9708-057 (AR)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
/f 57975 fr' Jr T/31/99
Date ? ) Signature of Contractoo KZ
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.
()<f 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.
!29.tRX)1.:6
(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 -spall forthwith comply with thosesprovisions.
Dater 1 a . --Applicant i f �! ✓
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 authorise representatives o�'is City to enter upon
the above-mentioned property�for inspection pur"poses.(
Signature (Owner/Agent)/ Date
TROL#
PERMIT#
BUILDING PERMIT CON •`
7 .O5 5726
DATE -,I
VALUATION{3 LOT TRACT
V
ADDRESS 5*4451XISiPER0 JOB 01 1 E
APN i6�}-�1CId i
OWNER CONTRACTOR / DESIGNER / ENGINEER
RTIEVEN C.'rt?1,1}CSt? �� RANCHO CAE?1 a'e"R.r'►NO DEVF:.OPM: WI'
3212 S%VErtItIN MILE V)kl 79087 COUi+i'1'11Y CLUB i')ft #201
PEBBLE Hl;t1e."4-{ f A OV53 BE.CijV TA)A 01.JNES CA 92201
0_60)145-775S (IMIA 1%.Q
USE OF PERMIT
MOON
N
ititl i x .lit it.fltit. r1I.l01 i. ION.
,.,c.c.s, dill �,:�.}fie >l iit i�'•iavi'v �e�i.L�r «H�
Iff.311A1,Al IED C'C,TS"To' Off' C:'ONI N'.E`H'!- "14,.'3.0N opm
4LAVN(11011t~ r -M 10146)439-318 81103f4
t`Y 'NnrJtiH"ITY?i VO -0 mi,". ;±jlf9 $,477 Vs
tvNPAIAN"WAt "I4A' 101-11M 421 _000 3.1 1-1.ki
F 1 0_'I'itWAI, 114,, it/i-!!t)tf-;f3t}-e1{i!J t13 1j
110,1'Mitt NO # t 1^- liit •000-1119-10) S3 fill
41'"()NO h,U )TI(ltd #ri.t: - ftV5 i)`) Ifl! 4YW).'?41-Of4l kf: 13
t41 fli•1-fii'a11, (A )NE ('12Th"# 0IN .AN$-} 171,x1,N <'114141{ $q1? 04
PAID
:'�rt�;WS WIt;+:NOW 5912.44
AUG 2 5 1997
NTA
DATE I eY DATE FINALED JINSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
'
Underground Ducts
Forms & Footings
_
Ducts Z (/f-
Slab Grade
_ L
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
- - 29'
F.A.U.
Framing
Z, 2 - 21 a
Compressor
Insulation
L
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wali Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final7-71 02
Final
BLOCKWALL APPROVALS
POOLS - SPAS
Steel:>
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
I I
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
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:
Bin-
::...:::::
..
�Ci of • a Qu inta- : ~ '
...........
............
...........
............
...........
0 Building 8i Safety Division
r
. P:O. Box 1504 ,
Permit #
X.La
78-495 Calle Tampico
Quinta, CA.92253 }
{
Building Permit Application and Tricking Sheet
Project Address:',:.,5
�v ase �o `
Owner's Name: "
ve,� G1
A P. Number:
i . - ', ,
Address.
-Legal Description:
Ciry,ST;'Zip:��+ e 3 s.
Contractor:
jj
s�,•,�o � ti
L .
Tele hone: a s=�
P � � y
Address:
D'--
Project. Description:�' ; .
Cih,:ST, Zip:
t �N`I
((
o��J,'3
D 2 vsSG S" .id 2 T _ – C..
Tele hone:
P 3
r
S
• -
State Lic. R':
City Lic. #:" l
C7
T
Arch.. Engr.Designer:4
Address:
City: ST. Zip..–�
IJIA%� (:
�W�
$(0 A `: 7 - 'VA-Wi e
IePh n.
-i
Construction T Ye: Occupancy:
YT
P
State Lic.
Project bPa (circle one):: New Add'n Alter Repair Demo
Nance of Contact Person: ��
t.
Sq. Ft.:• g�Q -:
# Stories:
# Units:
Telephone # of Contact Person:' . •;�
Estimated Value of Project:
::;:::
..............;:.:;.::: ;:.;:.;:.:
::'>'.'::':::>:.;;::>:>
A!?RL{
:................01.......0.............?#:.:...
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A......:......fS:...l.........................................................................................
<:<<:»>'><>::<<'z'><«>:s:»»'::::;:»>>:>::«>>' .
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
N0. PLUMBING FEES
ST FI_. 50 FT S
UNITS
SLAB GRADE
2ND FL. SO. FT
BONDING
YARD SPKLP. SYSTEM
POR S0 FT ,ri
MOBILEHOME SVC.
BAP SINK
GAR SO. FT. At
POWER OUTLET
ROOF DRAINS
CAR P -30. FT 4
GAS (ROUGH)
DRAINAGE PIPING
WALL SO FT 2
OTHER APPJEOUIP.
DRINKING FOUNTAIN
50 �T
TEMP. POLE
URINAL
ESTIMA'ED CONSTRUCTION VALUATION S
GROUT
WATER HEATER
SERVICE
FINAL INSP.
WATER PIPING
NOTE. Net tO ca :,sea as procerty !aa ia!> anon
WATER SYSTEM
GRADING
cu.
FLOOR DRAIN
MECHANICAL FEES
FINAL INSP.
WATER SOFTENER
VENT SYSTEM FAN EVARCOOL "OOD
SIGN
WASHER(AUTOMDISH)
APPLIANCE DRYER
REMARKS;
r,ARBAGE DISPOSAL
FURNACE UNIT 'WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FIRE ZONE ROOFING
KITCHEN SINK
ABSORPTION SYSTEM B.T U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE.TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. � c
BATH TUB
LATHING
SO. FT. ,�p c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID rr) 1+4 c
SEWAGE DISPOSAL
SO.FT.GAR 3 1A c
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING A AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL AREA
SLAB GRADE
ROUGH PLUMB,
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINA"
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu.
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
REMARKS;
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONSOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
m�e�. � vR a arvww � uwea�n� � Www
GARDEN WALL FINAL
Desert Sands Unified School District
Notice: 82-879 Highway 111
Document Cannot Be Duplicated Indio, CA 92201
619-775-3500 .
CERTIFICATE OF COMPLIANCE
Date 8/25/97
No. 16002
APN # 769-610-026
Jurisdiction La Quinta
Owner Name Steven Goldberg Permit #
No. 50845, Street Nispero Log #
City La Quinta Zip 92253 Study Area
Tract # Lot # Square Footage 810
Type of Development Residential Addition No. of Units 1
Comments
>tu to
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:
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of
1.84 X 810 or $ 1,490.40 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/First Bank/Rancho Capistrano Dev. Corp '345-7755
;4-
5-7755epone
Name on the check
By Dr. Doris Wilson :teams ,►
Superintendent
Fee collected /exempted by Pauline Pearson Payment Received X1.4 $1,49.0:40
Check No. 39766
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
ilect 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
A-)
i •-- I t_i'j / 1z) : b.J-H 1•-i••:Ull PALM VALLL i HUN E? I'3 :5bii I / /
The Citrus Course Homeowners Association
August 21, 1997
Rancho Capistrano Development
Attention: Rob
Re: 'The Citrus Course Homeowners Association
50-845 Nispero
Dear Rob:
Please accept this correspondence as notification that the plans submitted for'the room
addition at the above address have been revicwcd and approved by the Ilomeowners
Association's A mbitectural Committee.
Should you have any questions regarding this matter please contact me at the PCM Palm
Desert Office at (760) 341-7220.
Sincerely,
FOR TIE BOARD OF DIRECTORS
John Peterson
C: , Architectural Committee
Word/A.rchitcctural Mitrus risk 37
Managing Agpic Profcssioiw Community Managem m, Inc:.
23726 Bincher Drive • L,ake Fort t- California 9263Q • (RM) 369-774A
§M0MA .
Cic. P557902
RANCHO CAPISTRANO DEVELOPMENT
P.O. BOX 980
LA QUINTA, CA: 92253
7-28-97
RE: LOT# 69 CITRUS ESTATES -ADDITION
ELECTRICAL LOAD CALCULATION
8101.0 3 WATTS PER "_ ...........................2,430
FAU.................. ............................1,500
TOTAL.......... ................................3,930
1ST 1OKW @ 100%= ................................3,930
A/C LOAD @ 10036=.. ...............................3,000
TOTAL...........................................6,930
DIVIDE BY 240v=.... ..........................28.88 AMPS
FEED WITH 40 AMP CIRCUT
AUG - 1 3 - 9.7 WED 1 5 : 3 ® B B G ARCHITECTS, INC. R.01
ARCHITECTS
ust 13, 1997
Rancho Capistrano Development Company
AI TN: Rob Capetz
Goldberg Residence
r Rob:
Per our phone conversation on 8113197 please redline the electrical outlet at
the bathroom to be a GFI. We will call out the outlet as a GFI on our originals,
a"d your future sets will reflect this change.
I
Hny further questions or revisions, please call.
incerely,
1680 A_ IT TS
Anton Marinkovich
director Production
I
;I
:r
A BERKUS DESIGN STUDIO
26 C�Jkf't!cn;E ;��;;r; / IRVIrdE CALIFORNIA 92606 /
714/261-1795 / FAX 261 5J15 / E �'fAll.: � �;r.�r'i!aaFIA:3! {.i ,f f