0012-089 (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
rB PQ
Date .) ?r G_� Signature of Contractor 11'`�`� -_
OWNER -BUILDER DECL-ARi4TION
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 structureis 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:
Merl, Policy No.
?,[3 �L (fir /3 2. �_ '00 Unf i i
i
(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
R ...--
Code, Isoh I fo with—mpl"y�with tfiose- TgVIalons. % +
Date: t t{;tfi(1 Applicant _'- '� ""r �• �. r� J
Warning: Failure to secure Workers' Compensation,00verage is.unlawful and
shall subject an employer to crimirial•penalties and civil fines up to $100,000, in
addition to the cost of compensation, darrages-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 applicator 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 apo icati3iand state that the above information is
I.
correct. 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 fo,,' spectton,, urpo es.
Signature (Owner/Agent) � �,14� Dat � �'��C)
PERMIT PERMIT /1
,.BUILDING
DATE VALUATION LOT4iY�1-3� TRACT
��!l��liDl➢ fi'i8 � DC3
JOB SITE
APN
ADDRESS
: -9(M PAID.W, COURT
OWNER
CONTRACTOR/DESIGNER/ENGINEER
+
RC;IC x13►IRSr UFAiT MOUP
L.4M t" DNISULTING SERVICES
PO BOX 1490'
P101 BOX 937
LA QUIN TA CA 92253
LP.. QI)]t3TA CA 92".53
(760)7'7'1.23€`.+4 MIA
USE OF PERMIT
Sof 0L , F. .Y DVEi.UNG
SU1Pi+1..E.CAMTA3,PERMIT 'f0vpt1" 4a4*Si1CiwiwacFtA.walOF
C:C9A TR&C'TOR. Ile
.*
1%;57MMTM COST OF G:ONS'! RUCT'€.I;)K
0.00
MISCELLANEOUS 101-00D-423"000
QLC
SUB -TOTAL CONST'RUCCUON .AND PLAk CREC K
w
J S I •°AiE? ; '�30.lO
TOTAL YERMrr.1RXS DOE NOW
U.50
RECEIPT
DMT
/r �� 0)
BY
DATE NALE /�JJ
L]
INSPECTOR
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
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
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
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
Set Hacks
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. 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
COMMENTS:
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)
Certificate of Occupancy Oil � o
City of LaQuinta...-
Building and Saf.pet,y''D epartment
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 con p/iance with the various -ordinances
of .the City regulating bui/ding, construction or us`e. For the following."
BUILDING ADDRESS: 5:0-900 PALOMA COURT
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0012-089
Occupancy Group. R-3 Type -of Construction: VN Land Use Zone: RL
Owner of Building: BCK,JNVESTMENT GROUP
Building Official
Address: P..O.»BOX 1490
A
City: LA QUINTA, CA 92253
By: STEVE TRAX.EL
Date: 03-13-2003
POST IN A CONSPICUOUS PLACE
U 1 HL.4ND
EOTECHNIGAL- ' FOUNDATION ENGINEERS AND MATERIALS LABS
COMPACTION TESTING
Phone No. ='D ,a Branch Office: r
Fax No ' z, t r (Nuclear `Method. ASTM D-2922,
D-2950)
Test .No.,,.
Density Count
Moisture,Count t � •. .. ,.
Moisture'C81rectiori 1 '
• i
Mode & Depth { fi,
Wet Density, PCF ".
'Dry' Density; PCFf S` ..
%'M6 sture , t
Standard Dens' (MAX
�.
Optimum:Moistu�e �, t,
Compaction :ts
.� 1
Specified Density -
Y a •• ::--=yam" - _- z � �3
Test NStation ' �"�� Elevation: Mat
/a�fr A r
Lo tion
r �
' Test'No.. �, -� wStation Elevation Mat -1:
Location.
Test NO' --
'a
d' Station r Elevation Mat'I:
Location.
cYTest No.. 4 t Station `Elevation , Mat'I:
1[ Lo'cation. , yt F • r
Test.No t. Station Mat'l.
Location jr
+"I•.r
1 ' 1 x •
-Test;No:' `'' Station's t: ' " .:Elevation t� 7 ' Mat '
Y . s 's 7, y .5 r• ):"y d Lr 'Ri :x• h t ,. .u' Y
` ,Location. "
u•.� _ +,jt it Sry f„ wR4Siirra� pe. 1 4 r, 7 i :)r'1 �, Ott••. ` a ',c, r♦
Test No,!, r r Y Station ; Elevation , Mat I:
- Location
`
-, ✓...PROJECT No''..PROECT NAME
yCLIENT. DATE:. TECHNICIAN.J�ytl_,� Crl.
' Gauge Serial Nod_ :Density Std �o��y t v Moisture Std.: �G �'
Form No. 160 •Plaza Printers 344.231.:
r' '.•ra^• t r, 4a.t_t..t�+ 3^•:t �.i (": s i}� 7 �..y S i.i:,k -',�. .::r .
4� y
hhaa 9
P. O B Ox165 0 4
V,�;.a 78-495 CALLS TANI PLCO (7'60) 777-7000
� t
`'s1�tiGf r}�.v LA QUJWTA,' 6ALIFORNIA.9,2253� :`s � t '(TDD) (7.60) 777 '1.227 rl.
February 25, 2000>
Mr. John Kalogeris
D.O.D: Design i
P:O Box 1490,
La Quinta; CA 92253
a
F. ` `Side yard setbacks wlthmf,Image•Corrldor
yy3r.. _ a 4 '' t � -p -i,j r,+• }},,,,`i"��{{yy t ,,.
w • - d" uG . rr i'� ✓` r»• ik'4^ri "TH' ksy. 'r'' °_-Ci.a to >''r t 6 : it "ri - ✓ 'S 1
r,. . s . r� t t:. "# ',�•�F ti.5,� ri r M�,>va r' D� Y t. •r' 'Kr�"e,,,, .rh '� � a _ 1 -ids ,f
,} z � � . �6'!�'k+N'+t. a, .. � '�r;;i��t 7y �"r,�• '.is�q 3,� 'j{'" ��l} �•y',r • p G ' rt �W wt rY.�tt-t ; � �,
., ,... Z •i, .,. ad t:,;s t'� ;-..+�' IE 4 SFr „Y ta-,f,:§'ni1.fi`y."9ijS.'f�.' ry` -.y $7 �s �,�}Z .�•t•'>•"s`
Dear John:,
t.xtat i.{K�. 'r•.; . i> {y�i'� k i r,•4
-:.o ,. .'.iYa -k+ Ky Xa-.,t ;.tcy't.._ ,'$.. t. -,.+t 7�+4M ,�i "' ,pri' .y L'�f'.•, .:' ,M'z',aa i'Y, 'S-i^`'°m''`,'4-,••
,.c,; :..I .sem,-� n fr*r5,.h
This letter is intended to�confirin our com�ersat�on"todayiFnday,February 25;2000, to stopwork x< a>;
' w.• fx r �,. {". r�kp+ vngn�f�."7.,�,lt^•->.taf��*,i �• ,ti. t .. c
until further notice on the tw6,single`family dwellings currently.' r-. at at 7,8-505 ,
Avenida TuJunga`(769-063'-006) ;and 5 9 0 Paloma Court (769-063-007)31
;y
As you are now -aware the required25' 0' setback foreside yards hasnotlbe..en provided,iwhich is s;
not consistent^uvithahe requifements'ofResldential De vel opment.Standards'Section 9.50;02.0.
-
I will do my best'to keep�your.up to date v��ith any,developments wluch;changes.this stop.work
condition. �Please'.feel free to contact me should you have any'additibnal questions:
Sincerely,
u�•kTx✓.'.. Lb ,• 7,y >3 p-, t - r
•G .int i` '.f•'Y t`�' r o -K a .vS' 'L r'"Yrt� ,,-•>�"" :.ir - i' iE..r-s{•L
'7 SrS t a � i at. 5` t`,t„ 7 e� '+,s *.e•- t..,,i yp,,��
. _ i �'_/ w �� ; : `ft ; 4•,.•';s .+R. � t`�L t�.' �''� w � anti ti�ri .la ��, + _,, ti ;.:r .,+' �-,r^ .a. w+-. r�* }E�
Mark Harold
Building and Safety Manager
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