.36 have been paid for the property listed above.and that
building permits and/or Certificates of Occupancy for;this square footage in this proposed project i'tay now be issued.
Fees Paid By !St Bank - Sharon Bilis Check No. see above
Name on the check Telephone 760/56,4-7820
Funding Residentia0.
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Crystal Scott $15,138.36
Payment Recd OverfUnder
Signature
NOTICE: Pursuant to Government Code Section 66020(d)(1), 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 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, whiciever is earlier.
NOTICE: This Document NOT VALID if Duplicated
Embossed Original - Building Department/Applicant Copy - ApplicanUReceipt Copy - Accounting
*Ijrl,
RC DISTRICT - PLANNING- REVIEW FORM
This form.is to be used by CDD staff for review of single family dwellings in the RC (Cove
Residential) District per. Section 9.50.090 of the Zoning Code. Its. purpose is to determine:
1) that the proposed house design does not duplicate the same architectural style of any
house within 200 feet of the applicant, and/or 2) if there is a need for the applicant to file for
Master.Design Guidelines. If the applicant does need to file a Master Design Guideline, please
transmitted this information -to the Building and Safety Department as part of your correction
list. Please attach additional explanations as necessary.
APPLICANT Cove Development
SITE ADDRESS 53-350 Navarro
APN 774 - 095 - 006\ CASE NO.: 2002-687
LEGAL:. LOT 19 BLOCK 215 UNIT
CHECK AND APPROVED BY: Greg Trousdell DATE:
Inform the assigned Building plan checker upon your assignment to this case. The CDD
Executive Secretary maintains a log book to track applications and assign case numbers.
REQUIRED ITEM Y "N, COMMENT/CCRRECT.ION
Verify legal and APN information
Consistent with MDG on file las
applicable So
MDG filing required 15 filings since
9/3/98)
Architectural variety within. 20 Co
the surrounding area: 0 pian Go ncWLcept.
O pity m ri�ty
case N o
M aldol 't Con
b Wit
L
Architectural design features
Other Requirements:D',
7
I
Oct 30 02 01:32p sladden palm desert 760 772 3895 p.2
Y
�Sladden Engineering
6782 Stanton Ave., Suite A, Buena Park, CA 90621 (714) 523-0952 Fax (714) 523-1369
39-725 Garand Ln., Suite' G, Palm Desert, CA 92211 (760) 772-3893 Fax (760),772-3895
Date- D 7 ~ 7
Job No.
FIELD MEMO
Project Name / Z V f CGo�yl Gl ULk'( C� CIiE nt: L.—(/rc C \ / iY l (I >" P.t;>
Site AddressL C.%✓tS�Y"Vt- IA
Job Phone
Work Done
Test Summary / Footings Inspected
Test
No.
Location
Elev.
Dry
Oensity
Moist_.
%
%[Relative
Compaction
Ref. Max
pcf
Moist
%
2
Ii 3
-7,
I
Comments
Field Tech. - Super, or Agent
24 hour notice requested to schedule Field Technician. Thank yo-ilfor the opportunity to be of service.
r
Oct 30 02:10:52a sladden palm desert 760 772 3E95 p.3
*Sladden Engineering
6782 Stanton Ave., Suite A, Buena Park, CA 90621 (714) 523-0952 Fax (714) 523-1369
39-725 Garand Ln., Suite G, Palm Desert, CA 92211 (760) 772-3893 Fax (760) 772-3895
Date :✓U-
Job No. 95 'Z 7.-
FIELD MEMO.
Project Name Client: Le -o'
Site Address 1.OV✓► rTC�rl
Job Phone C .
Work Done
v 1 f
Test Summary / Footings Inspected
Test
No.
Location
Elev.
Dry
Density
Moist
%
46 Relative
Corr paction
Ref. Max
pct
Moist
%
/�•3 ��
%U • c -f
S
r
CommentsAll 70
11
F Id Tec 1i�--- Super. or Agent
24 hour notice requested to schedule Field Technician. Thank you for the opportunity b be of service.
OCT -30-2002 •WED 09:58 TEL: - I I NAME: P. 3
ficate' of Occupancy
City of La Ouinta
..c
Building and Safety Department OF �.
This Certificate issued pursuant to therequirements 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 budding construction or use. For the following:
BUILDING ADDRESS: 53-350 AVENIDA NAVARRO'
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0207-229
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RC
Owner of Building: COVE DEVELOPMENT Address: 2214, N. RIDGEWOOD ROAD
City: SANTA ANA, CA 92705
By: KIRK KIRKLAND
Date: FEBRUARY 20, 2003
Building Official
POST IN A CONSPICUOUS PLACE ,
I