0105-071 (SFD)LICENSED CONTRACTOR DECLARATION
L
| hereby mffinn under penalty of perjury that | um |iconooU under provisions of
Chapter (commencing with GooUon 7000) of Division 3u/mo Business and
Professionals. Code, and my. License iuinfull force and effect.
License # . ^ uo.o/aao Exp. Date
'
-17
,451'1 2J
Date 8iggatLiren/ Contracto
ER-13W|LOERDECLARADON
| hereby affirm under penalty ofperjury that |amoxem�hom8mCommomra
License Law for mo/nUmwingmaoon:'
( ) } aoowner mthe property, o,myemployees with wages aotheir sole
compensation, will Uothe work, and the structure ionot intended o,offered for
sale (Goo.7o44.Business & Professionals Cuua).
( ) |, as owner of the property, am exclusively contracting with licensed
contractorsm construct the project (Gov� 7044. a oinvva m Pnofaooiona|v
Code).
() |amexempt under GummnauPC.for this reason
_________
oom Gig?am,o mO�nv,
. .
�
WORKER'S CM
.
. . .
' | hereby affirm under penalty cf -perjurynnoof the following declarations:
()| have and will maintain acertificate ofconsent mself-insure for workers'
onmponoanon, as provided for by Section 3700 of the Labor Code, for the
performance nfthe work for which this permit ioissued.
maintain workers' compensation insurance, oorequired by
Sekbh 8700 of the- Labor Cmga, for the podnmnanoo of the wm,x for which this
permit is issued. My compensation insurance carrier policy no. are:
Carrier` ' Policy No. .
(This section need not, be completed if the permit valuation is for $10000mless).
(1 | certify that mthe performance o/the work for which this permit is issued,
| shall not employ any. person inany manner aoaambecome subject mthe
Workers' compensation laws nfCalifornia, and agree that if| should become
subject to the.workers' ohso/Section
Code; I shall forthwith comply w't6'thos r -Visions
Date:, Applicant- 4y,4X 7
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 ishereby made mthe Director oxBuilding and .
foi a permit subject" *!the conditions and restrictions set forth on~his
application.�. '
1. Each person upon whose behalf this application is m ademeach person at
whose request and for Whose benefit work ioperformed under o,pursuant m
any permit issued as result u,this uppnnouonagrees to, &uhon. indemnify
m hold harmless the City of uoQuinto. its omvors, agents and employees.
o.Any permit issued auaresult v,this application becomes niull and void if
work within.
wmis ncommenced within uuyo e of such
permit, orcessation ofwork for 18Vdays winsubject permit to. cancellation.
| certify that | have read this application and state that the above information io
cu,,om. | agree mcomply with on City, and State |owo relating tothe building
construction, d hereby txo,|ze repr?sentatives ofmi City ^uenter upon
PERMIT #
DATE VALUATION LOT TRACT
a 40 29147-2
JOB SITE
APN
ADDRESS
OWNER
CONTRACTOR DESIGNER ENGINEER
CARLSBAD CA 92008
0_4RLSEK) CA 92008
(760)804-,68,68 10KA, 3376
USE OF PERMIT
P001, ORDRIVFWAY APPROACH. 7S%, PWI CHI=. FFJ?, APPI-AW FOR
PORC",ATIO 577.00 S?
ES11WIXrED co Oil, CONSIrRUMION
PLAN CHECK FEE 101-000-439-�18
MECHANIC&L FRF, 101-10000421-1000
PUAC'TRICAL MW? 101 .,000-42a.000 $01.26
PLUMBING D719 101 -OM-419-000 S1801io
0MING "IF, 101-000-423-000 $20,00
CITY OF LA QUIN rA
FINANCE DEPT
RECEIPT
DATE /r7 /f,
BY
DATE F)NALEI),
�Ir
T OR
A
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
0.1
Ducts
Slab Grade
��'� ���
Return Air
Steel
Combustion Air
Roof Deck9/
_
Exhaust Fans
O.K. to Wrap
�� '
F.A.U.
Framing
,zz /
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,3�/D3
Final
_
�3
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final I
Gas Piping
PLUMBING APPROVALS
Gas Test
f/
Electric Final
Waste Lines
/
(J/�0� lQIL
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
//D/
Encapsulation
Gas Piping
Gas Test
_
3/-`0�,�j,
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
City of La Quinta
Building and Safety Department
'Y
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 compliance with the various ordinances
of the City regulating building construction or use. For the following:
BUILDING ADDRESS:
Use Classification: SINGLE FAMILY DWELLING
Occupancy Group: R-3 Type of Construction
57-535 SEMINOLE DRIVE
Owner of Building: CRV GOLF WEST, L.P.
Building Official
AM
Bldg. Permit No.: 0105-071
Land Use Zone: RL
Address: 5140 AVENIDA ENCIANS
City: CARLSBAD, CA 92008
By: DANIEL P. CRAWFORD JR.
Date: 5/30/03
POST IN A CONSPICUOUS PLACE
f
LICENSEU CONTRACTUR DECLARATION
$236,377.60 40 29147-2
I hereby affirm under penalty of perjury that I am licensed under provisions of
F—
Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
04, W
Professionals Code, and my License is in full force and effect.
O co
License # Cic. Class Exp. Date
r`
760335 B 03./31/2(
Z t—
Date Signature of Contractor
CDo�
0
JU CD
OWNER -BUILDER DECLARATION
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I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ dco
License Law for the following reason:
Z
( ) I, as owner of the property, or my employees with wages as their sole
MULTIPLE ISSUA14CE OF SAME PLAN TYPE.
compensation, will do the work, and the structure is not intended or offered for
sale (Sec. 7044, Business & Professionals Code).
4 ;
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
236,.377.(
Code).
�{ C'`)
() I am exempt under Section , B&RC. for this reason
N
O�
Date Signature -of Owner
C
MECHANICAL FEE 101-000-421-000 $35.50
-5Q
WORKER'S COMPENSATION DECLARATION
p Er
I hereby affirm under penalty of perjury one of the following declarations:
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() 1 have and will maintain a certificate of consent to self -insure for workers'
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compensation, as provided for by Section 3700 of the Labor Code, for the
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performance of the work for which this permit is issued.
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( ) I have and will maintain workers' compensation insurance, as required by
v O U Q
Section 3700 of the Labor Code, for the performance of the work for which this
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permit is issued. My workers' compensation insurance carrier & policy no. are:
$0.001
Cartier Policy No.
ao
U35 10 0001279
nd
BY
g(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
3
Code, I shall forthwith comply with those provisions.
Date: Applicant
a
Z
Q
F.
Warning: Failure to secure Workers' Compensation coverage is unlawful and
-J
shall subject an employer to criminal penalties and civil fines up to $100,000, in
a
addition to the cost of compensation, damages as provided for in Section 3706
Z i
of the Labor Code, interest and attorney's fees.
G�
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IMPORTANT Application is hereby made to the Director of Building and Safety
b
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
.� r I •
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
I .
the above-mentioned property for inspection purposes.
j•
Signature (Owner/Agent) Date
BUILDING PERMIT PERMITa
DATE VALUATION LOT 0105-071 TRACT
$236,377.60 40 29147-2
JOB SITE
APN
ADDRESS 57-535 SEMiNOLE DRIVE
761-140-015
OWNER
CONTRACTOR/ DESIGNER/ ENO INEER
ASHBROOK DEVELOPMENT COMPANY
ASHBROOK DEVELOPMENT CVMPAN
514 0 AVENIDA ENCII4A0
5 14 0 AVENLT)A ENCR4AS
CARLSBAD CA 92005
CARLSBAD CA 92008
(760)804-6868 CBI ff 3376
USE OF PERMIT
SINGL•F' F:AMIL•Y DWELLING
SFD - LOT 40 PLAN 3A - PERMIT DUES NOT INCLUDE BLOCKWALL,
POOL OR DRIVEWAY APPROACH. 75% PLAN CHECK FEE APPLIED FOR
MULTIPLE ISSUA14CE OF SAME PLAN TYPE.
CUSTOM CONSTRUCTION 2,301.00 SF
PORCH/PATIO 577.00 SF
0ARP,(WCARPORT (SF) 10,505,60
ESTimlTD COST OF CONSTRUCTION
236,.377.(
PERMIT fiYE: SUMMARY
CONSTRUCTION FEL 101-000-418-000 $1,119,00
PLAN CHECK FEE 101-000-439-3183 $226.73
MECHANICAL FEE 101-000-421-000 $35.50
ELECTRICAL, FEE 101-000-420-000 $161.26
PLUMBINCI FEE 101-000-419-000 $130.50
STRONG MOTION FEE - RESID 101-000-241-000 $23.64
ORADCNO FEE 101-000-423-000 $20.00
DnfEL•OPER IMPACT FEE $1,907.00
ARI' IN PUBLIC PLACES - RESIC 701-000-255-000 $90.94
SUB -TOTAL CONSTRUCTION AND PLAN CHECK
$3,814.57
LESS PRE -PAM EES
$0.001
TOTAL PEI�NITT FEES DLTE NOW
$3,814.57
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
Elm
Certificate. of'Odcupanc
O O�
City -of LaQuin'ta
. 8uildin.g.and SafetyDepartment OF
,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 compliance with the various ordinances
of the City regulating building construction or use. For the following:
BUILDING ADDRESS: "-57-535 SEMINOLE DRIVE
Use Classification: SINGLE FAMILY DWELLING Bldg., Permit -No.: 0105-071
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL-
Owner of Building: CRV GOLF WEST, L.P. Address: 5140 AVENIDA ENCIANS
City: CARLSBAD, CA 92008
By: DANIEL P. CRAWFORD JR.
Date: 5/30/03
Building Official -
POST IN A CONSPICUOUS PLACE - -
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