0307-076 (AR)LICENSED CONTRACTOR DECLARATION _
I hereby affirm under penalty of perjury that I am licensed under provisions of
CKapter 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
6133969 18 Ba (4- 1' j� '�?13 1 AD4,
Date ^+ ! '-'Signature of Contractor � j
OWNER -BUILDER DEC•L_ARA IONS
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 A, - } Signature of Owner
it rt T,
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:
CarrieritiipT 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 anykmanner so as to become subject to the
workers' compensation laws of California, and agree -that if I should become
subject to the workers' compensationjprovisions df Section 3700 of the Labor
Code, I shall forthwith comply with those proyisins.
Warning: Failure to secure Worker's' Compenbation'llcoverage is unlawful and
shall subject an employer to criminal�penalties hand civil fires up to $100,000, in
addition to the cost of compensation, damages as proVided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all ,,City, and State layvs relating to the building
construction, and hereby authorize representatives of\this City to enter upon
the above-mentioned property for ins ection pu doses.
-Signature (Owner/Agent) ± / N-4 Date ��-?21,:,>?
BUILDING PERMIT PERMIT#
0307_047f f1
DATE 'q p� VALUATION LOT TRACT pp
JOB;SITE hrnn u%�:�L=.
ADDRESS .i`I �stJ�a��aJ'Ia + . a lJ = . V
APN
772-4)7114)19 I
OWNER1�
-
CONTRACTOR / DESIGNER / EN_INEER _
�I
t7A VAN �J`lIJ..JV1.7ERG
i 111,J.1}!.l...LZi.l:.VELOP.lY].EV,VT COIZPOR,ATION
Si '84.r iaGa'D
731,552 nIF.Rr«MJJMIE
CA t1221?
33d.DI WE(,..eyl�y
(7 611177 39 5..5}. GiJ�it 3St1.1
USE OF PERMIT
CUM' )M CON:iTRUCTIONi�C Pa 0
li;V'r. °e!1fi' fF,'ia ,n,OST t.)r COexs'Y3.ARU'MTX,? `
l;sl��~i�.>`1f$
PLAN CMCK ME 11,0 1 -000-45.318 W-90
'
101.4;) )0f 418 -OW $126.00
4►4FCT'1, VNICAL• TIES 101-fl00 421.000 431.50
000-24.1.000 S1.66
MS. -T fJTALtS��I+T� ::'�Z I �7�+�a �E 1�� i? ,,t��3 0141 A;;.K
D
AUG 2 7 2003
IT
CFI OF + A QUINT ✓
Ar1XIge DEP,, . *
RECEIPT
DATE f% its
By `•.
DATE FINALED
INSPECTOR
i? r
.•_._.
.4iv
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
—
Ducts
Slab Grade
Return Air
Steel
— . 3
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
rl, 91— 23
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
-3
Final
— <
Final _ _ �
BLOCKWALL APPROVALS
Steel
POOLS - SPAS
Set Backs
Electric Bond
Footings
-
Main Drain
Bond Beam
_ p .. d b
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
1A A
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:
0
A
X
77
#
City of La Quinta
Building 8L Safety Division
P.O. Box .1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
f�
Project Address:,56 7-
O%srer's Namc: 5�c.le'j o 16 Ge -4x
A. P. Number: -
-
Address: �� N S'
Leval Description: Lor
qO I/
/ % 8 7
City. ST. Zip: L - L6 fZ ZS 3
Contractor:�
� ��,'
Telephone: � Lf_
Address:-? /yl4
l ewe
Project Description:
City, ST, Zip: y'(rti �L
/•
c4 C! Z�Z I (
i
_ 7 ,,-•., w d{ +
Telephone: 3 1f j'— 1 �l 3 (v
State Lic. # : i ii
Engr., Designer:
_ :.:
City Lic. # kT
3—�
V. g- CYC54P4c
II
Address:
'
136
City. ST, Zip:
Telephone:
P
`r '
''.:`. •. �`�::.: —
Construction Type: Occupancy:
State Lic. #:
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person:
J
Sq. Ft.: t q7
# Stories:
# Units:
Telephone # of Contact Person: Zsp - '5 1
stimated Value of Project: _ (ftr p U"
-=--Aso
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
p�
Plan Check submitted 7/,7
Item
Amount
Structural Calcs.
'� .
Reviewed, ready for corrections 12
Plan Check Deposit
Truss Cates.
Called Contact PersonQi°y,(,� Lt
Plan Check Balance
Energy Cates.
a
Plans picked up -7
Construction
e
Flood plain plan
Plans resubmitted
Mechanical a
3 S �(
Grading plan
2" Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.I.I. e
H.O.A. Approval
QQ
Plans resubmitted W' 114
Grading
IN HOUSE:-
'^' Review, readv for correctionissu g%Jo/
Developer Impact Fee
Planning Approval
Called Contact Person %AP Y.A.I,P.P.
.Q
/Pub. Wks. Appr
Date of permit issue
O j iS v
<tJl�
School Fees
Z) 0
w
P I'Ae4 S SI /✓G.'
.Sd"0 L
Total Permit Fees
Comments
S.F.
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:
Residential Addition 500 Sq Feet or Less
EXEMPT
This certifies that school facility fees imposed pursuant to
Education Code Section 17620 and Government Code 65995 Et Seq.
in the amount of $0.00 X 136 S.F. or $0.00 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 may now be issued.
Fees Paid By Exempt - Jimmy Haltzopoulos Check No.
Name on the check Telephone 760/773.9574
Funding Exempt
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Sharog McGilvrey Payment Recd $0.00
/2", ,/' , Over/Under
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, whichever is earlier.
NOTICE: This Document NOT VALID if Duplicated
Embossed Original - Building Department/Applicant Copy - Applicant/Receipt Copy - Accounting
CERTIFICATE OF COMPLIANCE
Desert Sands Unified School District
47950 Dune Palms Road
zq�o
o
r
Date
8/27/03
La Quinta, CA 92253
_< BERMUDA DUNES
Cn RANCHO MIRAGE d
No.
24887
(760) 771-8515
�¢ INDIAN WELLS ")
PALM DESERT y
.�INDIO
LA QUINTA
,y7i
d
Owner
Steven Goldberg
APN #
772-070-019
Address
50845 Nispero
Jurisdiction
La Quinta
City
La Quinta Zip 92253
Permit #
0307-076
Tract #
24890-4
Study Area
Type
Residential Addition
No. of Units
1
Lot # No. Street
S.F. Lot # No.
Street
Unit 1 69
50845 Nispero
136 Unit 6
Unit 2
Unit 7
Unit 3
Unit 8
Unit 4
Unit 9
Unit 5
Unit 10
Comments
S.F.
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:
Residential Addition 500 Sq Feet or Less
EXEMPT
This certifies that school facility fees imposed pursuant to
Education Code Section 17620 and Government Code 65995 Et Seq.
in the amount of $0.00 X 136 S.F. or $0.00 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 may now be issued.
Fees Paid By Exempt - Jimmy Haltzopoulos Check No.
Name on the check Telephone 760/773.9574
Funding Exempt
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Sharog McGilvrey Payment Recd $0.00
/2", ,/' , Over/Under
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, whichever is earlier.
NOTICE: This Document NOT VALID if Duplicated
Embossed Original - Building Department/Applicant Copy - Applicant/Receipt Copy - Accounting
UIRUS
COURSE HOMEOWNERS ASSOCIAY'ION
July 9, 2003
Steven & Elvia Godberg
50-845 Nispero
La Quinta, CA 92253
RE: Architectural Request
Citrus Course Homeowners Association
50-845 Nispero, La Quinta, CA 92253
Dear Mr. & Mrs. Goldberg:
Members of the Architectural Committee have reviewed the application and plan that you
submitted to extend your guest bedroom. The Committee has approved the application
and plan as submitted. The Committee would like to remind you to please forward a copy
of your permit from the city of La Quinta to Desert Resort Management.
When all work on the project has been completed, please notify this office in writing so
that the improvements may be inspected and signed off by the Architectural Committee
and your deposit can be returned to you.
Thank you for your patience during the review process. Good luck with your project!
Sincerely,
Tom Miller
Association Manager
On behalf of the Board of Directors
Citrus Course Homeowners Association
P.O.. Box 4772 Palm Desert, CA 92261-4772 i 73-550 Alessandro, Suite 5 Palm Desert, California
760.346.1161 - FAX 760.346.9918 - E-mail: drm@drmiriterner.com - www.citruscoursehoa.com
3/03 `.
CARLOS ELIAS
Civil.Engineer
38825 Charlesworth Dr. S T.12JCTu26L CBC M4TION'S
Cathedral City, CA 92234
(09).328-7271
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t f�
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No, 16839
�. •"`.,._ CMI. .-�'
3-4
( /Z 3/0 3
DESCRIPTION/S >>
>> STC COC.. (3459 P(,T• 065104
----- DESIGN DATA -------- --------------------------------------------I
AXIAL LOAD kips 0.80 0.00 0.00 0.00 0.00
X -X AXIS MOMENT ft -k 10.41 0.00 .0.00 0.00 0.00
AISC SECTION NAME ---->> TS7x5x1/4 None None None None
BOLT CAPACITY k 8.8 0 0 0 0
# BOLTS PER SIDE 2 0 0 0 0
BOLT AREA in 0.4418 0 0 0 0
...DIST. FROM PL EDGE in 1.25 0 0 0 0
BASEPLATE HEIGHT in 14 0 0 0 0
of WIDTH in 14 0 0 0 0
SUPPORT PIER HEIGHT in 48 0 0 0 0
It it WIDTH in 48 - 0 0 0 0
f1c psi 2,500 3,000 3,000 3,000 3,000
Fy ksi 36 36 36 36 36
LOAD DURATION FACTOR 1.33 1.00 1.00 1.00 1.00
AISC SECTION DEPTH in 7.00 0.00 0.00 0.00 0.00
.....FLANGE WIDTH in 5.000 0.000 0.000 0.000 0.000
.....FLANGE THICKNESS in 0.250 0.000 0.000 0.000 0.000
.....WEB THICKNESS in 0.250 0.000 0.000 0.000 0.000
------ PLATE DESIGN ------ ---------------------------------------------
MIN. REQ'D THICKNESS inj 0.59 0.00 0.00 0.00 0.00
Plate Analysis Type #1 0 0 0 0
Anchor Bolt Tension k 5.66 0.00 0.00 0.00 0.00
Actual Bearing psi 509 0 0 0 0
Allowable: Per ACI 10.15 2,975 0 0 0 0
Per AISC 1.5.5 2,328 0 0 0 0
Max. Plate Capacity for
Allowable Bearing k 456:2 0.0 0.0 0.0 0.0
----- PLATE ANALYSIS ---->>> Use If Actual Thickness Varies From Min. --
ACTUAL PLATE THICKNESS in 0 0 0 0 0
Max. Allow Plate Fb ksi 35.91 0.00 0.00 0.00 0.00
Actual fb ksi 0.00 0.00 0.00 0.00 0.00
DESCRIPTION/S >>
----- DESIGN DATA----------------------------------------------------�
AXIAL LOAD kips 0.80 0.00 0.00 0.00 0.00
X -X AXIS MOMENT ft -k 10.41 0.00 0.00 0.00 0.00
AISC SECTION NAME ---->> TS7x5x1/4 None None None None
BOLT CAPACITY
# BOLTS PER SIDE
BOLT AREA
...DIST. FROM PL EDGE
BASEPLATE HEIGHT
of WIDTH
SUPPORT PIER HEIGHT
of of WIDTH
k
in
in
in
in
in
in
8.8
0
0
0
0
2
0
0
0
0
0.4418
0
0
0
0
1.25
0
_-:: 0,-� ,
0
0
14 0 �Q�� _c� 0 F. 0 0
14 0 ci 0 0 0
48 0 No. ' 839 , 0 0
J' CFVR. ,� ••
REGISTERED INSPECTOR'S WEEKLY REPORT
JON TANDY
78-194 Elenbrook Ct.
Palm Desert, CA 92211
Office (760) 772-7192
Fax (760) 772-7193
Pager (760) 776-3338
TYPE OF
INSPECTION
PERFORMED
O REINFORCED CONCRETE ❑ STRUCT. STEEL ASSEMBLY
❑ POST TENSIONED CONCRETE ❑ ASPHALT
❑ REINFORCED_ MASONRY ❑ FIRE PROOFING
O
❑ OTHER
JOB LOCATION -� e `�_ •!
CxJ v' Y3 ��.
REPORT SEQUENCE N0.
TYPE F STRUCTURE
fPERMITCAXJNO.
D yjq
DAY OF WEEK
MATERIAL DESCRIPTION-VO
lU� S
ARCHITECT
INSPEOCIR
HRS. CHARGED
ENGINEER
ASSISTANTS
MRS. CHARGED
INSPECTION
DATE..-.
GENERAL SUB
CONTRACTOR — CONTRACTOR
'�• (.C�Z� i GJ `�JL.
�- .. Y S
06
L
04 Na asp .-
G��J •
v `e -S
�•�-els c � � � �..
—77
COPY SENT TO CLIENT'.p,•CONTINUED
ON NEXT PAGE O
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.
S URE JOF REGISTERED INSP O
DATE OF RE RT REGISTER NUMBER