0307-008 (SFD)LICENSED CONTRACTOR DECLARATION
t;hherebvtaffirm under penalty of perjury that I am licensed under provisions of
6;ap09 (commencing with Section 7000) of Division 3 of. the Business and
Professionals Code, and my License is in full force and effect. v
4 . Li 'ense # Lic. Class ' Exp. Date
80602.2 13 031.3112:
Date �t'`�` Signature Of
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
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). - -
( ) 1, 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:
Cartier SIA TE COMPENSATI Policy No. 1670405
(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 shall forthwith comply with those provisions:.`~-w•--.�..,,• ,
Applicant—
Warning: Failure to secure Workers' Compensation ove age is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000; in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the 'conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnity
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for,inspection purposes.
Signature (Owner/Agent),,-'°_ -� Date
-.BUILDING}PERMIT- PERMIT#
0307-ON '
DATE is ry VALUATION'.LOT `$-' TRACT��,
JOB SITE-
ADDRESS � 7 SC1VAT�LELM
APN
� - •ii31
OWNER
CONTRACTOR /DESIGNER
w
DyNy 1yE OARMA
./ENGINEER
YC.
.562 GI,EX 0AU Bx i b,
45.010 DESERT i1".1EW U'
CA 91340
LA QUJNTA CA 922.53
(76S)12410-.5400 031M 4410
USE OF PERMIT
SF0.4335 SQ.rr. USII39NCF, RVIII..'frill' CONS"WL PERMIT DOP.S
RA'TE
'NOT INCLUDE BLOCK WALLS, ROOI , 31'x., OP. FIRE Plt SEPARATE
PERMIT &1INSPECTION BY PUBLIC --WORKS DEPT. REQUIREEn,
TRACT COTnI31 UC'P10O1<i = �,333,Od1 SIP
PORCHIPATIO 461.09 SF
GARAWCARPORT 9,30.40 SF
TMWATED COST 011' COM1i .U.MON
2.58,'769,80
CONSTRUCT FEE 101.000.418-000 8.1,196,00
rLAAiCHiTt E�1rF1. 101-000-439-316 $1,"6.04
PEE DEPO3I;" 101-000-439.31.8 -$1,000,00
ECHAXICAI, ".X 101 000-421-000, $163.0tt
.
ELECTRICAL M1 101,xQ00.420.000 '$259,3
PI,t1A9I IND FEE 101-000-419-000 $301.25
STRONG MOTION FEE RESID 101.1000-241.000
Cf1ZA1?[1bf3I+'F -101-000-x.23.0-00 X13.00.
DEVE'LCIFER IMPACT 1'EE
ART IN PUBLIC PLPCM • RESIX 27tl-(I0.0-445-000 $146.92
'
SLB -TOTAL C0NMMYC1100 AND PLAN CM CK
$gs���.•12 .
IMS PRE -PAID FFXA
-$1,000.00
FEES F?17E. Now
2,2003'.'.
"IFINYE�`
ANCE
[RECEIPT
DAuT�yEf ? �y
BY J
DATE FIN D
INSPECT
INSPECTION RECORD
I— OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
to 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
p
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
6
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 I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
4-tHeater
Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Seaver Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final p S—
Utility Notice (Gas)
ELECTRICAL APPROVAL�
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:
CERTIFICATE .OF COMPLIANCE , • i ' �s� .,
Desert Sands Unified School District
.47950 Dune
� Palms Road ¢ BERMUDA DUNES r
La -Qu i nta• CA 92253 _ rn RANCHO MIRAGE t_J ,
Date 9/11/03 c INDIAN WELLS �.
760 771-851 5 PALM DESERT
No. 24945 ( �, ���{� LAOUINTA �1
'.
Owner Danny& Sue`Garcia APN # 762-250-001 ,
Address 562 Glen Oaks-Blvd.. Jurisdiction La Quinta�
I City San Zip 91340 , . Permit # F.
Tract # '28034, Study Area a ;
Type Single,Family Residence No. of Units,
Lot # : No.'
Street S.F.' Lot.# Mo'. Street S.F.
Unit'll '28034 .57995 South .Valley Lane - 4335 Unit 6
Unit 2 -� y Unit 7-
. Unit3 Unit.8.
Unit 4` . ... Unit 9
Unit 5 j Unit 10 ;.
Comments
At the present time, the'Desert Sands Unified School District does not collect fees on-garages/carports, covered patiostwalkways,•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:
:This certifies that school facility fees imposed pursuant to
in the amount of $2.14 X',.4,335 S.F. or, $9,276.90 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 CC/First American Bank/Terry Ross Check No. 178630
} Name on the check Telephone 861-7372
Funding Residential
By Dr. Doris. Wilson'. ;
Superintendent
V
Fee collected /exempted by -Espe Lara ' , Payment Recd $0.00;
$9,276.90 Over/Under
.:
Signature »
NOTICE: Pursuant to Govemment,Code Section 66020(d)(1); this will serve to notify you that the 90-day approval period in.which you may protest thewfees 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
03/29/2004 22:26 6195163388 CONCORDE PAGE 01
CONC0RD•1✓iCONSU�LTING G -ROUP, INC.
4
ENGINEE ERING & CONSTR'UC'I'ION MANAGEMENT -
3505 CAMINO DEI; RIO'SOU'I'H, #.350 +
SAN DIEGO, CA 92408 "
PH: (619)'516-3377 FAX: (6 19) 5.16-3.388'
MEMORANDUM/FAX COVER SHEET ,f
TO: r•ROM:
GARY KRIIP11
COMPANY: DATE; �•
CITY OF LA QUINTA 03/30/04
FAX NUM ER! TOTAL NO. Or PA -;FS INCLOWNG COVER:
760/77'7-7011 1
PHONE N MBER: SGNUr R'S REFERENCE NUMAFR:
YOUR REFERRNCF., NUMBER:
RE: GARCIA RESIDENCE `
57995 S VALLEY LANE "
y
X URGE 7.' X FOR REVIEW X PLEASE COMMENT X PLE,ISE REPLY D PLEASE RECYCLE
notes/C(onuncnts .
GARY:
THIS N TE IS TO CONFIRM THAT FOLLOWING THE COMPLETION OF ANCHOR'BOLT
HOLD OWNS, TI -IE FRAMING FOR THE REFF_FFNCED PROJECT IS IN. GENERAL
CONFORMANCE WITH CONSTRUCTION DOCUMENTS ANT) DESIGN INTENT. "
PLEASE CALL IF YOU HAVE ANY QUESTIONS .
KRIPAN ARAYANAN
04►�
tl:• <'icrf
1
c
f JON TANDY
.-�_.. 78-194 Elenbrook Ct.
Palm Desert, CA 92211 �>
Office (760) 772-7192 '
SPEC I AL INSPECTIONFak (760) 772-7193
Pager (760) 776-3338
REGISTEREMNSPECTOR'S WEEKLY REPORT
ION
r
❑ REINFORCED CONCRETE TRUCT. STEEL ASSEMBLY
❑ POST TENSIONED CONCRETE ASPHALT
'REINFORCED MASONRY ❑ FIRE PROOFING
❑ r,PiGD
1❑/OTHER q�-0MED
JOB LOCATION u -N 0e t1e C� LA- tOo `��^
I` e®�}
REPORT SEQUENCE NO.
TYPE OF TWdC7ilRE ��
IDESCRIPTION
PERMITNO.
DATES g. ,
DAY OF WEEK
MATERIAL
A'16 /� `
ILL
ARCHITjCj T�
��.{J�����'p�- `
I SpPIEI T
-.) I,
HRS. CHARGED
0 -7 o�O
S M A0•
ENGINFjrR `coe��
ASSISTANTS
HAS.CHARGED
-"D TEINSPECTION
CONTRACTOR-�{I��- —c�s5 --�,-fL/- C:ONTRACSUBTOR._...... UJA%-�-
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COPY SENT TO CLIENT ❑
CONTIN ON NEXT PAGE ❑
PAGE OF
CERTIFICATION OF COMPLIANCE
dHEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MV
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.
DIGN TURE OF REGIST� S P ECJO�
DATES OF REPORT REGISTER NUMBER `
REGISTERED INSPECTOR'S WEEKLY REPORT
I
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
PERFORMED5
O REINFORCED CONCRETE O STRUCT. STEEL ASSEMBLY
❑ POST TENSIONED CONCRETE O ASPHALT
❑ REINFORCED_ MASONRY O FIRE PROOFING
❑ 4;
O SER - V�
JOB LOCATION`5(I
,._ ` �eq "` L-A �V C
`
REPORT SEQUENCE NO.
TYPE S E
R15
� , X ��
PERMIT NO.
DITELDc10
DAY OF WEEK
MATERIAL DESCRIPTION
/A �� of ��
A ITE
INSPEOR_
HRS. CHARGED
ENGINEE/r "
ASSISTANTS
HRS. CHARGED
INSPECTION
DATE
GENERAL�C SUB
CONTRACTOR (•tom ��. CONTRACTOR
� O I
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C-��C..s' �u�
X—
COPY SENT TO CLIENT O
CON NUED N NE -XT PAGE O
PAGE y 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.
SIG ATURE OF REGISTERED IN CT
0-3
DATE OF .RE RT REGISTER NUMBER
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